Food Poisoning Lawyer & Attorney : Marler Clark : Food Poison Journal

Here's what egg producers had to say after one of their largest, Wright County Egg,  poisoned thousands with Salmonella in conjunction with a recall of half a billion eggs:  it's your fault.  It is a stunning position to take in light of FDA findings from an inspection of Wright County Egg facilities in Galt, Iowa, as listed in pleadings filed on behalf of Marler Clark clients in Federal District Court in Iowa this week.   Here are some "highlights,"  with further listings at Marlerblog and the FDA:

• Chicken manure located in the manure pits below the egg laying operations was observed to be approximately 4 feet high to 8 feet high at [multiple]locations.  The outside access doors to the manure pits at these locations had been pushed out by the weight of the manure, leaving open access to wildlife or domesticated animals.
• Un-baited, unsealed holes appearing to be rodent burrows located along the second floor baseboards were observed.
• Dark liquid which appeared to be manure was observed seeping through the concrete foundation to the outside of the laying houses at [multiple] locations.
• Standing water approximately 3 inches deep was observed at the southeast corner of the manure pit located inside Layer 1 – House 13.
• Un-caged birds (chickens having escaped) were observed in the egg laying operations in contact with the egg laying birds at Layer 3 – Houses 9 and 16. The un-caged birds were using the manure, which was approximately 8 feet high, to access the egg laying area.
• Layer 3 – House 11, the house entrance door to access both House 11 and 12 was blocked with excessive amounts of manure in the manure pits.
• There were between 2 to 5 live mice observed inside the egg laying Houses 1, 2, 3, 5, 7, 9, 10, 11, and 14.
•  Live and dead flies too numerous to count were observed at [multiple] locations inside the egg laying houses. The live flies were on and around egg belts, feed, shell eggs and walkways in the different sections of each egg laying area. In addition, live and dead maggots too numerous to count were observed on the manure pit floor located in Layer 2 – House 7.

The egg industry's position took a well-deserved beating from several critics, including Seattle University School of Law Professor Catherine O'Neill.  O'Neill likened the industry's tactics to those employed by environmental polluters who, rather than contain or limit their environmental destruction, ask those who are affronted by it to alter their behavior, a practice she calls "risk avoidance."

The arguments raised by O'Neill and others are further strengthened by a story today in the Wall Street Journal.  Alicia Mundy and Bill Tomson report today on consumers' misplaced reliance on the USDA "Grade A" stamp on eggs:

To some shoppers, the meaning of the "USDA Grade A" shield on egg cartons seems pretty obvious.

"It means that the rabbi's blessed this as kosher, right?" said Stephen Potter, an early-morning shopper at a Safeway store in Alexandria, Va.

"It means they've been checked. It's the quality seal. They're safe," suggested Susan Hergenrather, who was cruising the aisles at a Harris Teeter supermarket.

Wrong and wrong. The mark on the carton just means that the U.S. Department of Agriculture had a "grader" at an egg-packing facility who checked the eggs' size and color and made sure the shells weren't cracked, a USDA official said. Consumers "misunderstand" the shield, he said.

Marking the eggs "Grade A"  is not mandatory, but likely allows producers to charge more for eggs.   But, contrary to public perception, it does not signify any inspection with respect to human pathogens, "the USDA isn't looking for bacteria such as salmonella in the egg or the hen," according to USDA officials quoted in the article.   Mundy and Tomson explain:

The egg side is different from the meat side at the USDA, where inspection programs are mandatory and the inspectors' job includes looking for sanitation problems. "The USDA mark of inspection is only applied to meat products after inspectors in the plant have confirmed its safety and wholesomeness," said Brian Mabry, a department spokesman.

So consumers, remember, its not the egg producers job to maintain sanitation at their own, basically unregulated facilities.   They expect you to do their job.  But they won't mention that,  and don't put warnings or cooking instructions on their products, outside of a misleading government stamp.   And if you get sick, remember, it's your own fault.

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Nobody can speak more authoritatively about the risks of foodpoisoning than those who have succumbed to severe illness in large outbreaks, and had there lives permanently changed as a result.  Barb Pruitt will not be in Washington DC next week to speak with key senators and staffers on the importance of new food safety legislation, but hers is certainly a voice that needs to be heard as well.

A little background first.  Barb was infected by Salmonella typhimurium in an 2009 outbreak ultimately linked to lettuce from Salinas valley California.  Barb's illness very quickly became life-threatening because the bacteria caused the tissues in her gastrointestinal tract to die, leading to a perforation of her small intestine that allowed the bacteria to escape into her bloodstream.  She ultimately had to be life-flighted to a major medical center, where she underwent emergency surgery to remove approximately four feet of her small intestine.  She has spent over a month in the hospital, and has endured constant, severe gastrointesinal problems ever since as a result of her inability to properly digest foods due to the loss of her small intestine.  Barb's problems, including multiple days a week where she suffers 15-20 bouts of diarrhea, are permanent.

Senator Harry Reid, who has spoken with food safety victims in the past seeking passage of the Food Safety Modernization Act, and every other senator and staffer who can help get the bill, S 510, to the floor for a vote, need to know about Barb.  Her illness was caused by a product, lettuce, that is regulated by the FDA; and its certainly possible that earlier action on the Food Safety Modernization Act would have helped to prevent her life from being permanently changed.  At the very least, action on S 510 now will help others avoid what Barb has gone through. 

Barb Pruitt's Statement to the Senate:

First, let me make it clear that I have no authority or expertise in the field of foodborne illnesses, however; I am a survivor of Salmonella poisoning and can speak from experience. I speak for ALL that have experienced, could experience, or have died from food poisoning. In addition, I speak for those that are left disabled for life, such as me, due to the inadequacies and failures within our food industries. I choose to be the voice for us all.

If I were to personally stand before you today, I would implore you to please pursue the vote for the Food Safety Modernization Act. The Act will enable increased authority for the FDA and food regulations will be more effective. What I like best is that the Act would require preventative programs. It is clear that the regulations we currently have in place are not followed nor are they effective. The Food Safety Modernization Act would provide necessary modification of and improved regulations. Food poisoning is preventable, let us enforce it.

As citizens, we should not be fearful of the food that we consume. We are hard working Americans who spend our hard working money on life’s necessities - FOOD. We should NOT under any circumstances fear the consumption of our food; we assume and TRUST that our food is prepared with quality and that it is SAFE. No one ever assumes that their next bite of food may sicken them or worse yet kill them, leaving families destroyed and experiencing financial devastation with medical bills.

The failure in our system is that producers focus on quantity rather than quality. They have the ability to focus on quantity rather than quality because our current structured food regulations are failing. We have the power to change that. We must stand together and apply strict regulations and by all means ENFORCE them. We have to give authority where necessary to preserve human life and quality of life.

When a food product is produced and sent to the public, when tainted, millions of unsuspecting people may be facing a death sentence or lifetime disabilities. It is not like a piece of clothing that has been sewn incorrectly so therefore it is sold at a discount store. This is food we are talking about. Our food, more often than not, is not tested for quality until it is consumed by the public. There is no taking it back once it has been eaten and someone falls prey to illness.

Every case of foodborne illness is a case of a failure in our food industry reguations and a lack of regard for human life as producers are able to ignore current regulations and push for quantity rather than quality. It is sad that we have come to the point of actually having to babysit our food supply, not only on a local level but worldwide; we must also be strict with our incoming food as well. All food must be produced with the mindset that EVERY human life is valuable.

I urgently ask you to please vote on this Act and pass it. Stronger regulations, increased involvement from authorities, and preventative programs are a necessity. I know I am but only one voice, but I hope that I am ultimately a strong, and unfortunately very experienced, voice.  

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Today the FDA released its Form 483 Inspection Observation Report from the on-site inspections it recently conducted at Wright County Egg's egg laying farms/plants, and the findings are nothing short of disgusting.  Here are just a sampling of the conditions witnessed by FDA's inspectors: 

• Chicken manure located in the manure pits below the egg laying operations was observed to be approximately 4 feet high to 8 feet high at the following locations: Layer 1 – House 1; Layer 3 – Houses 2, 7, 17, and 18. The outside access doors to the manure pits at these locations had been pushed out by the weight of the manure, leaving open access to wildlife or domesticated animals.
• Un-baited, unsealed holes appearing to be rodent burrows located along the second floor baseboards were observed inside Layer 1 – Houses 1-9 and 11-13; Layer 2 – Houses 7 and 11; Layer 3 – Houses 1, 3, 4, 5, and 6; Layer 4 – House 3.
• Dark liquid which appeared to be manure was observed seeping through the concrete foundation to the outside of the laying houses at the following locations: Layer 1 – Houses 1, 2, 3, 4, 5, 8, 11, 12, and 14; and Layer 3 – Houses 1, 8, 13, and 17.
• Standing water approximately 3 inches deep was observed at the southeast corner of the manure pit located inside Layer 1 – House 13.
• Un-caged birds (chickens having escaped) were observed in the egg laying operations in contact with the egg laying birds at Layer 3 – Houses 9 and 16. The un-caged birds were using the manure, which was approximately 8 feet high, to access the egg laying area.
• Layer 3 – House 11, the house entrance door to access both House 11 and 12 was blocked with excessive amounts of manure in the manure pits.
• There were between 2 to 5 live mice observed inside the egg laying Houses 1, 2, 3, 5, 7, 9, 10, 11, and 14.
• Live and dead flies too numerous to count were observed at the following locations inside the egg laying houses: Layer 1 – Houses 3, 4, 6, 8, 9, 11, and 12; Layer 2 – Houses 7 and 11; Layer 3 – Houses 3, 4, 4, 5, 7, 8, 15, 16, 17, and 18. The live flies were on and around egg belts, feed, shell eggs and walkways in the different sections of each egg laying area. In addition, live and dead maggots too numerous to count were observed on the manure pit floor located in Layer 2 – House 7.
• You did not document washing and disinfecting of your dead hen truck and manure equipment prior to moving from farm to farm.
• You did not maintain records documenting the washing and disinfection of the trailers used for the movement of pullets to laying houses.
• Birds were observed roosting and flying, chicks heard chirping in the storage and milking facilities. In addition, nesting material was observed in the feed mill closed mixing system, ingredient storage and truck filling areas.
• Outdoor whole kernel corn grain bins 4 and 6 observed to have the topside doors/lids open to the environment and pigeons were observed entering and leaving these openings. Birds were also observed sitting/flying around and over the openings.

In addition, numerous samples were collected during the course of te inspection and tested by an FDA laboratory.  The results revealed the following positive analytical results for Salmonella Enteritidis:

• On 8/13/2010, an environmental sample was collected from Layer 2, house 7 manure swab from row 1 – left side.
• On 8/16/2010, an environmental sample was collected from Layer 2, house 11 at manure scraper blade from row 3 – right side.
• On 8/13/2010, an environmental sample was collected from Layer 4, house 3 at walkway 1 – right side and walkway 3 – right side.
• On 8/14/2010, a sample of meat and bone meal was collected from ingredient bin 7 located at your feed mill.
• On 8/17/2010, a sample of finished feed “Developer” pullet feed was collected from the feed mill.
• On 8/16/2010, an environmental sample was collected from the roof level covered ingredient bin chute 8; Second Floor ingredient bin cover 19 (ingredient bin 19 holds ground corn) located at your feed mill.

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Sometimes major food-safety events (i.e. large-scale outbreaks and recalls) have the effect of bringing important issues to the fore, thereby preventing them from being ignored any longer.  The 2006 Spinch E. coli O157 recall certainly did; the Leafy Green Marketing Agreement--which sets forth standardized, fairly stringent rules for the production of leafy greens--came out the other end of the illness vortex that sickened over 200 people and killed 5 (not 3, which is normally the number given).  (It has also been effective at reducing the number of people that we represent in produce-related outbreaks).  Maybe the egg outbreak will leave senators with absolutely no excuse for letting the issue of food safety and recalls languish any longer in the hands of producers alone.  

It never hurts to have widely-viewed media outlets supporting the cause.  Boston Globe's op-ed today, "Egg debacle reveals loopholes:"

IF FEDERAL inspectors had miraculously discovered salmonella bacteria at two Iowa egg farms before the microbes infected at least 1,470 people with food poisoning this summer, they would have had no authority to mandate a recall of potentially contaminated eggs.

Eventually, the two farms agreed voluntarily to recall more than a half-billion eggs in the largest outbreak of this salmonella strain since government scientists began keeping track in the late 1970s. But granting mandatory recall authority to the Food and Drug Administration should be a no-brainer response by Congress to this latest demonstration of the yawning gaps in the nation’s safety net for food.

Today's editorial in the USA Today titled "Egg recalls fit pattern of negligence, lax oversight:"

Here we go again. With the massive recall by two farms in Iowa, eggs now join spinach, hamburger and peanuts on a list of things you thought you could eat without worry but now might have doubts about.

***

The FDA, like other federal regulators, has a sad history of inspecting but ignoring: For six years, for example, inspectors found violations at the Del Rey Tortilleria in Chicago, whose tortillas were repeatedly linked to outbreaks of vomiting and diarrhea in school kids. It wasn't until last year that FDA higher-ups finally moved to shut the plant down.

As for bad eggs, broader vaccination of chickens would help. So would a long-stalled food safety bill, pending in the Senate, that would mandate inspections of farms and give the FDA authority to order recalls that are now voluntary. Good, but even this is no magic bullet. The agency will need more money for inspections. Just as important, instead of just writing up violations, it needs to crack down on rogue companies, treating them the same way the criminal justice system treats repeat offenders.

The FDA, like other federal regulators, has a sad history of inspecting but ignoring: For six years, for example, inspectors found violations at the Del Rey Tortilleria in Chicago, whose tortillas were repeatedly linked to outbreaks of vomiting and diarrhea in school kids. It wasn't until last year that FDA higher-ups finally moved to shut the plant down.

And this from Mina Kimes in an article that appeared on CNN and in Fortune titled "Egg recall is a golden opportunity to whip food safety into shape:"

The section of the bill [S 510, aka "Food Safety Modernization Act"] that calls for increased surveillance may be the most pertinent to the current salmonella outbreak. Bill Marler, a Seattle attorney who specializes in taking on food recall cases (including the current egg outbreak), thinks that particular proposal, which calls on the Department of Health and Human Services to establish a pilot project to improve tracking methods and enhance surveillance systems, could have helped regulators catch the outbreak much earlier.

"There's no question in my mind that, if there was more communication and coordination going on between health departments, this thing would have been figured out months ago," says Marler.

Though the salmonella outbreak began in May, the first egg recall didn't occur until mid-August. Such delays are common, says Marler. "If you look back historically at every major food-borne illness outbreak, by the time the CDC or state or local health departments are announcing an outbreak that's nationwide in scope, the outbreak is usually over," he says.

It's definitely hard to look past the current issues that matter in this outbreak--thousands of people ill, millions of eggs recalled, and blatant disregard for health and safety by the company involved.  See Decosters in Iowa: a checkered history, which appeared today in the Des Moines Register.  But maybe it'll all give us some momentum before we go into retrospective mode again, and things become less important. 

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BJ's grocery establishments in 8 states appear to be the only retailers to have received the Cargill ground beef products that have sickened 3 people in New York and Maine since early August.  The 8 states where BJ's stores are known to have received recalled product are New York, Maine, Connecticut, Virginia, New Jersey, New Hampshire, Massachussetts, and Maryland.  The stores that received the recalled product are as follows:

New York:

• BJ's Wholesale Club, 1440 Central Ave., Albany
• BJ's Wholesale Club, 5183 Transit Rd., Clarence
• BJ's Wholesale Club, Two Chevy Dr., East Syracuse
• BJ's Wholesale Club, 131-07 40th Rd., Ste. A100, Flushing
• BJ's Wholesale Club, 300 Bellwood Dr., Greece
• BJ's Wholesale Club, 232 Larkin Dr., Monroe
• BJ's Wholesale Club, 756 State Highway 28, Oneonta
• BJ's Wholesale Club, 3303 Crompond Rd., Yorktown Heights

Maine:

• BJ's Wholesale Club, 110 Mt. Auburn Ave., Auburn
• BJ's Wholesale Club, 513 Warren Avenue, Portland

Connecticut:

• BJ's Wholesale Club, 1046 Tolland Turnpike, Manchester

Virginia:

• BJ's Wholesale Club, 2301 Taylor Rd., Chesapeake

New Jersey:

• BJ's Wholesale Club, 941 Route 37 W, Tom River

New Hampshire:

• BJ's Wholesale Club, 400 Quality Dr., Hooksett
• BJ's Wholesale Club, 8 Sexton Ave., Nashua
• BJ's Wholesale Club, 262 Plainfield Rd., West Lebanon

Massachussetts:

• BJ's Wholesale Club, 287 Washington Street, Attleboro
• BJ's Wholesale Club, 777 Washington St., Auburn
• BJ's Wholesale Club, 115 Erdman Way, Leominster
• BJ's Wholesale Club, 105 Shops At 5 Way, Plymouth
• BJ's Wholesale Club, 5 Ward St, Revere
• BJ's Wholesale Club, 85 Cedar St, Stoneham
• BJ's Wholesale Club, 2085 Bay St., Taunton
• BJ's Wholesale Club, 66 Seyon St, Waltham
• BJ's Wholesale Club, 622 Washington St, Weymouth

Maryland:

• BJ's Wholesale Club, 4201 Wholesale Club Drive, Baltimore

 

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At least 3 people have been sickened recently in Maine and New York after consuming ground beef manufactured by Cargill (but sold under various brand names) that was contaminated by E. coli O126, a rare strain of shiga-toxin producing Escherichia coli.  There is no indication yet whether any of the victims developed hemolytic uremic syndrome, or HUS.

Unfortunately, both states' residents have experienced E. coli illness in the wake of other major outbreaks recently.  In late October of 2009, Fairbank Farms, a New York state ground beef company, recalled over half a million pounds of beef after being linked to an E. coli O157:H7 outbreak that sickened at least 26 people in 8 states, including both New York and Maine.  Five people developed HUS.

And in April and May 2010, shredded romaine lettuce distributed by Freshway Foods sickened at least 33 people in New York, Pennsylvania, Tennessee, Michigan and Ohio with E. coli O145 (yet another non-O157 outbreak).  Among the 30 patients with available information, 12 (40%) were hospitalized. Three people developed HUS. 

In the current E. coli outbreak linked to Cargill ground beef products, the recalled products bear  establishment number "EST. 9400" inside the USDA mark of inspection. These products were produced on June 11, 2010, and were shipped to distribution centers in Connecticut and Maryland for further distribution. It is important to note that the above listed products were repackaged into consumer-size packages and sold under different retail brand names.

FSIS and the establishment are concerned that consumers may also freeze the product before use and that some product may still be in consumers' freezers. FSIS strongly encourages consumers to check their freezers and immediately discard any product subject to this recall.

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Cargill Meat Solutions Corp., a Wyalusing, Pa. establishment, is recalling approximately 8,500 pounds of ground beef products that may be contaminated with E. coli O26, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.

* 42-pound cases of "GROUND BEEF FINE 90/10," containing three (3) - approximately 14 pound chubs each. These products have a "use/freeze by" date of "07/01/10," and an identifying product code of "W69032."

The products subject to recall bears the establishment number "EST. 9400" inside the USDA mark of inspection. These products were produced on June 11, 2010, and were shipped to distribution centers in Connecticut and Maryland for further distribution. It is important to note that the above listed products were repackaged into consumer-size packages and sold under different retail brand names. 

FSIS and the establishment are concerned that consumers may also freeze the product before use and that some product may still be in consumers' freezers. FSIS strongly encourages consumers to check their freezers and immediately discard any product subject to this recall.

FSIS became aware of the problem on August 5, 2010 when the agency was notified by the Maine Department of Agriculture, Food and Rural Resources of an E. coli O26 cluster of illnesses. In conjunction with the Maine Department of Health and Human Services, Maine Department of Agriculture, Food and Rural Resources, the New York State Department of Health, and New York State Department of Agriculture & Markets, two (2) case-patients have been identified in Maine, as well as one (1) case-patient in New York with a rare, indistinguishable PFGE pattern as determined by PFGE subtyping in PulseNet. PulseNet is a national network of public health and food regulatory agency laboratories coordinated by the Centers for Disease Control and Prevention (CDC). Illness onset dates range from June 24, 2010, through July 16, 2010.

FSIS determined that there is an association between the ground beef products subject to recall and the cluster of illnesses in the states of Maine and New York. FSIS regulations and statute allow the agency to take action on a product under its jurisdiction in cases where the product is convincingly associated to illness by evidence collected though an epidemiological, traceback investigation, and/or laboratory analysis. FSIS is continuing to work with affected state public health partners and the company on the investigation.

E. coli O26 is a bacterium that can cause bloody diarrhea, dehydration, and in the most severe cases, kidney failure. The very young, seniors and persons with weak immune systems are the most susceptible to foodborne illness. Individuals concerned about an illness should contact a health care provider.

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Sheila Mclaughlin at the Cincinnati Enquirer today reported that as many as 264 restaurants in the greater Cincinnati, Louisville, and Indianapolis metro areas received recalled eggs from Wright County Egg company, which has been linked to a major Salmonella outbreak that has sickened thousands.  

Documents from the Indiana Department of Health indicate that 264 Asian restaurants in Greater Cincinnati, Louisville and Indianapolis received the Wright County eggs through DW Trading, and that many have already used them.

Hamilton County health inspectors were checking Friday on six Asian restaurants that apparently were not notified of the recall by DW Trading.

Spokeswoman Megan Hummel did not know how many total restaurants in Hamilton County may have received the eggs. She and others are cautioning Asian restaurant patrons not to panic.

“It’s different if you are in some type of other restaurant where they have a Caesar salad and sometimes it has raw eggs in it – or a chocolate mousse. You don’t get those at Asian restaurants. They are usually scrambled up and should be cooked hard,” Hummel said

Aside from Wright County Egg's clear failures, which lead to this public health nightmare, Ms. Mclaughlin raises another issue of pre-eminent concern in foodpoisoning outbreaks, particularly outbreaks and recalls the magnitude of this one:  the importance of all companies in the chain of distribution of recalled products doing all they can to notify retail centers that they have received contaminated food. 

As with many problems that we currently face in our food supply, this one is particularly potent in large part because of the nature of our production and distribution systems. This is also a discussion that is not only long overdue (see 2007 ConAgra pot pie outbreak), but has been raised multiple times before. Phyllis Entis, at efoodalert.com recently made several recommendations to address the problem:

1. Provide a retail distribution list for all recalls. The list should include food service outlets, restaurants, cafés, and institutional kitchens – not just retail stores.

2. Require retail stores to post a prominent recall notice on the store shelf or refrigerator/freezer where the recalled product is typically displayed. This is already done in some countries, including the United Kingdom.

3. Fine retailers who ignore recall notices and neglect to remove recalled products from sale. This has been done in Australia.

4. Post on FDA and USDA web sites in a timely fashion the reports for all inspections during which "significant violations" or "significant deviations" were noted (FDA does this selectively, based on its perception of the public's interest in the results of specific inspections).

5. Post on FDA and USDA web sites in a timely fashion all Warning Letters and other enforcement actions taken (FDA posts Warning Letters, although not always timely).

I would also add a report back requirement for retailers--i.e. that the retailer must report back to (agency/recalling company) within a certain number of days of receiving notice of a recall through dedicated channels, plus fines for each day that the retailer does not report back as required. Something for the FDA to consider when the Food Safety Modernization Act is finally passed.

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Over the course of the last several months, I have periodically reviewed major Salmonella outbreaks that have occurred at various restaurants, and from other food sources, over the first 2/3 of 2010.  Obviously, this fourth installment is heavy on the eggs.  No matter how you cook it up, 2010 has been a year dominated by Salmonella contamination, a bacteria that the CDC estimates causes about 30,000 illnesses nationally . . . even in a normal year. 

Here are a list of twelve major outbreaks that do not appear to have any association with the current egg salmonella outbreak:

1. ConAgra's Marie Calendar's brand Cheesy Chicken and Rice frozen entrees

2. Skokie Country Club Outbreak

3. Caldwell Fresh Foods Sprouts Outbreak

4. Utah Raw Milk Outbreak

5. Casa Lopez Outbreak in Ohio

6. Los Dos Amigos Outbreak

7. Subway Outbreak in Illinois

8. Salami and Pepper Outbreak

9. Chico "Margarita Mix Off" Outbreak

10. Salmonella spinach and lettuce outbreaks/recalls

11.  Salmonella baildon and hartford outbreaks linked to Taco Bell

12.  Salmonella Typhi Outbreak linked to Goya frozen mamey fruit

Others receiving votes:

Originally, it was also thought that Salmonella outbreaks had occurred at Bullocks BBQ restaurant in Durham, North Carolina, Baker Street Restaurant and Pub in Kenosha, Wisconsin, and The Fort Restaurant in Morrison, Colorado.  Outbreaks surely did happen there, but health authorities have since determined that those clusters of illness were actually sub-outbreaks in the larger Salmonella enteritidis outbreak linked to Wright County Egg and Hillandale Farms, companies that have since recalled over half a billion eggs.

Wright County Egg - Hillandale Farms Salmonella Outbreak:

The CDC updated its case count today in the Salmonella outbreak linked to these two egg companies.  Now it counts 2,403 illnesses, from as many as 26 restaurant or other foodservice event outbreaks nationally, that match the strain of Salmonella enteritidis associated with Wright County Egg and Hillandale Farms' outbreak and recall.  The CDC's summary:

In early July 2010, CDC identified a nationwide sustained increase in the number of Salmonella Enteritidis isolates with PFGE pattern JEGX01.0004 uploaded to PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections. This increase began in May 2010, and is evident in the epidemic curve, or epi curve. From May 1 to August 25, 2010, a total of 2,403 illnesses were reported. However, some cases from this time period have not been reported yet, and some of these cases may not be related to this outbreak. Based on the previous 5 years of reports to PulseNet, we would expect approximately 933 total illnesses during this same period. Many states have reported increases of this pattern since May. Because of the large number of expected cases during this period, standard methods of molecular subtyping alone are not sufficient to determine which reported cases might be outbreak-associated. CDC is currently conducting testing using advanced molecular methodologies to help distinguish between outbreak-related cases and sporadic (or background) cases.

See also: the latest on the FDA's investigation into the egg outbreak. 

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The U.S. Food and Drug Administration (FDA) announced today that feed given to chickens at both Hillandale Farms and Wright County Egg could be the source of the Salmonella bacteria that has caused an outbreak of 2,403 confirmed illnesses throughout the United States.

As reported on CNN.com today:

Testing at two Wright County Egg farms in Iowa confirmed the presence of Salmonella in the food mill and at least two locations, said Sherri McGarry of the Food and Drug Administration. She said investigators are still drawing samples at Hillandale Farms.

The feed could have been contaminated in a number of ways, including by birds, rodents and people's shoes or boots, officials said.

In addition, the list of egg manufacturers recalling product linked to the Salmonella outbreak was updated by the FDA today (click on the link for product-specific information):

• Albertson
• Albertsons
• Alta Dena Dairy
• Bayview
• Becky
• Boomsma's
• Cal Egg
• California Ranch Fresh
• Cardenas Market
• Challenge Dairy
• Country Eggs, Inc.
• Driftwood Dairy
• Dutch Farms
• Farm Fresh
• Farmer's Gems
• Glenview
• Hidden Villa Ranch
• Hillandale
• Hillandale Farms
• James Farms
• Kemps
• Lucerne
• Lund
• Mi Pueblo
• Mountain Dairy
• No Brand Name Available
• Nulaid
• Pacific Coast
• Ralph's
• Shoreland
• Sun Valley
• Sunny Farms
• Sunny Meadow
• Sunshine
• Trafficanda
• Trafficanda Egg Ranch
• West Creek
• Wholesome Farms
• Yucaipa Valley

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According to press reports, late yesterday afternoon a federal judge recommended approval of a $12 million settlement for those sickened or killed in last year's salmonella outbreak tied to a Virginia-based peanut processor. This includes nearly 50 families represented by Marler Clark.

U.S. Magistrate Judge Michael Urbanski issued his recommendation late Wednesday for the payments for the more than 120 personal injury claims related to the outbreak. The settlement must now be approved by a bankruptcy court judge. The outbreak traced to Lynchburg-based Peanut Corp. of America's plants in Georgia and Texas was linked to the illnesses of about 700 people and the deaths of at least nine. Peanut Corp. filed for Chapter 7 bankruptcy to dissolve amid fallout from the outbreak. The money provided by the company's insurers will be distributed based on the extent of victims' illnesses.

And, Stewart Parnell is still not in Jail.

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Back on February 3, 2010, in the wake of another big salmonella outbreak linked, ultimately, to an FDA regulated product (pepper), I authored a blog-post titled "The slow flow of information about food outbreaks."  It discussed what was perceived as unreasonable delays in acting on infromation that suggested there was a problem with a particular product.  Today, Alison Young at USA Today conjured up some old memories, as she detailed what appear to have been more delays in the ever-expanding salmonella outbreak and recall linked to eggs from Wright County Egg and Hillandale Farms. 

State and federal health agencies identified an Iowa egg company as a likely source of illness at least two weeks before the firm launched a massive egg recall Aug. 13 and the public got its first hint of a growing national salmonella outbreak, health officials said in interviews with USA TODAY.

In late July, the Centers for Disease Control and Prevention even considered reminding the public generally about the dangers of eating undercooked eggs, said Ian Williams, chief of the agency's outbreak response branch. The CDC decided it would be more effective to wait until the Food and Drug Administration (FDA) completed its investigation of the company, Wright County Egg in Galt, Iowa.

One of the problems is, as the USA Today article notes, "The FDA didn't contact Wright County Egg until Aug. 10 and didn't provide detailed information until Aug. 12," according to company spokeswoman Hinda Mitchell. "The recall decision was made after a discussion with FDA officials the next morning," she said.  The FDA's version of events differs slightly, but even it acknowledges that it didn't contact Wright County Egg about the need to recall eggs until August 11.

So to summarize, the CDC and Pulsenet notice an approximate 4-fold increase in Salmonella enteritidis illnesses in multiple states since late April.  Two of the most competent epidemiological units in the world (California and Minnesota) are able to finger Wright County Egg as the common supplier in multiple restaurant outbreaks involving the exact same strain of Salmonella enteritidis as was involved in the 4-fold increase.  Notably, this information is available in late July, which is not too long after the peak illness count in the outbreak (late June/early July); yet the FDA isn't able to get confirming information sufficient to "encourage" Wright County Egg to recall until August 11 or 12? 

The full scope of this outbreak--including the number of illnesses that occurred after public health officials knew of the likely link to Wright County Egg--is not yet known.  But we certainly have enough information to know that more timely, efficient action by federal regulators could have prompted an earlier recall.  But this is obviously not the result of simple regulatory inattention:  the FDA certainly did not want more people to get sick than already had in the outbreak through late July, when it learned of the link to Wright County Egg. 

Again the USA Today, identifying one of the problems:  "The FDA doesn't have the power to require companies to recall products, and regulators often must convince companies there's enough evidence for them to take the costly action of launching a voluntary recall. A bill pending in Congress would give the FDA mandatory recall authority."  

To the extent that the delays evident in this outbreak are the result of a somewhat-hamstrung federal agency, S 510, a/k/a "The Food Safety Modernization Act," needs to finally pass the last house of Congress so that people don't continue to get sick well after outbreaks like this should have been discovered and the contaminated product identified.  In a recent Fortune magazine article, Bill Marler discussed the issue in depth:

The section of the bill that calls for increased surveillance may be the most pertinent to the current salmonella outbreak. Bill Marler, a Seattle attorney who specializes in taking on food recall cases (including the current egg outbreak), thinks that particular proposal, which calls on the Department of Health and Human Services to establish a pilot project to improve tracking methods and enhance surveillance systems, could have helped regulators catch the outbreak much earlier.

"There's no question in my mind that, if there was more communication and coordination going on between health departments, this thing would have been figured out months ago," says Marler.

Though the salmonella outbreak began in May, the first egg recall didn't occur until mid-August. Such delays are common, says Marler. "If you look back historically at every major food-borne illness outbreak, by the time the CDC or state or local health departments are announcing an outbreak that's nationwide in scope, the outbreak is usually over," he says.

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As per usual, a very informative post from Phyllis Entis at efoodalert.com providing an update on the nationwide Salmonella enteritidis outbreak on a state by state basis.  The state by state breakdown is preceded by her accurate observation that the public is still left without conclusive, easily accessible, information about where these contaminated eggs have been distributed.

The states she provides updates on, where there is indication of related illness: Alaska,  California, Colorado, Iowa, Minnesota, Nebraska, Nevada, South Dakota, and Texas. We have confirmation that cases in North Carolina and Wisconsin are also linked. Unfortunately, the fact that a state is not on the list does not mean residents there are necessary safe, or have avoided illness thus far.   As frequently pointed out here, and by Bill Marler, a glaring weakness in our food safety system is efficient communication between state health departments, and between state and federal health agencies.

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1938 was the year that Congress passed the Federal Food, Drug, and Cosmetic Act, which gave the FDA the authority to oversee the safety of many aspects of our food supply.  Also in 1938:

• The average price of a new home was $3,900
• A gallon of gas cost a dime
• Average annual wages were $1,730
• The Fair Labor Standards Act set the minimum wage at twenty-five cents
• Oil was DISCOVERED in Saudi Arabia
• And Adolf Hitler was designated Time Magazine's "Person of the Year."

Fortunately, and unfortunately as to a few things, we have moved on from 1938 in most respects.  One thing that really hasn't changed, however, is the regulatory framework that binds and guides the FDA in regulating our food supply.  It is well past time for work to be done on this issue--i.e. a vote on, and passage of, Senate bill 510, a/k/a "The Food Safety Modernization Act."

Would Linda Rivera be healthy and well had Congress acted prior to the spring 2009 Nestle cookie dough E. coli outbreak?   Would we be in the midst of a half-billion egg recall and a huge national Salmonella outbreak?

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During this Egg Salmonella Outbreak, I have been asked more than once about our experience handling Salmonella Lawsuits.  We have compiled quite a list over at Marler Clark.

Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis (the disease caused by Salmonella) is the second most common foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95% of those cases are foodborne-related. Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 or 31% of all food-related deaths are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

Salmonella infection occurs when the bacteria are ingested, typically from food derived from infected food-animals, but it can also occur by ingesting the feces of an infected animal or person. Food sources include raw or undercooked eggs/egg products, raw milk or raw milk products, contaminated water, meat and meat products, and poultry. Raw fruits and vegetables contaminated during slicing have been implicated in several foodborne outbreaks. We are involved in representing families of children who have suffered from this bacterium.

* A & R Bar-be-que Salmonella Outbreak - Tennessee
* Adrift Restaurant Salmonella Outbreak – Washington
* Baker Street Restaurant Salmonella Outbreak 2010
* Beaches Sandy Bay Resort Salmonella Outbreak – Jamaica
* Black Forest Bakery Salmonella Outbreak - Michigan
* Bogey’s Restaurant / Quality Inn Salmonella Outbreak - Washington
* Brook-Lea Country Club Salmonella Outbreak - New York
* Café Santa Fe Salmonella Outbreak - Arkansas
* Cantaloupe Salmonella Litchfield Outbreak, 2008 - Nationwide
* Cargill Ground Beef Salmonella Newport Outbreak - Nationwide
* Caudill Alfalfa Sprouts Salmonella Outbreak - Multistate, 2009
* Chili’s Salmonella Outbreak - Illinois
* City of Alamosa Salmonella Outbreak - Colorado
* ConAgra Marie Callender’s Cheesy Chicken and Rice - Salmonella Chester outbreak
* ConAgra Peanut Butter Salmonella Outbreak - Nationwide
* ConAgra Pot Pie Salmonella Outbreak - Nationwide
* Corky & Lenny’s Salmonella Outbreak - Ohio
* Daniele International Pepper Salame/Salami - Salmonella: Nationwide
* Economart Salmonella Outbreak - North Dakota
* Fern Hill Golf & Country Club Salmonella Outbreak - Michigan
* Golden Corral Salmonella Outbreak - Georgia
* Harmony Farms Salmonella Outbreak - Washington and Oregon
* Illinois Subway Salmonella Hvittingfoss Outbreak
* KFC Salmonella Outbreak - Colorado
* King Soopers Salmonella Outbreak - Colorado
* Linh’s Bakery Salmonella Outbreak - Virginia
* Malt-O-Meal Salmonella Outbreak, 1998 - Nationwide
* Malt-O-Meal Salmonella Outbreak, 2008 - Maine, Minnesota
* Old South Salmonella Outbreak - South Carolina
* Orchid Island Orange Juice Salmonella Outbreak - Nationwide
* Outbreak of Salmonella Newport in Caldwell Foods Alfalfa Sprouts, 10 states
* Paramount Farms Almonds Salmonella Outbreak - California, Nationwide
* Pars Cove Salmonella Outbreak at Taste of Chicago - Illinois
* Peanut Corporation of America Peanut Butter Salmonella Outbreak - Nationwide
* Quizno’s Salmonella Outbreak - Minnesota
* San Antonio Taco Salmonella Outbreak - Tennessee
* Seasons on the Pond Salmonella Outbreak - Colorado
* Setton Pistachios Salmonella Outbreak - Nationwide
* Sheetz and Coronet Foods Salmonella Outbreak - Pennsylvania, Eastern States
* Sprouters Northwest Salmonella Typhimurium Outbreak - Washington and Oregon
* Sun Orchard Salmonella Outbreak - Multistate
* Sushi King Salmonella Outbreak - Arkansas
* Susie Cantaloupe Salmonella Outbreak - Nationwide
* Taco Bell Salmonella Hartford and Baildon outbreaks, Nationwide, 2010
* Union International Foods - Spices, sauces, oils Salmonella Outbreak - Western States
* Veggie Booty Salmonella Outbreak - Nationwide
* Viva Cantaloupe Salmonella Outbreak - Nationwide
* Wal-Mart Jalapeno and Serrano Pepper Salmonella Outbreak - Nationwide
* Wal-Mart Salmonella Outbreak - Indiana
* Western Sizzlin’ Salmonella Outbreak - North Carolina
* Wright County Egg Salmonella Outbreak Nationwide, 2010
* Wyndham Anatole Hotel Salmonella Outbreak - Texas

I would also urge you to check out www.outbreakdatabase.com.

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While details on the full magnitude of the nationwide Wright County Egg recall and related Salmonella enteritidis outbreak continue to unfold, the conversation on prevention has begun.  One such preventative measure being discussed involves vaccinations.

In an article published in today's Washington Post by Associated Press writer Michael Crumb, he writes:

Low-cost vaccines that may have helped prevent the kind of salmonella outbreak that has led to the recall of more than a half-billion eggs haven't been given to half of the nation's egg-laying hens.

The vaccines aren't required in the U.S., although in Great Britain, officials say vaccinations have given them the safest egg supply in Europe. A survey conducted by the European food safety agency in 2009 found that about 1 percent of British flocks had salmonella compared to about 60 to 70 percent of flocks elsewhere in Europe, said Amanda Cryer, spokeswoman for the British Egg Information Service.

The vaccine works by protecting the hens from contracting the bacteria in the first place, thereby stopping the spread among the flock.

Of course, vaccines are only one part of a possible solution.  As Mr. Crumb's article points out, vaccines may help prevent the spread of this nasty bug, but they will do nothing to prevent the less-than-stellar animal handling and food manufacturing practices that encourage the spread of these foodborne bugs in the first place.

Doug Grian-Sherman, senior scientist at the Union of Concerned Scientists, said the vaccine deserves additional study, but it would likely have only have limited effectiveness against a bacteria like salmonella, which has many different strains.

"It's only going to be a Band-Aid on a much bigger problem," he said.

It would be more effective to give the FDA additional authority to stop repeat offenders and pull contaminated products off shelves and to move away from big production facilities that ship across the nation and can quickly spread disease, Grian-Sherman said.

"The way we produce a lot of our food and meat and eggs in particular, has gotten to a scale where it's very difficult to prevent these problems," he said. "That needs to change and we need to think about producing food on a scale that is better for the communities and safer for consumers."

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Officials with Grand Traverse County Health Department have reported three probable cases of  Shigatoxin-producing E.coli in the past week.  Information was not provided on the specific strain, but the most common pathogenic strain of the bacteria is E. coli O157:H7.   According to this report, "All cases were in children and all three attended the Northwestern Michigan Fair in Grand Traverse County between August 9 and August 13.  The onset of symptoms, including bloody diarrhea, were between August 15 and August 17.

It appears that the illnesses are linked to exposure to animals at the fair:

"Considering the number of animals in close proximity to people at that venue, it seems likely that their infections were contracted there", stated Dr. Michael Collins, Medical Director for the Grand Traverse County Health Department. "Though we will probably never know exactly which animal or animals were involved as sources".

E. coli O157:H7 is most often harbored by ruminants, including cattle, sheep, and goats.  Outbreaks of illness, and E. coli O157:H7, have been repeatedly linked to animal/child interaction at petting zoos and fairs.   For many years, the CDC and the National Association of State Public Health Veterinarians (NASPHV) has provided a list of guidelines and recommendations aimed at reducing or eliminating the risk of such transmission.

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 Wright County Egg's August 13 and 18 recall, and Hillandale Farms' August 20 recall, of over half a billion eggs combined, and the Salmonella outbreak that has occurred in the collective recalls' wake, have dominated the food safety news lately.  With over 1,000 illnesses and a company at the epicenter with a shoddy safety and health record, that is no surprise.  But another point is worthy of note, or maybe the fortunate lack of a point.  Although they had a rocky start to 2010, recalling almost 6,000,000 pounds of beef products, meat companies have avoided any major E. coli O157:H7 outbreaks through, almost, the end of summer. 

The last 3 years were not good for the industry.  In 2007, beef companies recalled over twenty-nine million pounds of meat, including Cargill's recall of nearly one million pounds of hamburger patties, one of which sickened Stephanie Smith. 2008 saw at least sixteen recalls of beef products, totaling at least 2,361,295 pounds of meat. And in 2009, beef companies recalled almost 2 million pounds of meat due to various contamination and processing problems.

Thus, the almost total absence of E. coli O157 in beef this summer is an accomplishment that should be applauded, and hopefully is not just attributable to pure luck, but represents a committment to meaningful manufacturing advances that have truly helped to reduce the bacterial load on retail meat products.

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Zemco Industries, a Buffalo, N.Y., establishment, is recalling approximately 380,000 pounds of deli meat products that may be contaminated with Listeria monocytogenes, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today. These products were distributed to delicatessens where they were further processed into sandwiches.

The products subject to recall include:

25.5-pound cases of "Marketside Grab and Go Sandwiches BLACK FOREST HAM With Natural Juices Coated with Caramel Color" with the number 17800 1300.

28.49-pound cases of "Marketside Grab and Go Sandwiches HOT HAM, HARD SALAMI, PEPPERONI, SANDWICH PEPPERS" with the number 17803 1300.

32.67-pound cases of "Marketside Grab and Go Sandwiches VIRGINIA BRAND HAM With Natural Juices, MADE IN NEW YORK, FULLY COOKED BACON, SANDWICH PICKLES, SANDWICH PEPPERS" with the number 17804 1300.

25.5-pound cases of "Marketside Grab and Go Sandwiches ANGUS ROAST BEEF Coated with Caramel Color" with the number 17805 1300.

 

The packages also bear vendor number "398412808" and the USDA mark of inspection. The meat products were produced on various dates from June 18 to July 2, 2010, and have various "Use By" dates ranging from August 20 to September 10, 2010. The products were distributed nationwide to a single retail chain.

The problem was discovered as a result of a retail sample collected by the State of Georgia that confirmed positive for Listeria monocytogenes. FSIS has received no reports of illnesses associated with consumption of this product.

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The link between Hillandale and Wright County Egg was made clearer this morning by Mary Clare Jalonick of the Associated Press who reported that both businesses "share suppliers of chickens and feed as well as ties to an Iowa business routinely cited for violating state and federal law."

The company Quality Egg supplies young chickens and feed to both Wright County Egg and Hillandale Farms. The two share other suppliers, said Jewanna Porter, a spokeswoman for the egg industry, but she did not name them.

That business with a history of violations that Ms. Jalonick refers to is DeCoster Farms, owned by businessman Austin "Jack" DeCoster.  She continues:

DeCoster is no stranger to controversy in his food and farm operations:

• In 1994, the state of Iowa assessed at least four separate penalties against DeCoster Farms for environmental violations, many of them involving hog waste.
• In 1997, DeCoster Egg Farms agreed to pay $2 million in fines to settle citations brought in 1996 for health and safety violations at DeCoster's farm in Turner, Maine. The nation's labor secretary at the time, Robert Reich, said conditions were "as dangerous and oppressive as any sweatshop." Reich's successor, Alexis Herman, called the state of the farms "simply atrocious," citing unguarded machinery, electrical hazards, exposure to harmful bacteria and other unsanitary conditions.
• In 2000, Iowa designated DeCoster a "habitual violator" of environmental regulations for problems that included hog manure runoff into waterways. The label made him subject to increased penalties and prohibited him from building new farms.
• In 2002, the federal Equal Employment Opportunity Commission announced a more than $1.5 million settlement of an employment discrimination lawsuit against DeCoster Farms on behalf of Mexican women who reported they were subjected to sexual harassment, including rape, abuse and retaliation by some supervisory workers at DeCoster's Wright County plants.
• In 2007, 51 workers were arrested during an immigration raid at six DeCoster egg farms. His farms had been the subject of at least three previous raids.
• In June 2010, Maine Contract Farming, the successor company to DeCoster Egg Farms, agreed in state court to pay $25,000 in penalties and to make a one-time payment of $100,000 to the Maine Department of Agriculture over animal cruelty allegations that were spurred by a hidden-camera investigation by an animal welfare organization.

William D. Marler, a Seattle attorney for a person who filed suit alleging illness from tainted eggs in a salad at a restaurant in Kenosha, Wis., said Sunday his firm has been retained by two dozen families and was representing a woman who was hospitalized in California.

"The history of ignoring the law makes the sickening of 1,300 and the forced recall of 550 million eggs shockingly understandable," Marler said in an e-mail to The Associated Press. "You have to wonder where the USDA and FDA inspectors were."

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Over 500,000,000 eggs have been recalled due to potential contamination by Salmonella enteritidis.  The recalls have been initiated by two apparently distinct corporations, Wright County Egg and Hillandale Farms, although reports certainly suggest that the two companies have close ties, including part of their egg production operations.  The CDC estimates that, as of August 19, there have been 1,953 illnesses nationally caused by the same strain of Salmonella enteritidis, many of which are thought to be related to the Wright County Egg outbreak.

Here is a summary of what we know, to date, about the retail sources of people's confirmed illnesses nationally:

     --California: 266 confirmed cases, including 43 in Los Angeles County. 

     --Colorado: 28 cases in June and July, versus the usual 7 cases for that time frame; some of the cases were from an outbreak associated with The Fort, a restaurant in Jefferson County.

     --Minnesota: 14 cases, linked to at least two separate restaurant outbreaks, one of which is rumored to be Mi Rancho, a relatively new Mexican cuisine restaurant in north Bemidji, whose eggs were traced to Hillandale Farms.

     --Southern Nevada: 30 cases since January – four times the usual number.

     --Texas: more than 150 cases in 40 or more counties since mid-May; investigations are in progress to determine how many are linked to Wright County's eggs.

     --Wisconsin: 21 cases linked to the Baker Street Restaurant and Pub in Kenosha.

In addition to the lawsuit we have filed against Wright County Egg in the outbreak at Baker Street Restaurant in Wisconsin, we have been contacted by 45 people from all across the country, including the specific states listed above.  Specifically, we have been retained by multiple people from Ohio, North Carolina, and Oregon to investigate their suspicious Salmonella enteritidis illnesses during the time frame of this outbreak; and tomorrow, we will be filing suit on behalf of an 11-year-old California girl who was sickened in early July after consuming recalled eggs.  The young girl was hospitalized for several days during her severe, acute illness. 

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550,000,000 eggs and 1,300 ill and KARE TV Minneapolis reports on this impact on one family – the Danielsons.

Todd Danielson, said, "Everybody had diarrhea. That was kind of the first thing, and then headaches and then throwing up and then it was body aches. I couldn't even move. I mean it was like in your joints it hurt so bad. It was worse than any flu I've ever had." His daughter, 10-year-old Brittany Danielson, said, "We thought we had the flu but then we saw the egg recall and we figured that's what it was because my dad read off the symptoms from the computer and those were all the symptoms we had."

They believed they had symptoms of salmonella poisoning from tainted eggs. But it wasn't until the recall was expanded on Friday that their suspicions were confirmed. The Hillandale 18-count eggs they bought at Wal-Mart were recalled.

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The half billion egg recall is fast turning into one of those situations that's almost to incredible to believe.  Alec MacGillis at the Washington Post profiled the DeCoster family, founders of Wright County Egg, today in his article titled "Before salmonella outbreak, egg firm had long record of violations."  Among the lowlights:

-- In 1992, a criminal complaint against DeCoster's operation on Maryland's Eastern Shore alleged that it had sold eggs to a store in Cecilton and to the Cecil County Detention Center in violation of a salmonella quarantine order.

-- In 1996, DeCoster was fined $3.6 million for health and safety violations at the family's Turner egg farm, which then-Labor Secretary Robert Reich termed "as dangerous and oppressive as any sweatshop we have seen." Regulators found that workers had been forced to handle manure and dead chickens with their bare hands and to live in filthy trailers.

-- In 1999, the company paid $5 million to settle wage-and-hour claims involving 3,000 workers.

-- In 2001, the Iowa Supreme Court ruled that DeCoster was a "repeat violator" of state environmental laws, citing violations involving the family's hog-farming operations. The family was forbidden to expand its hog-farming interests in the state.

-- Also in 2001, DeCoster Farms of Iowa settled, for $1.5 million, a complaint brought by the Equal Employment Opportunity Commission that DeCoster had subjected 11 undocumented female workers from Mexico to a "sexually hostile work environment," including sexual assault and rape by supervisors.

-- In 2002, the Occupational Safety and Health Administration fined the family's Maine Contract Farming operation $345,810 for an array of violations. The same year, DeCoster Egg Farms of Maine paid $3.2 million to settle a lawsuit filed in 1998 by Mexican workers alleging discrimination in housing and working conditions.

-- In 2003, Jack DeCoster paid the federal government $2.1 million as part of a plea agreement after federal agents found more than 100 undocumented workers at his Iowa egg farms. It was the largest penalty ever against an Iowa employer. Three years later, agents found 30 workers suspected of being illegal immigrants at a DeCoster farm in Iowa. And in 2007, raids in Iowa uncovered 51 more undocumented workers.

-- In 2006, Ohio's Agriculture Department revoked the permits of Ohio Fresh Eggs because its new co-owners, including Hillandale founder Orland Bethel, had failed to disclose that DeCoster had put up $126 million for the purchase, far more than their $10,000, and was heavily involved in managing the company. By playing down DeCoster's role, the owners had avoided a background check into DeCoster's "habitual violator" status in Iowa. An appeals court overturned the revocation.

-- In 2008, OSHA cited DeCoster's Maine Contract Farming for violations that included forcing workers to retrieve eggs the previous winter from inside a building that had collapsed under ice and snow.

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In what may be part of the rolling recall in the wake of the half billion egg recall by Hillandale Farms and Wright County Egg company, the nation's largest egg seller, Cal-Maine Foods Inc., has recalled 9.6 million eggs (800,000 dozen) due to potential Salmonella enteritidis contamination.  AP reports:

Cal-Maine said it was notified by an Iowa egg producer that between April 9 and Aug. 19, the producer sold 32 truckloads of eggs, or about 800,000 dozen eggs, to the company. The affected products were added Friday to the expanded nationwide recall related to almost 2,000 illnesses from the strain of salmonella reported between May and July, almost 1,300 more than usual.

It wasn't immediately clear which Iowa producer supplied the Cal-Maine eggs. Iowa's Hillandale Farms said Friday that it was recalling its eggs after laboratory tests confirmed illnesses associated with them. The company did not say how many eggs were being recalled or if it is connected to Wright County Egg, another Iowa farm that recalled 380 million eggs earlier this week.

The eggs subject to Cal-Maine's recall were not produced at any Cal-Maine facility.  Nevertheless, and particularly because of its large market share, doesn't Cal-Maine have an obligation to consumers to know and monitor the companies who is supplying eggs to it?  With a recall now over half a billion eggs, it is more than just a possibility now that Hillandale and Wright County Egg's environmental and flock conditions were not being maintained and monitored like they should have been--i.e. according to the FDA's "egg rule."

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Eggs have garnered the lion's share of attention recently, but with 2010 being such a salmonella dominated year in terms of food safety events, not surprising that two other common culprits have again been recalled due to salmonella contamination.

Yesterday, New York State Agriculture Commissioner Patrick Hooker today alerted consumers that Snow White Food Products Inc., located in 621 Bergen Street in Brooklyn, New York, recalled certain packages of "Alfalfa Sprouts" due to the presence of Salmonella.  The recalled "Alfalfa Sprouts" is packaged in a 3.5 ounce plastic clamshell container which is uncoded. It has a UPC code of 0-46421-11236-6. The product was distributed in New York State.  The contamination was discovered after a sample analyzed by the New York State Food Laboratory revealed the presence of Salmonella in some 3.5 ounce containers of Snow White Food Products "Alfalfa Sprouts." Production and sale of the product has been suspended.

And today, GloryBee Foods, Inc., of Eugene, Oregon voluntarily recalled Aunt Patty's brand 5 pound bags of Whole Raw Pistachios and 25 lb. boxes of Specialty Commodities brand Whole Raw Pistachios Kernels, because it has the potential to be contaminated with Salmonella. Also today, AustiNuts Wholesale, Inc. issued a voluntary recall of pistachio kernel products due to salmonella contamination.  Are the AustiNuts and GloryBee recalls related to a July recall of pistachios by California Delights, Inc.?

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Today, the monolithic recall of eggs due to salmonella contamination grew even bigger.  Hillandale Farms, of Iowa (like Wright County Egg Co.), voluntarily recalled 170 million eggs that it sent to 14 states, stating that “laboratory-confirmed illnesses” had been associated with the eggs.  Federal officials followed Hillendale's announcement with the clarification that, in addition to Wright County Egg's eggs, Hillendale's eggs were, in part, the cause of the large national salmonella outbreak that has sickened close to 2,000 people in multiple states since May. 

One Illinois egg producer, National Pasteurized Egg, has seized this opportunity by announcing earlier today that it has ramped up production of its Davidson's Safest Choice Pasteurized Shell Eggs to meet anticipated increased demand for its product.  So yes, it is obviously entirely possible, assuming egg companies can foot the increased production cost bill, to eliminate the problem of Salmonella contamination of shell eggs.

Pasteurization has long been a critical public health measure, and a boon to our collective wellness.  Personally, having seen the devastation first hand that can be wrought by unpasteurized, raw products (see Barb Pruitt's story by CNN's Elizabeth Landau today) I would trade the dubious deleterious effects brought on by pasteurization of virtually any food product that I consume, if that option was widely available. 

Is it time to consider a similar final kill step on all foods intended to be consumed raw?  Food irradiation is based on the principle of using energy to ionize a material, in this case food. Ionizing irradiation treatment involves chemical reactions with microbes, but these reactions are not dissimilar to chemical reactions induced by cooking, canning, curing, drying, freezing, or other food processing techniques. There are pros and cons to every food processing technique. In food irradiation, high speed particles or rays are harnessed by a machine. The particles used for this purpose are common in nature, and part of the energy that comes from the sun. These particles are focused in the process to penetrate the food, and result in the creation of free radicals that damage the DNA of organisms, especially microbial contaminants at the doses used for food. Depending on the organism and irradiation dose, this process is capable of enhancing food safety and quality of the food. 

And what about taste?  According to leading scientists at UC Davis,

Most irradiated food tastes the same as non-irradiated.

Flavor changes depend on the type of food being irradiated, the irradiation dose, and the temperature during treatment.

Many fruits and vegetables are unchanged by low dose irradiation. Irradiation can substitute for insect quarantine treatments that damage fruit quality, so irradiated fruit may taste better. Dried fruit softens slightly and is easier to rehydrate.

Poultry, pork and other meats show little or no flavor change at the level of irradiation currently approved by the FDA. High dose irradiation needed to prepare food for astronauts is done while the meat is frozen to preserve flavor.
 

In addition to pasteurization, is irradiation the silver bullet in combating the seemingly endless contamination problems we see in our food supply?  Read a multi-part series on the pros and cons of irradiation on commercially produced foods. 

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In the midst of a massive Salmonella outbreak and egg recall, CNN reporter Elizabeth Landau's thoughts turned to the human toll that Salmonella infection can have.  Ms. Landau spoke with our client, Barb Pruitt, who, at age 41, had several feet of her small intestine surgically removed as a result of a severe salmonella infection. 

The culprit food in Barb's case?  Lettuce.  Yet another FDA-regulated product.   

Ms. Landau's article in full:

For most people, salmonella can be nasty for a few days or maybe a week, but then it's gone. Specific treatment isn't needed to recover.

Common symptoms are diarrhea and vomiting, and bacteria in the lining of the intestines can damage cells, causing bloody diarrhea. "That's where your immune system stops it," said Craig Altier of Cornell University's College of Veterinary Medicine.

But in rare cases, the bacterial infection can be deadly. About 400 people in the United States die every year from salmonella, according to the Centers for Disease Control and Prevention.

The current nationwide recall of eggs because of possible salmonella hits close to home for Barbara Pruitt, who nearly lost her life when her case of salmonella got out of control last year.

Pruitt, 42, of Lakeview, Oregon, has never fully recovered from the damage the infection did to her system.

"I walk, talk and breathe medical issues all the time," she said.

It all started one day in early August 2009. She felt as if she had the flu, with achiness, fatigue and nausea. Her symptoms worsened over the next few days, until one morning at 3:30 she woke up barely able to walk, vomiting and losing control of her bowels as she tried to find her cell phone.

Her teenage daughter drove her to the hospital. Doctors said she was having septic shock and tachycardia.

Doctors removed part of her small intestine. She lost about 40 pounds in three weeks, she said.

Pruitt's memory of those days is vague, but she does recall a tube down her throat while her children were standing over her.

"I couldn't figure out where I was, and honestly I was trying to figure out if I was dead or alive," she said.
 

She learned later that one of the doctors told her husband that he didn't think Pruitt would survive. Her family thought it was a death watch.

The cause of her illness was Salmonella typhimurium, which is not the same as Salmonella enteritidis, the strain reported in the current massive recall of eggs. But these are both the most common strains to give humans diarrhea, and usually manifest themselves in the similar ways clinically, Altier said.

For salmonella to cause severe damage, as in Pruitt's case, the bacteria leave the intestine and enter the bloodstream, causing sepsis, Altier said.

Those most at risk for more serious salmonella infections are the elderly, small children and people with compromised immune systems, he said.

"It's an extreme outcome of salmonella," Pruitt said. Doctors "don't know why it impacted me so greatly," whereas other people recover in a few days.

In between hospitalizations, a state public health department contacted Pruitt, asking her about what she had eaten around the time of her illness. The one thing that she and others with this strain of salmonella had in common was lettuce. Pruitt had eaten a sandwich with lettuce on it the day before she initially fell ill.

Pruitt spent August to November in and out of hospitals. Today, she is still having bowel issues and extreme joint pain and feels sick to her stomach a lot. She can't work more than four to six hours a day, she says.

Both at work and in family activities, she has to plan extremely carefully for situations in which she needs a bathroom right away. Everyone knows about her condition, but she also struggles with embarassment.

"My whole day revolves around dealing with my medical issues or us working around my medical issues," she said. "We now plan how I can participate rather than focusing on the enjoyment of anything that we would like to do."

As for the current egg recall situation, Pruitt says it will be a long time before she eats eggs again, either.

Pruitt won't even eat lettuce that she has grown in her own garden, because it makes her want to vomit.

"It's very hard to talk about it and to hold back tears," she said. "If I can stress anything to anybody, I cannot believe how my life changed."
 

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August 20, 2010 update on Salmonella outbreak and multi-state egg recall.

Illnesses in at least seven additional people in Minnesota have been connected with an expanded multi-state recall of eggs from an Iowa producer due to contamination with Salmonella. This brings the total number of cases in Minnesota linked to the recall to 14. The additional Salmonella Enteriditis cases were identified as part of a restaurant outbreak in Bemidji, Minnesota in May. Shell eggs were identified as the likely source of this outbreak and were traced back by the Minnesota Department of Agriculture and FDA to Hillandale Farms of New Hampton, Iowa. Eggs from Hillandale Farms have now been included in an expanded egg recall that also includes Wright County Egg.

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From an FDA Press release today:  Hillandale Farms of Iowa is voluntarily recalling shell eggs because they have the potential to be contaminated with Salmonella. Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections, endocarditis, or arthritis.

Eggs affected by this recall were distributed to grocery distribution centers, retail grocery stores and foodservice companies which service or are located in fourteen states, including the following: Arkansas, California, Iowa, Illinois, Indiana, Kansas, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Texas, and Wisconsin.

There have been laboratory-confirmed Salmonella enteritidis illnesses associated with the shell eggs; the investigation is ongoing.

Eggs are distributed under the following brand names: Hillandale Farms, Sunny Farms, and Sunny Meadow in 6-egg cartons, dozen-egg cartons, 18-egg cartons, 30-egg package, and 5-dozen cases. Loose eggs are packaged under the following brand names: Wholesome Farms and West Creek in 15 and 30-dozen tray packs. The loose eggs may also be repackaged by customers.

The only eggs effected by this recall have plant numbers P1860 or P1663 and Julian dates as follows:

P1860 – Julian dates ranging from 099 to 230
P1663 – Julian dates ranging from 137 to 230

Only eggs with these plant numbers are effected - even though the brand name may be the same

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Nearly 80 reported cases of Salmonella in Durham, North Carolina this past April are ultimately related to the nationwide outbreak due to contaminated eggs sold by Wright County Egg, of Iowa.   In a report dated July 9, 2010, the state Health Department concluded that the illnesses resulted from a contaminated commercial pasteurized egg white product used in meringue on desserts. 

Today, those health officials were quoted confirming the link between that egg product, and the ongoing national outbreak:

In the days and weeks to come, we will likely see confirmation that additional clusters of illnesses are ultimately related to the Wright County Egg products.

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The Salt Lake Valley Health Department is issuing a Hepatitis A health alert for people who ate at a Salt Lake City Quizno's restaurant on August 6 or 7. Patrons of the Quizno's at 30 East Broadway (300 South) on August 6 or 7 are urged to get an injection of immune globulin (IG) or hepatitis A vaccine as soon as possible. Vaccinations will be available at the Salt Lake Valley Health Department City Clinic at 621 South 200 East on Thursday, August 19 until 5:00 p.m., Friday, August 20 from 8:30 a.m. to 6:30 p.m. or Saturday, August 21 from 8:00 a.m. to 12:00 p.m.

People who ate at the restaurant between July 27 and August 5 may also have been exposed, but would not benefit from immunizations, as the shots must be given within 14 days of exposure. Those individuals should watch for signs of hepatitis A, which include nausea, vomiting, dark urine and jaundice, and contact their health care providers if they become sick.
 

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Though careful to point out the possibility that not all have been confirmed as part of the egg outbreak, the CDC now counts 1,953 people who have been confirmed for the same strain of Salmonella enteritidis as the one involved in the Salmonella egg outbreak since May of this year--though the real number of victims may be in the tens of thousands.  Food safety legislation has been pending, some would say languishing, in the Senate for a long time--legislation that may well have prevented this outbreak.  And, quite notably, the FDA's "egg rule" took effect in July of this year (too late for the regulatory measures in it to have prevented the current egg outbreak), despite being proposed by the FDA almost a decade ago.  Indisputably, the testing, sanitation, and flock maintenance regulations in the Egg Rule would have given the regulatory framework to prevent the situation Wright County Egg now finds itself in. 

It is time that watershed food safety events (i.e. devastating outbreaks) stop serving as the impetus for change.  See also, Spinach E. coli outbreak and Leafy Greens Marketing Agreement.  One way to make that happen is for the government to give itself the authority it needs to help effect change.  Pass the Food Safety Modernization Act now, and while we're at it, let's just take the forward-thinking, undeniably legitimate public health measure of declaring all non-O157 shiga toxin producing strains of E. coli "adulterants" now too.  Legislate now. 

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FDA NEWS RELEASE

Fast Facts:

The current recall of eggs in their shells, or “shell eggs,” is part of an ongoing and intensive investigation by local, state, and federal officials into the cause of recent cases of Salmonella Enteritidis.

This recall affects shell eggs produced by Wright County Egg of Galt, Iowa. The eggs are packaged under different brand names and distributed nationwide.

The shell eggs may contain Salmonella Enteritidis (SE) and may cause serious illness.

Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

Consumers should throw away the product or return the product to the store.

What is the Problem?

An outbreak of Salmonella Enteritidis (SE) that has sickened hundreds of people across the country has led to a recall of shell eggs.

What is Being Done about the Problem?

Working closely with the Centers for Disease Control and Prevention (CDC) and state public health partners, the FDA reviewed epidemiologic and environmental investigation documents and identified 3 best-case clusters of Salmonella Enteritidis illnesses. Tracebacks revealed Wright County Egg in Iowa as the common shell egg supplier in these clusters.

On August 13, Wright County Egg voluntarily conducted a nationwide recall of shell eggs on 3 of its 5 farms. Further epidemiologic and traceback information led to Wright County Egg expanding its recall on August 18 to cover all 5 farms and 380 million eggs (according to company figures).

The Agency has activated its emergency operations command center with scientists, investigators, epidemiologists, and communication experts. In addition, the FDA deployed an initial team of 10 investigators to Wright County Egg in Iowa to inspect the farms and determine the source of the contamination. More investigators are being deployed to help on-site, looking to find the source of the contamination. Investigators are performing environmental assessments of farm conditions and practices including pest and rodent controls, biosecurity plans, environmental monitoring, sanitary controls, and feed sources.

The FDA is initiating effectiveness checks of the recall, conducting checks at retail stores, wholesalers and distributors to make sure the recalled shell eggs are being removed from the market.

The FDA is in ongoing communications with Wright County Egg to ensure that appropriate preventive measures are put in place to reduce the risk of recurrence.

What are the Symptoms of Illness?

Continue Reading...

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The CDC released a graphic today that is a striking illustration of both the size of the egg outbreak, as well as the increase in Salmonella enteritidis illnesses nationally over the baseline level in the last five years:

What's really scary is that, as recently as late July, the green bars were still about 3/4 as high as they were during the peak times of late June and early July, with many illnesses surveilled in the month of August certainly yet to be reported.  Translation:  there have been a heck of a lot of people ill nationally in this outbreak, and probably many who are still ill or yet to become infected--depending on the success of Wright County Egg's efforts, in conjunction with FDA, to recall implicated eggs. 

In addition to contacts from lots of sick people (Possibly as many as 50,000 victims of the Salmonella egg outbreak so far?) we are getting lots of questions from consumers who are understandably worried about the eggs they've got in the refrigerator right now, and whether its safe to buy or consume eggs at all.  Wright County Egg company's August 18 recall includes eggs with Julian dates ranging from 136 to 229 and plant numbers 1720 and 1942.  The August 13 recall includes eggs with Julian dates ranging from 136 to 225 and plant numbers 1026, 1413, and 1946.  Read FDA's most recent update on the recall.  The plant number and Julian dates will be positioned on cartons as pictured here:

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They just keep coming.   Today is the announcement by Oregon health officials of 23 Salmonella infections linked to dairy products from the Umpqua Dairy in Oregon.  Two of those ill have been hospitalized, according to this report.  The illnesses were traced to product from the company's production plant in Roseburg Oregon. 

Officials said the illnesses occurred in Lane,  Douglas, Linn County, Coos Marion, Jackson, Josephine, Deschutes and Klamath counties.  The report states that:

The dairy has suspended operation of its Roseburg plant and is working with the state health and agriculture departments to thoroughly disinfect the plant and equipment and review its processing procedures.

While the cases were traced to milk, the dairy is recalling all products from the same production line, including:   half-and-half, cream, buttermilk and Umpqua-brand one-gallon orange juice and fruit drinks.  Recalled products have the plant code 41-62 stamped on them.  Other products, including ice cream, sour cream and cottage cheese, are not being recalled.

Oregon health official Paul Cieslak was quoted discussing the surprising nature of the recall given that the milk is pasteurized. 

“This was a puzzler,” Cieslak said. “Pasteurized milk is a very safe product and therefore a very improbable cause of a food-borne illness.”  He said it appears Umpqua products were being properly pasteurized. That has led investigators to suspect the contamination came after pasteurization, probably in the packaging process.

Perhaps tomorrow we can go a whole day without a new Salmonella outbreak.

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Denmark has been successful in the control of Salmonella Enteriditis  in broiler chickens, layer hens, and pigs through careful surveillance, culling, farm sanitation, pasteurization, and sanitary slaughter.  Denmark has now has the safest eggs in the world. And they achieved this only by an effective industry-government partnership, something we should take special note of, given the positive political climate in the US right now. See the paper (link here) from the CDC below for a review of the Danish approach.

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Roseburg, Ore., company is working with state agencies to ensure safe milk and juice products

Oregon Public Health officials today want to make sure consumers are aware of a recall of certain milk and drink products by Umpqua Dairy Products Co. sold in Oregon, southwest Washington and northern California. Umpqua, headquartered in Roseburg, Ore., instituted the milk products recall today after salmonellosis cases were linked to milk produced at its Roseburg plant.

Milk, half and half, cream and buttermilk as well as Umpqua Dairy brand gallon orange juice and fruit drinks are part of the recall. Ice cream and other dairy products, including sour cream and cottage cheese, are not being recalled.

Umpqua Dairy has temporarily suspended operation while it is working with public health officials and the Oregon Department of Agriculture to review their processing systems so the company can ensure its products are safe for public consumption.

The recall comes after 23 people, all in Oregon, have been laboratory-confirmed with matching DNA patterns of Salmonella Braenderup. Two people have been hospitalized. No deaths have been reported. Public health officials have been investigating the outbreak since the first cases were reported in October 2009.

“This outbreak has unfolded slowly and it was just recently that we were able to confirm the matching Salmonella strain in the Umpqua milk plant. We want to tell consumers that if they have any Umpqua milk at home, they should discard it or ask for a refund from the store where it was purchased. The risk to consumers is very low. We have had approximately one illness reported for every million containers that Umpqua has sold during this period,” said Paul Cieslak, M.D., Oregon Public Health Division.

All Umpqua Dairy products are pasteurized. The pasteurization process is effective at removing Salmonella. Recent testing at the Roseburg Dairy, however, identified this type of Salmonella on several different surfaces.

The following numbers of people from these counties have been infected with this Salmonella: Douglas, 6; Marion, 3; Jackson, 3; Lane, 3; Linn, 3; Josephine, 2; Coos, 1; Deschutes, 1; and Klamath, 1. The median age of those sickened is 13 years.

Umpqua also sells under the labels: Cascade, Great Value, Lady Lee, Market of Choice and Sherm’s. The company also supplies milk to Dairy Queens in Oregon and Washington. Those products that should be discarded or returned have a plant code 41-62 stamped on them. The recall affects milk, purchased on or prior to Monday, Aug. 16, 2010 or earlier or with an expiration date of Sept. 5, 2010 or earlier; buttermilk with an expiration date of Sept. 10, 2010, or earlier; orange juice and fruit drink with an expiration date of Sept. 15 or earlier.

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The list keeps expanding of manufacturers who packaged and sold Wright County eggs, currently the subject of a massive recall related to an ongoing nationwide Salmonella outbreak.  Thankfully, we have people like Phyllis Entis over at eFoodAlert.com to help keep up on the ever-expanding list of implicated products being recalled in this debacle.  Phyllis has been compiling and updating the recall list with details on the corresponding manufacturing dates and product label codes.  Here is her latest update:

Recalled eggs were packed in in varying sizes of cartons (6-egg cartons, dozen egg cartons, 18-egg cartons) with Julian dates ranging from 136 to 225 and plant numbers 1026, 1413 and 1946. Dates and codes can be found stamped on the end of the egg carton. The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P-1946 223.

• Albertson:- Albertson's store brand, packaged and recalled by Wright County Egg (Galt, IA)
• Bayview:- Bayview Large 5 dozen (UPC 7-17544-30172-1; plant P-1686; Julian dates 142-149) produced by Wright County Egg and packaged by NuCal Foods; distributed to food wholesalers and retailers in California and Nevada.
• Boomsma/Dutch Farms:- Distributed to Walgreens stores in Iowa, Minnesota, Kansas, Nebraska, Missouri, South Dakota and Arkansas. Wright County Eggs used unauthorized egg cartons to package and sell eggs under the Dutch Farms name without Dutch Farms knowledge. Dutch Farms is seeking legal representation.
• Farm Fresh:- Packaged and recalled by Wright County Egg.
• Glenview Farms:- The Lund Egg Co. (Woodville, WI) has issued a Class I Recall on eggs including some Glenview Farms product.
• Hillandale:- Packaged and recalled by Wright County Egg.
• Kemps:- Packaged and recalled by Wright County Egg.
• Lucerne:- Lucerne Foods recalls Lucerne Grade AA eggs in 12-count and 18-count cartons (packed and recalled by Wright County Egg), sold at Safeway Food & Drug stores in Northern California and Northern Nevada (“Sell By” dates of May 16, 2010 to August 13, 2010, followed by Plant code numbers P1026, P1413 or P1946); and in Denver, New Mexico, Nebraska, South Dakota and Wyoming (“Sell By” dates of June 29, 2010 to September 12, 2010, followed by Plant code number P1026)
• Lund:- The Lund Egg Co. (Woodville, WI) has issued a Class I Recall on eggs including some Glenview Farms product.
• Mountain Dairy:- Mountain Dairy AA Grade Large Eggs, 18 ct., AA Grade Large Eggs, 12 CT, and AA Grade Medium Eggs, 5 dozen, sold in Food4Less, Foodsco, and Ralphs stores (members of the Kroger family of stores); Mountain Dairy Medium 5dz (UPC 0-11110-89969-9; Plant P-1951; Julian dates 193-208) were produced by Wright County Egg and packed by Nucal Foods.
• Nulaid:- Nulaid Medium 5dz (Plant P-1091 & P-1951; Julian dates of 167-174 and 195-210, respectively); produced by Wright County Egg and packed by NuCal Foods.
• Ralph's:- Ralph's AA Grade Large Eggs, 12 ct., and AA Grade Large Eggs, 18 ct., sold in Food 4 Less, Foodsco, and Ralphs stores (members of the Kroger family of stores)
• Shoreland:- Packaged and recalled by Wright County Egg.
• Sunshine:- Sunshine Extra Large Eggs (sku 01175), sold in Trader Joe's stores in Southern California and Las Vegas, NV
• Sun Valley:- Sun Valley Medium 5dz (UPC 6-48065-11432-6; PlantP-1951; Julian dates195-209); produced by Wright County Egg and packed by NuCal Foods. Distributed to food wholesalers and retailers in California and Nevada.
• Trafficanda:- Packaged and recalled by Wright County Egg.

In addition to the recall notices listed above, U.S. Foodservice has reported that some eggs supplied to restaurants and food service customers by U.S. Foodservice, Sysco Corp. and Restaurant Depot (Jetro), are included in the Wright County Egg recall.

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Salmonella Enteritidis and Shell Eggs:

Salmonella contamination of eggs is an important public health problem in the United States. Salmonella contamination of eggs by serotype enteritidis--the strain involved in the massive Salmonella outbreak and recall associated with eggs from Wright County Egg--more specifically, was formerly a problem that occurred most frequently in the northeastern United States, but now illness caused by S. enteritidis is increasing in other parts of the country as well. 

Most types of Salmonella live in the intestinal tracts of animals and birds and are transmitted to humans by contaminated foods of animal origin. Stringent procedures for cleaning and inspecting eggs were implemented in the 1970s and have made salmonellosis caused by external fecal contamination of egg shells extremely rare. However, unlike eggborne salmonellosis of past decades, the current epidemic is due to intact and disinfected grade A eggs. The reason for this is that Salmonella enteritidis silently infects the ovaries of healthy appearing hens and contaminates the eggs before the shells are formed.

Although most infected hens have been found in the northeastern United States, the infection also occurs in hens in other areas of the country. In the Northeast, approximately one in 10,000 eggs may be internally contaminated. In other parts of the United States, contaminated eggs appear less common. Only a small number of hens seem to be infected at any given time, and an infected hen can lay many normal eggs while only occasionally laying an egg contaminated with the Salmonella bacterium.
 

Reducing the Risk of Salmonella Enteritidis Infection:

*  Keep eggs refrigerated.

*  Discard cracked or dirty eggs.

*  Wash hands and cooking utensils with soap and water after contact with raw eggs.

*  Eat eggs promptly after cooking. Do not keep eggs warm for more than 2hours.

*  Refrigerate unused or leftover egg- containing foods.

*  Avoid eating raw eggs (as in homemade ice cream or eggnog). Commercially manufactured ice cream and eggnog are made with pasteurized eggs and have not been linked with Salmonella enteritidis infections.

*  Avoid restaurant dishes made with raw or undercooked, unpasteurized eggs. Restaurants should use pasteurized eggs in any recipe (such as Hollandaise sauce or caesar salad dressing) that calls for pooling of raw eggs.
 

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The Salmonella outbreaks just keep coming.  Two different strains of the bacteria have been  associated with over 150 illnesses tied to Taco Bell, and hundreds, if not thousands, more are linked to recently recalled eggs.  Now, it appears that pickles in Chicago are the source of a new outbreak. 

Cook County public health officials have reportedly stated that six confirmed cases of salmonella have been linked to "pickles purchased from the Assi Market in the Chicago suburb of Niles. Five people have been hospitalized."

The ill persons ate pickles made at the market and sold in plastic bags between July 25 and July 27, with an Aug. 24 sell-by date.  There is no word yet on which strain of Salmonella is invovled, although cross-contamination has been raised as a possibility.

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228,000,000 Eggs Recalled

Thousands Likely Sickened

First Lawsuit Filed

FDA is collaborating with Federal and state partners to investigate a nationwide increase of Salmonella Enteritidis (SE) infections. Partners include the Centers for Disease Control and Prevention (CDC), the U.S. Department of Agriculture, and state public health and agriculture officials. Joint FDA/CDC field investigation teams are working to identify potential sources of SE infection in shell eggs.

Since May 2010, CDC has identified a nationwide, four-fold increase in the number of SE isolates through PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories. CDC received reports of approximately 200 SE cases every week during late June and early July. Normally, CDC has received an average of some 50 reports of SE illness each week for the past five years. Many states have also reported increases of this pattern since May 2010.

Epidemiologic investigations conducted by public health officials in California, Colorado, and Minnesota have revealed several restaurants or events where more than one person ill with this type of SE has eaten. Preliminary information from these investigations suggests that shell eggs are the likely source of infections in many of these restaurants or events.

FDA, CDC, and state partners conducted a traceback investigation and found many of these restaurants or events received shell eggs from a single firm, Wright County Egg, in Galt, Iowa. FDA is currently conducting an extensive investigation at the firm in Iowa. The investigation involves sampling, records review and looking for potential sources of contamination, such as feed. As the investigation continues, updates will be made available.

On August 13, 2010, Wright County Egg of Galt, Iowa, conducted a nationwide voluntary recall of shell eggs that it had shipped since May 19, 2010 to food wholesalers, distribution centers and foodservice companies in California, Illinois, Missouri, Colorado, Nebraska, Minnesota, Wisconsin and Iowa. These companies distribute nationwide.

The recalled shell eggs are packaged under the following brand names: Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms and Kemps.

State and local partners are also investigating human Salmonella infections in Arizona, Connecticut, Massachusetts, Maryland, North Carolina, Nevada, Oregon, Pennsylvania, Tennessee and Texas.

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Multiple Brands of Shell Eggs due to Possible Salmonella Contamination

What You Need To Know:

Egg Farms Owner: Wright County Egg of Galt, IA.

Recalled products are distributed nationwide. Affected labels and brand names include: Please check the list and numbers.  Recalled products are distributed nationwide

Affected labels and brand names include:

Albertsons
Boomsma’s
Country Eggs, Inc.
Dutch Farms
Farm Fresh
Glenview Farms (US Foodservice brand)
Hillandale
Kemps
Lucerne (Safeway Brand)
Lund (Lund Egg Co. of Woodville, WI)
Mountain Dairy
Ralph’s,
Shoreland
Sunshine
Trafficanda

All labels are packed in varying sizes of cartons, including but potentially not limited to, 6-egg cartons, dozen-egg cartons, 18-egg cartons, 15-dozen cartons.  Dates and codes can be found stamped on the end of the egg carton.  Recalled Eggs have plant numbers 1026, 1413 and 1946 and Julian dates ranging from 136 to 225.  The plant number begins with the letter “P.” The Julian date follows the plant number, for example: “P-1946 223.”

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More States will likely report illnesses in coming days in massive Egg recall

California Health officials report that Salmonella Enteritidis (SE)-tainted eggs have sickened at least 266 Californians with salmonella, despite a multi-state recall. Seven cases of salmonella were linked to the same recall in Minnesota.  In addition, Wright County Egg is reported to be recalling 228 million eggs after being linked to the outbreak.

The FDA announced that since May 2010, CDC has identified a nationwide, four-fold increase in the number of SE isolates through PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories. CDC received reports of approximately 200 SE cases every week during late June and early July. Normally, CDC has received an average of some 50 reports of SE illness each week for the past five years. Many states have also reported increases of this pattern since May 2010.

Epidemiologic investigations conducted by public health officials in California, Colorado, and Minnesota have revealed several restaurants or events where more than one person ill with this type of SE has eaten. Preliminary information from these investigations suggests that shell eggs are the likely source of infections in many of these restaurants or events.

The FDA, CDC, and state partners conducted a traceback investigation and found many of these restaurants or events received shell eggs from a single firm, Wright County Egg, in Galt, Iowa. Eggs from Wright County Egg of Galt, Iowa, were delivered to wholesalers, distribution centers and food service companies in California, Illinois, Missouri, Colorado, Nebraska, Minnesota, Wisconsin and Iowa.

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With an estimated 228,000,000 individual eggs subject to Wright County Egg's massive recall yesterday, and the subsequent cascade of companies issuing their own recalls because they used contaminated Wright County eggs, this mary very well turn into one of the largest food product recalls and outbreaks in recent memory.  After all, only minutes ago, California health officials announced that 266 residents (that is 266 residents of California alone) were sickened in the outbreak; multiplied by the magic number 38.6 (i.e. the estimated number of unconfirmed cases in any Salmonella outbreak), there may be more than 10,000 victims of this outbreak in California alone. 

What is the extent of Wright County Egg's liability in this outbreak?  The answer depends on the number of cases counted in the end-reckoning, and the numbers will probably be staggering.  But what about its culpability?  The in-depth discovery that will certainly happen in the wake of the lawsuits that we intend to file against the company will follow the FDA's guidance document to egg producers.  See Egg Guidance in full.   

Here's a select few questions to be asked, and very clear answers, according to the FDA:

A.  Cleaning and Disinfection:

1. When am I required to clean and disinfect my poultry houses?

You must clean and disinfect your poultry houses before new laying hens are added to the houses if you have had an environmental test or an egg test that was positive for SE [Salmonella enteritidis] at any point during the life of a flock that was housed in the poultry houses prior to depopulation.  [editor's note:  with as many illnesses nationally as there appear to be, has Wright County Egg had to just destroy its entire flock of laying hens?]

(21 CFR 118.4(d))

2. What procedures must I follow when cleaning and disinfecting my poultry houses?

When cleaning and disinfecting your poultry houses, you must follow these procedures:

You must remove all visible manure;
You must dry clean your positive poultry houses to remove dust, feathers, and old feed; and
Following cleaning, you must disinfect your positive poultry houses with spray, aerosol, fumigation, or another appropriate disinfection method.
(21 CFR 118.4(d)(1), (d)(2), and (d)(3))
 

B.  Refrigeration:

1. When must I refrigerate my eggs?
You are required to refrigerate eggs from farms with 3,000 or more laying hens beginning 36 hours after they are laid.

(21 CFR 118.4(e))

2. What is the maximum temperature required for holding and transporting eggs that are at least 36 hours old?
The maximum temperature requirement for holding and transporting eggs that are at least 36 hours old is 45 degrees F ambient (air) temperature.

(21 CFR 118.4(e))

C.  Environmental testing for SE

1. Why must I test my poultry house environment for SE?
Environmental testing for SE is one indicator of the effectiveness of your SE prevention plan.

(21 CFR 118.5(a))

2. When must I test my poultry house environment for SE?
In addition to the required environmental test of the pullet environment when pullets are 14 to 16 weeks of age (§118.4(a)(2)(i)), you must perform environmental testing for SE (as described in §§118.7 and 118.8) in each poultry house when any group of laying hens constituting the flock within the poultry house is 40 to 45 weeks of age (§118.5(a)). If you induce a molt in a flock or a group in a flock, you must perform additional environmental testing for SE in the poultry house at 4 to 6 weeks after the end of each molting process. Each time a flock or group within the flock is molted, you must perform environmental testing in the poultry house at 4 to 6 weeks after the end of the molting process.

(21 CFR 118.5(b))

3. What am I required to do if my environmental test is negative?
If your environmental test at 40 to 45 weeks is negative and your laying hens do not undergo induced molting, you do not need to perform any additional environmental testing within that poultry house, unless the poultry house contains more than one group of laying hens. If the poultry house contains more than one group of laying hens, you must perform environmental testing on the poultry house when each group of laying hens is 40 to 45 weeks of age. (21 CFR 118.5(a)(1)) If your environmental test at 4 to 6 weeks after the end of the molting process is negative and none of your laying hens in that poultry house is molted again, then you do not need to perform any additional environmental testing in that poultry house.

(21 CFR 118.5(b)(1))

4. What am I required to do if my environmental test is positive?
If your environmental test at 40 to 45 weeks is positive, then you must:

Review and make any necessary adjustments to your SE prevention plan to ensure that all measures are being properly implemented; AND either
Begin egg testing, as described in § 118.6; OR
Divert eggs to treatment for the life of the flock in that poultry house.
(21 CFR 118.5(a)(2))

If your environmental test at 4 to 6 weeks after the end of a molting process is positive, then you must:

Review and make any necessary adjustments to your SE prevention plan to ensure that all measures are being properly implemented; AND either
Begin egg testing, as described in § 118.6; OR
Divert eggs to treatment for the life of the flock in that poultry house.
(21 CFR 118.5(b)(2))

5. When must I have the results from egg testing?
You must have results of egg testing within 10-calendar days of receiving notification of the positive environmental test.

(21 CFR 118.5(a)(2)(ii))

D.  Testing Eggs for SE

1. When must I test eggs for SE?
You must test eggs for SE whenever you have an environmental test positive for SE and you choose not to divert eggs from the flock in the positive house to a treatment for the life of that flock. If the environmental test for pullets at 14 to 16 weeks of age is positive, you must either divert eggs to treatment for the life of that flock or conduct egg testing within 2 weeks of the start of egg laying.

(21 CFR 118.6 (a)(1))

2. How do I test eggs for SE?
You must conduct four egg tests on the flock in the positive poultry house at 2-week intervals.

(21 CFR 118.6 (c))

3. If all four egg tests are negative for SE, am I required to do any further egg testing?
No. If all four egg tests are negative for SE, you do not need to test any more eggs from that flock.

(21 CFR 118.6 (c))

4. What do I do if any of the four egg tests is positive?
If any of the four egg tests is positive for SE, you must divert, upon receiving notification of an SE-positive egg test, all eggs from that flock to treatment for the life of the flock or until four egg tests at 2-week intervals are negative for SE.

(21 CFR 118.6 (c) and (d))

5. What if one of my four egg tests is positive, and I divert to treatment and then later achieve negative results for four egg tests at 2-week intervals?
In this situation, you may return to table egg production, upon receiving notification of a negative result for the fourth egg test. However, you must conduct one egg test per month on that flock for the life of the flock.

(21 CFR 118.6 (e))

6. If all my monthly egg tests are negative for SE, may I continue to supply eggs to the table egg market?
Yes. As long as all of your monthly egg tests are negative for SE, you may continue to supply eggs to the table egg market.

(21 CFR 118.6 (e) (1))

7. What am I required to do if any of my monthly egg tests is positive for SE?
If any of the monthly egg tests is positive for SE, you must divert eggs from the positive flock to treatment for the life of the flock or until four egg tests at 2-week intervals are negative for SE.

(21 CFR 118.6 (e) (2))

8. Am I required to label or otherwise identify eggs I am diverting to treatment?
Yes. If you are diverting eggs, the pallet, case, or other shipping container must be labeled and all documents accompanying the shipment must contain the following statement:

“Federal law requires that these eggs must be treated to achieve at least a 5-log destruction of Salmonella Enteritidis or processed as egg products in accordance with the Egg Products Inspection Act, 21 CFR 118.6(f).”

This statement must be legible and conspicuous.

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An Ohio victim of the Salmonella outbreaks linked to Taco Bell filed a food poisoning lawsuit in the Court of Common Pleas of Scioto County, Ohio today. The lawsuit was filed against the food chain parent company Yum! Brands on behalf of a Scioto county resident by Bill Marler of food safety law firm Marler Clark and by Fred Wendel of the Columbus firm Stewart & DeChant.

Two parallel outbreaks of Salmonella have been identified by Centers for Disease Control (CDC), both linked to the Taco Bell restaurant chain. Salmonella Hartford and Salmonella Baildon--the two outbreak strains--are rare and strong, sickening at least 155 people in 21 states and sending more than 30% of the ill to the hospital. More than 60% of the victims reported eating at Taco Bell.

Tammy Hale purchased food from a Taco Bell in Wheelersburg at the beginning of June. The next day she began to experience gastrointestinal symptoms, which worsened over the next several days until she had to be hospitalized. During her four-day hospitalization, tests revealed that she had been infected with the outbreak strain of Salmonella Hartford. She is still recovering from her illness.

"Ohio has been hard-hit by these outbreaks," said food safety advocate and attorney Bill Marler. "Studies show that for every confirmed Salmonella illness in an outbreak, another 38.5 people who are sick don't visit the doctor or don't get tested. Using that math, close to a thousand Ohioans have likely been sickened. Many, like Tammy, are still trying to regain their health. At this point in the outbreak, our job is to help them do that."

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And I thought the last installment of this running Salmonella outbreak tally was compelling. To bring things up-to-date, however, there are several additional major salmonella outbreaks to report on--outbreaks that have caused, conservatively, many thousands of people across the country to suffer severe illnesses. The culprits: Taco Bell; shell eggs; and frozen mamey pulp.

First, however, to recap, here is a selection of ten major Salmonella outbreaks that occurred from January to July 2010:

1. ConAgra's Marie Calendar's brand Cheesy Chicken and Rice frozen entrees
2. Skokie Country Club Outbreak
3. Caldwell Fresh Foods Sprouts Outbreak
4. Utah Raw Milk Outbreak
5. Casa Lopez Outbreak in Ohio
6. Los Dos Amigos Outbreak
7. Subway Outbreak in Illinois
8. Salami and Pepper Outbreak
9. Chico "Margarita Mix Off" Outbreak
10. Salmonella spinach and lettuce outbreaks/recalls

Two other outbreaks in recent months are worthy of note, and the question is whether they are part of a larger outbreak more national in scope.  We recently reported on a Salmonella outbreak at the Fort restaurant in Morrison, Colorado that sickened nearly 30 people.  At the time, Colorado health officials stated that the CDC and FDA were involved in the investigation, trying to determine whether the Fort outbreak was linked to larger national outbreak of identical illnesses.

The suspicious larger national outbreak was, of course, announced yesterday.  The CDC stated that it has seen a four-fold increase (from around 50 to around 200) in weekly reports of a particular strain of Salmonella enteritidis from multiple states since May.  Salmonella enteritidis is a strain that is extremely common, and is also commonly associated with eggs.  Also yesterday, Wright County Egg company from Iowa issued a large national recall of its shell egg products.  The eggs affected by this recall were distributed to food wholesalers, distribution centers and foodservice companies in California, Illinois, Missouri, Colorado, Nebraska, Minnesota, Wisconsin and Iowa. These companies distribute nationwide.

And then there is the rash of Salmonella enteritidis illnesses that struck Kenosha County, Wisconsin, in June.  Many of the illnesses, including that of our client Tanja Dzinovic, were linked to Baker Street Restaurant and Pub.  Our current question:  were the Baker street illnesses linked to Wright County Egg too? 

Taco Bell:

Currently, the CDC counts 155 cases of Salmonella Baildon and Hartford in many states linked to a “national Mexican restaurant chain” now, due in large part to our lawsuit on behalf of Jo Ann Smith, known to be Taco Bell. The Taco Bell outbreak is national in scope, having caused illness from April through July (with a peak in late may and june).

Goya brand frozen mamey pulp:

And finally, an outbreak of typhoid fever in California and Nevada has been traced to Goya brand frozen mamey pulp. The CDC has identified 5 people in California and 4 in Southern Nevada with Typhoid fever linked to the outbreak. Typhoid fever is caused by infection with Salmonella Typhi, and can be a life-threatening disease. It is very rare in the US, with only about 400 cases reported each year. It can take up to 8 weeks for someone who has been infected to show symptoms, so it is very likely that the numbers in this outbreak will grow.

Mamey is also called sapote or zapote, and is a tropical fruit grown primarily in Central and South America. It is prepared by removing the inner seed and consuming the flesh raw, or adding it to milkshakes, jellies, or other foods or beverages. When preparing frozen mamey fruit pulp, it is peeled and mashed, and then consumed as a shake or smoothie. Frozen mamey pulp is available in grocery stores throughout the US. Packages have a shelf life of 2-3 years. The product has been recalled from grocery stores, and consumers should check their freezers.
It is widely known that foodpoisoning illnesses are underreported nationally, meaning that only a fraction of the total cases of illness are ever detected by medical providers and public health authorities. For Salmonella specifically, it is estimated that, in any outbreak situation, the actual number of Salmonella victims is as many as 38 times the number of “confirmed cases.” Thus, in the three new outbreaks summarized above, in all likelihood there are tens of thousands of victims nationally.
 

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On July 9, 2009, FDA published in the Federal Register a final rule that established a regulation part 118 (21 CFR part 118) entitled "Prevention of Salmonella Enteritidis in Shell Eggs During Production, Transportation, and Storage." The egg rule in part 118 requires shell egg producers to implement measures to prevent Salmonella Enteritidis (SE) from contaminating eggs on the farm and from further growth during storage and transportation, and requires these producers to maintain records concerning their compliance with the rule and to register with FDA.

In other Salmonella enteritidis news, the CDC just announced that "Approximately 200 isolates were [of the most common enteritidis strain] uploaded to PulseNet on a weekly basis during late June and early July compared to an expected ~50 uploads a week on average during this same period in the previous 5 years. Many states have reported increases of this pattern since May."

CDC also states:

Epidemiologic investigations conducted by public health officials in California, Colorado, and Minnesota have revealed several restaurants or events where more than one ill person with the outbreak strain has eaten. Preliminary data suggests that shell eggs are a likely source of infections in many of these restaurants or events. State partners, FDA, and CDC, conducted a traceback and found many of these restaurants or events received shell eggs from a single firm, Wright County Egg, in Galt, Iowa. FDA is currently conducting an extensive investigation at the firm in Iowa. The investigation includes CDC participation and involves sampling, records review and looking for potential sources of contamination, such as feed.

Wright County Egg has recalled shell eggs with the following brand names: Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms and Kemps. Eggs are packed in varying sizes of cartons (6-egg cartons, dozen egg cartons, 18-egg cartons) with Julian dates ranging from 136 to 225 and plant numbers 1026, 1413 and 1946. Dates and codes can be found stamped on the end of the egg carton. The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P-1946 223.

With an outbreak the scope of which may be as monumental as the CDC figures intimate, it will be interesting to see which of the Salmonella enteritidis "prevention measures" set forth in the FDA's Egg Rule Wright County Egg was, or was not, implementing. 

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CDC is collaborating with public health officials in many states, the US Food and Drug Administration (FDA), and the US Department of Agriculture’s Food Safety and Inspection Service to investigate a nationwide increase of Salmonella Enteritidis (SE) infections with an indistinguishable pulsed-field gel electrophoresis (PFGE) pattern JEGXX01.0004. This is the most common PFGE pattern for SE in the PulseNet database. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak.

In May 2010, CDC identified a nationwide increase in the number of Salmonella Enteritidis isolates with PFGE pattern JEGXX01.0004 uploaded to PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections. The increase represents approximately a four-fold increase over the expected number of reported isolates of this particular PFGE pattern. Approximately 200 isolates were uploaded to PulseNet on a weekly basis during late June and early July compared to an expected ~50 uploads a week on average during this same period in the previous 5 years. Many states have reported increases of this pattern since May.

Epidemiologic investigations conducted by public health officials in California, Colorado, and Minnesota have revealed several restaurants or events where more than one ill person with the outbreak strain has eaten. Preliminary data suggests that shell eggs are a likely source of infections in many of these restaurants or events. State partners, FDA, and CDC, conducted a traceback and found many of these restaurants or events received shell eggs from a single firm, Wright County Egg, in Galt, Iowa. FDA is currently conducting an extensive investigation at the firm in Iowa. The investigation includes CDC participation and involves sampling, records review and looking for potential sources of contamination, such as feed. The investigation continues and updates will be made available.

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Twenty-five cases of Salmonella Oranienberg in Ontario may be linked to green onions, according to the is report.  A large portion of those affected are males aged in their 20s.  The source of the outbreak is has not been confirmed, but the Canadian Food Inspection Agency, "is warning individuals not to consume green onions from five Highland Farms Supermarkets, as they may be contaminated."

The report provided information on the implicated green onions, sold "between July 30th to August 1st, unwrapped with a rubber band, and did not have a lot code sticker or product name, at a number of Highland Farms locations."

Produce has been the confirmed and/or suspected source of a number of outbreaks and recalls already this year.   Recently, outbreaks of two different strains Salmonella in multiple states have been associated with Taco Bell, most likely to produce ingredients.

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From MDHP Release:

Consumers, food preparers reminded to cook eggs thoroughly

Illnesses in at least seven people in Minnesota are connected with a multi-state recall of eggs from an Iowa producer due to contamination with Salmonella, state health officials said today. The Salmonella Enteriditis cases were identified in two restaurant outbreaks in May and July, in which eggs were identified as the likely source. Eggs were traced back by the Minnesota Department of Agriculture to Wright County Egg of Galt, IA. Restaurant clusters with the same strain have been identified in additional states.

Health officials emphasized that while seven cases in Minnesota have been linked with the recall, there are potentially many more cases that could be involved. So far this year, Minnesota has received more reports of Salmonella Enteriditis infections of this strain than were reported in previous years, according to Kirk Smith, a foodborne illness supervisor with the Minnesota Department of Health. It is estimated that for every confirmed case of Salmonella, there are approximately 38 unconfirmed cases. Salmonella Enteriditis is one of the most common strains of Salmonella circulating.

The eggs affected by this recall were distributed to food wholesalers, distribution centers and foodservice companies in California, Illinois, Missouri, Colorado, Nebraska, Minnesota, Wisconsin and Iowa. These companies distribute nationwide.

Eggs from Wright County Egg are packaged under the following brand names: Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms and Kemps. Eggs are packed in varying sizes of cartons (6-egg cartons, dozen egg cartons, 18-egg cartons) with Julian dates ranging from 136 to 225 and plant numbers 1026, 1413 and 1946. Dates and codes can be found stamped on the end of the egg carton. The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P-1946 223.

To prevent illness, Smith said it’s important for consumers to cook eggs thoroughly before eating to destroy any Salmonella or other bacteria. Consumers who believe they may have purchased these shell eggs should not eat them but should return them to the store where they were purchased for a full refund. Restaurants should use pasteurized eggs in dishes where the eggs may not be cooked thoroughly, such as Hollandaise sauce or Caesar salad dressing, Smith said.

Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience diarrhea, fever, and abdominal pain. Anyone who believes they may have become ill with Salmonella should contact their health care provider.

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Wright County Egg of Galt, Iowa is voluntarily recalling specific Julian dates of shell eggs produced by their farms because they have the potential to be contaminated with Salmonella. Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections, endocarditis or arthritis.

Eggs affected by this recall were distributed to food wholesalers, distribution centers and foodservice companies in California, Illinois, Missouri, Colorado, Nebraska, Minnesota, Wisconsin and Iowa. These companies distribute nationwide.

Eggs are packaged under the following brand names: Lucerne, Albertson, Mountain Dairy, Ralph’s, Boomsma’s, Sunshine, Hillandale, Trafficanda, Farm Fresh, Shoreland, Lund, Dutch Farms and Kemps. Eggs are packed in varying sizes of cartons (6-egg cartons, dozen egg cartons, 18-egg cartons) with Julian dates ranging from 136 to 225 and plant numbers 1026, 1413 and 1946. Dates and codes can be found stamped on the end of the egg carton. The plant number begins with the letter P and then the number. The Julian date follows the plant number, for example: P-1946 223.

There have been confirmed Salmonella enteritidis illnesses relating to the shell eggs and traceback investigations are ongoing.

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Ohio, Illinois, Kentucky, and Wisconsin Lead the Illness Count

An Ohio victim of the Salmonella outbreaks linked to Taco Bell will file a food poisoning lawsuit in the Court of Common Pleas of Scioto County, Ohio today. The lawsuit will be filed against the food chain parent company Yum! Brands on behalf of a Scioto county resident by Bill Marler of food safety law firm Marler Clark and by Fred Wendel of the Columbus firm Stewart & DeChant.

Two parallel outbreaks of Salmonella have been identified by Centers for Disease Control (CDC), both linked to the Taco Bell restaurant chain. Salmonella Hartford and Salmonella Baildon—the two outbreak strains—are rare and strong, sickening at least 155 people in 21 states and sending more than 30% of the ill to the hospital. More than 60% of the victims reported eating at Taco Bell.

Tammy Hale purchased food from a Taco Bell in Wheelersburg at the beginning of June. The next day she began to experience gastrointestinal symptoms, which worsened over the next several days until she had to be hospitalized. During her four-day hospitalization, tests revealed that she had been infected with the outbreak strain of Salmonella Hartford. She is still recovering from her illness.

“Ohio has been hard-hit by these outbreaks,” said food safety advocate and attorney Bill Marler. “Studies show that for every confirmed Salmonella illness in an outbreak, another 38.5 people who are sick don’t visit the doctor or don’t get tested. Using that math, close to a thousand Ohioans have likely been sickened. Many, like Tammy, are still trying to regain their health. At this point in the outbreak, our job is to help them do that.”

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The CDC released a report today linking 79 Salmonella infections to dry pet food.   According to the New York Times, this is the first time human infections have been linked to dry dog or cat food:

The infections occurred from January 2006 through October 2008 in 21 states. More than 23,000 tons of pet food were recalled, affecting 105 brands, and the manufacturing plant, in western Pennsylvania, was shut in 2008.

The report on the outbreak does not identify the manufacturer of the implicated product.  The strain involved was the uncommon Salmonella schwarzengrund.  32 of the 79 reported illnesses occurred in children age 2 or younger.  This apparently led authors of the study to recommend that children under 5 not be allowed to touch or eat pet food, and be "kept away from pet feeding areas."

According to the newspaper report, CDC officials also stressed the importance of hand washing after handling pet food or cleaning up after pets.

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Taco Bell Hepatitis A Green Onion Outbreak - 2000

CDC that Hepatitis A outbreak investigations were also underway in Russell County, Kentucky and Clark County, Nevada. Taco Bell green onions would soon be implicated in these outbreaks as well.

Taco Bell E. coli Lettuce Outbreak - 2006

This outbreak was clearly linked to Taco Bell restaurants in the northeastern United States. As of December 14, 2006, Thursday, 71 persons with illness associated with the Taco Bell restaurant outbreak have been reported to CDC from 5 states: New Jersey (33), New York (22), Pennsylvania (13), Delaware (2), and South Carolina (1). States with Taco Bell restaurants where persons confirmed to have the outbreak strain have eaten are New Jersey, New York, Pennsylvania, and Delaware. (The patient from South Carolina ate at a Taco Bell restaurant in Pennsylvania). Other cases of illness are under investigation by state public health officials. Among these 71 ill persons, 53 (75%) were hospitalized and 8 (11%) developed a type of kidney failure called hemolytic-uremic syndrome (HUS).

Food items include a variety of different ingredients. By comparing foods consumed by ill and well persons, investigators can show statistical links between illness and consumption of particular food ingredients. Public health investigators have identified a few ingredients that were consumed more often by ill persons than well persons and were statistically linked with illness: lettuce, cheddar cheese, and ground beef. This analysis also indicates that onions of any type are not linked to this outbreak. The investigators have also gathered additional information about the locations of involved restaurants, the patterns of distribution of food ingredients, and the characteristics and preparation of food ingredients. Evaluation of all these data indicates that shredded lettuce consumed at Taco Bell restaurants in the northeastern United States was the most likely source of the outbreak.

Taco Bell Salmonella (to be determined) Outbreak - 2010

In both outbreaks, the FDA worked with CDC and state partners to conduct a traceback investigation. The tracebacks focused on produce that ill individuals reported eating and that had been implicated in previous outbreaks of salmonellosis. The extensive traceback effort was initiated to determine if a common source or supplier could be identified to help focus the epidemiologic investigations. No common food source was identified in either traceback. The FDA also sampled and tested produce items and did not find either outbreak strain. As with previous outbreaks in which contaminated produce may be the factor, produce tracebacks present substantial challenges because of the short shelf life of the product and the industry's comingling of product from multiple sources.

Salmonella Hartford Outbreak

A total of 75 individuals infected with a matching strain of Salmonella Hartford have been reported from 15 states since April 1, 2010. The number of ill people identified in each state with this strain is as follows: CO (1), GA (1), IL (5), IN (11), KY (23), MA (2), MI (3), MT (1), NC (1), NH (1), NY (1), OH (19), PA (1), SC (1) and WI (4). Among those for whom information is available about when symptoms started, illnesses began between April 30, 2010 and July 18, 2010. Case-patients range in age from <1 to 80 years old, and the median age is 39 years. Fifty-seven percent of patients are female. Among the 47 patients with available hospitalization information, 15 (32 %) were hospitalized.

Salmonella Baildon Outbreak

A total of 80 individuals infected with a matching strain of Salmonella Baildon have been reported from 15 states since May 1, 2010. The number of ill people identified in each state with this strain is as follows: CT (1), GA (1), IA (1), IL (20), IN (4), KY (5), MA (1), MI (4), MN (5), NJ (6), NY (2), OH (6), OR (1), WA (1) and WI (22). Among those for whom information is available about when symptoms started, illnesses began between May 11, 2010 and July 19, 2010. Case-patients range in age from 1 to 82 years old, and the median age is 47 years. Seventy-four percent of patients are female. Among the 68 patients with available hospitalization information, 27 (40 %) were hospitalized.

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Salmonella Hartford Outbreak Investigation

As of August 1, 2010, a total of 75 individuals infected with a matching strain of Salmonella Hartford have been reported from 15 states since April 1, 2010. The number of ill people identified in each state with this strain is as follows: CO (1), GA (1), IL (5), IN (11), KY (23), MA (2), MI (3), MT (1), NC (1), NH (1), NY (1), OH (19), PA (1), SC (1) and WI (4). Among those for whom information is available about when symptoms started, illnesses began between April 30, 2010 and July 18, 2010.

Case-patients range in age from <1 to 80 years old, and the median age is 39 years. Fifty-seven percent of patients are female. Among the 47 patients with available hospitalization information, 15 (32 %) were hospitalized. No deaths have been reported.

Salmonella Baildon Outbreak Investigation

As of August 1, 2010, a total of 80 individuals infected with a matching strain of Salmonella Baildon have been reported from 15 states since May 1, 2010. The number of ill people identified in each state with this strain is as follows: CT (1), GA (1), IA (1), IL (20), IN (4), KY (5), MA (1), MI (4), MN (5), NJ (6), NY (2), OH (6), OR (1), WA (1) and WI (22). Among those for whom information is available about when symptoms started, illnesses began between May 11, 2010 and July 19, 2010.

Case-patients range in age from 1 to 82 years old, and the median age is 47 years. Seventy-four percent of patients are female. Among the 68 patients with available hospitalization information, 27 (40 %) were hospitalized. No deaths have been reported.

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A small cluster of E. coli O157:H7 illnesses detected by the California Department of Public Health has prompted Valley Meat Company, from Modesto CA, to recall one million pounds of frozen ground beef products..

USDA's Food Safety and Inspection Service learned of the problem on July 15 when CDPH reported the E. coli O157:H7 cluster of illnesses, all of whom had a rare strain as determined by PFGE subtyping. A total of six patients with illness onset dates between April 8 and June 18, 2010 were reported. After further review, CDPH added another patient from February to the case count, bringing the count to seven. FSIS is continuing to work with the CDPH and the company on the investigation. 

The long list of products subject to the recall can be found here, on the FSIS website. In its recall statement, FSIS expresses concern that ground beef products subject to the recall may still be in consumers homes because the products are frozen. 

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The CDC announced that it has been investigating an outbreak of Salmonella linked to a Mexican fast food chain. There are two strains of Salmonella involved - Salmonella Hartford and Salmonella Baildon. Both appear to be linked to the same restaurant. As of August 4, 155 people have been confirmed as part of the outbreaks.

75 Salmonella Hartford illnesses since April 1. The breakdown by state is Colorado (1 ill), Georgia (1 ill), Illinois (5), Indiana (11), Kentucky (23), Massachusetts (2), Michigan (3), Montana (1), North Carolina (1), New Hampshire (1), New York (1), Ohio (19), Pennsylvania (1), South Carolina (1) and Wisconsin (4).

80 Salmonella Bialdon illnesses since May 1. The number of ill people identified in each state with this strain is as follows: Connecticut (1), Georgia (1), Iowa (1), Illinois (20), Indiana (4), Kentucky (5), Massachusetts (1), Michigan (4), Minnesota (5), New Jersey (6), New Jersey (2), Ohio (6), Oregon (1), Washington (1) and Wisconsin (22).

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We've been providing a monthly running tally of major Salmonella outbreaks since this spring.  Three more outbreaks to report today; one a little weird--Salmonella I4,[5],12:i:l inked to frozen mice; another a Salmonella outbreak linked to the famous Fort restaurant in Morrison, Colorado; and the last, and biggest, a major Salmonella serotype baildon and hartford outbreak linked to Taco Bell.  

The Salmonella outbreaks reported in past editions of this running tally include

1. ConAgra's Marie Calendar's brand Cheesy Chicken and Rice frozen entrees
2. Skokie Country Club Outbreak
3. Caldwell Fresh Foods Sprouts Outbreak
4. Utah Raw Milk Outbreak
5. Casa Lopez Outbreak in Ohio
6. Los Dos Amigos Outbreak
7. Subway Outbreak in Illinois
8. Salami and Pepper Outbreak
9. Chico "Margarita Mix Off" Outbreak
10. Salmonella spinach and lettuce outbreaks/recalls

Salmonella Outbreak at The Fort: 

An outbreak of Salmonella in Morrison, Colorado has been linked to The Fort restaurant there. At least 28 patrons of the restaurant have been sickened, many after consuming rattlesnake cake, a crab-cake like dish made with rattlesnake meat. The Jefferson County Health Department has not yet identified the ingredient that made the diners ill, but it may be eggs or even the rattlesnake meat itself.

Mexican restaurant Salmonella baildon and hartford outbreak:

The CDC has announced that it is investigating outbreaks of Salmonella linked to a Mexican fast food chain, which they have not yet named. There are two strains of Salmonella involved - Salmonella Hartford and Salmonella Baildon. Both may be linked to the same restaurant. As of August 4, 150 people have been confirmed as part of the outbreaks. The Salmonella Hartford outbreak has reported 75 ill in 15 states since April 1. The breakdown by state is CO (1 ill), GA (1 ill), IL (5), IN (11), KY (23), MA (2), MI (3), MT (1), NC (1), NH (1), NY (1), OH (19), PA (1), SC (1) and WI (4). The Salmonella Bialdon outbreak has reported 80 ill persons since May 1, 2010. The number of ill people identified in each state with this strain is as follows: CT (1), GA (1), IA (1), IL (20), IN (4), KY (5), MA (1), MI (4), MN (5), NJ (6), NY (2), OH (6), OR (1), WA (1) and WI (22).

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CDC announced this afternoon that it is investigating two multistate outbreaks of Salmonella infections, each involving a different Salmonella serotype: Hartford and Baildon. Both of these Salmonella serotypes are rare, and ill persons in both outbreaks have a similar age and geographic distribution.

An analysis indicates that eating at a Mexican-style fast food restaurant chain, Restaurant Chain A, is associated with some illnesses. Among persons eating at Restaurant Chain A, no specific food item or ingredient was found to be associated with illness for either outbreak.

An extensive traceback effort was initiated to determine if a common source or supplier could be identified to help focus the epidemiologic investigations. No common food source was identified in either traceback.

Salmonella Hartford Outbreak Investigation

As of August 1, 2010, a total of 75 individuals infected with a matching strain of Salmonella Hartford have been reported from 15 states since April 1, 2010. The number of ill people identified in each state with this strain is as follows: CO (1), GA (1), IL (5), IN (11), KY (23), MA (2), MI (3), MT (1), NC (1), NH (1), NY (1), OH (19), PA (1), SC (1) and WI (4). Among those for whom information is available about when symptoms started, illnesses began between April 30, 2010 and July 18, 2010. Case-patients range in age from <1 to 80 years old, and the median age is 39 years. Fifty-seven percent of patients are female. Among the 47 patients with available hospitalization information, 15 (32 %) were hospitalized. No deaths have been reported.

Salmonella Baildon Outbreak Investigation

As of August 1, 2010, a total of 80 individuals infected with a matching strain of Salmonella Baildon have been reported from 15 states since May 1, 2010. The number of ill people identified in each state with this strain is as follows: CT (1), GA (1), IA (1), IL (20), IN (4), KY (5), MA (1), MI (4), MN (5), NJ (6), NY (2), OH (6), OR (1), WA (1) and WI (22). Among those for whom information is available about when symptoms started, illnesses began between May 11, 2010 and July 19, 2010. Case-patients range in age from 1 to 82 years old, and the median age is 47 years. Seventy-four percent of patients are female. Among the 68 patients with available hospitalization information, 27 (40 %) were hospitalized. No deaths have been reported.

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The debate rages on, as usual, with no shortage of passion on both sides.  Sometimes, however, sheer lunacy prevails over reasoned and fact-based argument.  It used to come most frequently from Weston A Price and devotees who long denied that raw milk presented any risks at all, or that it had ever caused any outbreaks.  But WAP has been quiet lately, likely due in no small part to the rash of Salmonella, campylobacter, and E. coli O157:H7 outbreaks that have ocurred thus far in 2010.

Lunacy prevails again, however, as characterized in Sara Burrows Carolina Journal article this morning about the raw milk underground.  Discussing North Carolina's ban on the sale of raw milk, and the lengths that some people go to to get their milk nonetheless, Burrows states:

The ban leaves Laura only one legal option for obtaining raw milk — purchasing it under the moniker “pet milk.” Farmers can sell raw milk for pet consumption, as long as it is labeled as such and includes the warning “Not for human consumption” in half-inch lettering.

The farmers know their customers are not buying several gallons of milk — at $10 to $15 a gallon — for their cats, but they operate on a “don’t ask, don’t tell” basis, handing over the goods with a wink and a nod.

Even though they are within their legal rights to sell “pet milk,” farmers who do so constantly are harassed and sometimes raided.

The state Department of Agriculture adopted a rule in 2007 that would have forced farmers to dye raw milk grey, so families wouldn’t mix up the “cat’s milk” with the “people’s milk.” Rep. Pricey Harrison, D-Guilford, wrote a bill that overturned the rule before it went into effect.

Also, the Ag Department has tried to force pet-milk producers to register as feed manufacturers, even though there is no law requiring it. The process adds costs and regulatory burdens many small dairy operations can’t afford. Most choose to operate under the radar to avoid the hassle.

There is so much wrong, and dangerous, with this that it is hard to know where to start, and harder still to understand any desires to paint the pet-food-milk-for-human-consumption issue in a sympathetic light.  Again Ms. Burrows:

Many pet-milk producers are small dairy farmers, who supplement their income from pasteurized milk by selling raw milk on the side. Others aren’t commercial farmers but simply rural homeowners who have a cow or goat in their backyards.

Most don’t advertise their product and often won’t admit they sell it at all. Those who do are targeted, Foster said.

Unlicensed and unregulated.  Sounds like exactly the kind of establishments you can have faith in with regard to sanitation and food safety. 

So what.  What's the harm in allowing unlicensed, unregulated producers to sell raw milk completely under the radar to families who feed it to their kids?  The harmful, life-changing effects of E. coli O157:H7 and hemolytic uremic syndrome ("HUS") have been addressed many times before.  They kill and destroy lives.  

But there are financial issues that need to be considered by those who sell pet food milk for human consumption.  One is medical costs.  Most of the HUS victims we represent have medical costs topping $250,000 for hospitalization, dialysis, and other treatment that typically lasts one or two months.  Many of these victims face future medical costs that will run into the tens of millions of dollars, once all the costs and effects of advancing kidney failure, end stage kidney disease, and multiple transplantations are taken into account.

So from where do these large sums of money come?  The first possibility is the liability insurance carrier for the defendant milk producer/farmer.  From first hand experience, I can tell you that the kind of milk-farmer we're talking about here (i.e. the underground farmer that Ms. Burrows describes) is not going to have business insurance, and his homeowners insurance is going to exclude personal injuries arising from a business pursuit.  Thus, the farmer's insurance is not going to be a viable source to cover the often monumental costs discussed above; and even if he has homeowners that doesn't exclude coverage, it's not going to be even close to enough to cover these costs in many HUS cases.

The second source is the farmer's assets.  Very likely the farmer who is trying to supplement his pet-food milk income by selling it for human consumption is not going to have anything close to enough to cover the cost of past medical treatment, not to mention future medical costs, in virtually any HUS case.  

The final sources--the injured party's personal insurance, if the family is lucky enough to have it, or taxpayer money in the form of state medicaid.   

So the upshot is, in the best case scenario, you've got life-altering injuries--ones that will rob kids of the ability, in many cases, to pursue a career, raise a family, or do anything that they have a natural right to do in this country--suffered by somebody lucky enough to have insurance (maybe Obamacare isn't such a bad thing?).  And in the worst case scenario, you've got a grievously injured person with absolutely zero realistic recourse, all because an unlicensed and unregulated pet food farmer wanted to supplement his income by selling pet food for human consumption.  

A couple of other thoughts taken from an article I wrote several months ago: 

Many states have confronted cow and herd-share agreements head-on, and most have closed the legislative loophole by specifically outlawing the practice. But not even that has deterred proponents of raw milk; it has, in fact, forced some into ever-more-dangerous, and highly illegal, distributive schemes, including placing a “pet food only” label on raw milk that they know, or have reason to know, will or may be consumed by human beings. Alaska, Colorado, and North Carolina require raw milk to be dyed before being marketed as pet food in order to address this problem specifically.

But, clearly, this type of despicable mislabeling would be illegal in more than just those three states, regardless of the dye requirement. In most states, it would violate consumer protection laws; and additionally would make the job of trial lawyers representing kids who have been sickened by the product a lot easier, as the “pet food only” label is more than an implicit admission that the product is not fit for human consumption and is, as a result, unreasonably dangerous and defective. Punitive damages, in states where they are available, would be sought with gusto.

Is there no thought whatsoever preceding the actions of people who would engage in this sort of conduct?  How dumb do you have to be to believe that labeling something as "pet food" is going to insulate you from liability?  Or better yet, how dumb do you think the rest of the populace is to allow such conduct to occur, and go on, unchecked?  Regardless of where you sit in the wide-ranging, and often annoyingly passionate debate over raw milk, you should not be in favor of measures like this. 

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According to the Colorado Health Department, at least 28 people have become sick from Salmonella poisoning while dining at The Fort restaurant in Morrison. Customers became ill after eating at the restaurant between July 10 and July 16. Health department officials think the salmonella is linked to undercooked eggs. Many diners became ill after eating rattlesnake cakes, an exotic dish that contained the eggs. The department has sent samples of the salmonella strain to the U.S. Centers for Disease Control and Prevention to see if it's linked to outbreaks elsewhere in the country. (photo from AP).  From "The Fort's" menu:

Appetizers

Rattlesnake Cake

A Diamondback Rattlesnake Cake (similar to a crab cake) topped with a sweet and spicy avacodo relish and cilantro micro greens, served with Dixon chile aoli. $25 (subject to availability)

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Another outbreak to report in Colorado.  The Colorado Department of Public Health and Environment announced today a Salmonella outbreak linked to The Fort restaurant in Morrison, Colorado.  The outbreak claimed at least two dozen victims in the month of July, and is believed to have been linked to eggs.  Salmonella enteritidis???

Colorado has seen its share of foodpoisoning (and milk poisoning) this summer, despite a relatively quiet stretch nationally for foodpoisoning recently.  Earlier this summer, Rocky Mountain Natural Meats recalled over 66,000 pounds of bison and buffalo meat after a cluster of E. coli illnesses in Colorado and New York were linked to the product. Health authorities have identified at least 5 illnesses amongst Colorado residents, and at least one illness in New York.  The products were sold under the Great Range brand, among others.

Another E. coli O157:H7 outbreak, with perhaps more devastating effect, has been linked to raw milk from Billy Goat Dairy in Longmont, Boulder County, Colorado. The Boulder County Health Department counted at least 30 confirmed cases of E. coli O157:H7 and campylobacter infection amongst consumers of the raw milk.  Among the 30 confirmed cases are two children who suffered severe illnesses requiring hospitalization. 

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There have been at least nine outbreak with illnesses since January that have been reported. Also, there are others - like an Campylobacter outbreak with two illnesses in Massachusetts that the state has not yet announced (Why?).  Here are some details so far on most of the known outbreaks and recalls (click on image to download details):

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Specialty Farms LLC is voluntarily recalling certain Alfalfa sprout products with a best if sold by date of "8/3/2010" and "8/1/2010" that has the potential to be contaminated with Listeria Monocytogenes.  The recall includes Specialty Farms brand Organic Alfalfa Sprouts Blend and Organic Sprout Salad sold in 4 ounces plastic containers, and bearing a "best if sold by" date of 8/3/2010.  The product descriptions and UPC are: Specialty Farms Organic Alfalfa Sprouts Blend 509800108 and Specialty Farms Organic Sprout Salad 8192400024.

Specialty-Farms, LLC is also voluntarily recalling Stop & Shop brand Natures Promise Organic Alfalfa Sprouts 4 ounce container and 8 ounce bag and Natures Promise Organic Zesty Sprouts 4 ounce, best if sold by date of 8/1/2010. [Further identification on the package includes the following: Certified Organic by NOFA-NY, Certified Organic LLC.]  The product descriptions and UPC are: Natures Promise Organic Alfalfa Sprouts (4 oz) 8826704741; Natures Promise Organic Alfalfa Sprouts (8 oz) 8826704102; and Natures Promise Organic Zesty Sprouts (4 oz) 8826703903.

The products have been distributed thru distributors and to retail stores in CT, NH, MA, ME, NJ, NY, PA, RI, VT.  This recall is in addition to Specialty Farms' July 29 2010 recall.  To date, no illnesses have been reported as being linked to the potentially contaminated product.

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Contaminated well water from a resort near Hebgen Lake (near West Yellowstone, Montana) is being blamed for the stomach and intestinal maladies plaguing more than 80 people, public health officials said Friday. The Montana Department of Public Health and Human Services has confirmed 14 cases of campylobacter illness, a common GI ailment that can cause diarrhea, cramping, abdominal pain and fever.  At least 70 more cases are probably caused by the same bacteria, the officials said.

"(Campylobacter) is one of the most common, if not the most common, gastrointestinal illnesses in the U.S.," said Matt Kelley, health officer for the Gallatin City-County Health Department. "What was unusual about this one was we were seeing over a dozen, maybe two-dozen cases (last) Thursday and Friday."

Officials think contaminated water from one of two wells at the Campfire Lodge Resort, located outside West Yellowstone, is to blame. The suspect well has been shut off, and the resort's restaurant has been closed, Kelley said, and a boil water order has been issued.

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Yesterday, along with Gary Newland, a Chicago-area personal injury lawyer, we filed suit on behalf of Anita Fowler for a foodpoisoning illness that she developed after eating at a wedding reception held at Di Nolfo's banquet hall in Mokena, Illinois.  Will County health officials are investigating a number of illnesses (reports of more than 50 people sickened) that are apparently linked to the outbreak.  At least one person has tested positive for norovirus, which would seem to fit under the circumstances of this large outbreak.  Multiple people required hospitalization for treatment of their illnesses.

Norovirus;

The Centers for Disease Control and Prevention (CDC) estimates that noroviruses cause 23 million cases of acute gastroenteritis annually, making noroviruses the leading cause of gastroenteritis in the United States (CDC, 2006; Fankhauser, et al., 2002; Mead, et al., 1999). Of viruses, only the common cold is reported more often than viral gastroenteritis (norovirus) (Benson & Merano, 1998).

Nature has created an ingenious bug in norovirus. The round blue ball structure of norovirus is actually a protein surrounding the virus’s genetic material. The virus attaches to the outside of cells lining the intestine, and then transfers its genetic material into those cells. Once the genetic material has been transferred, norovirus reproduces, finally killing the human cells and releasing new copies of itself that attach to more cells of the intestine’s lining.
 

Transmission of Norovirus:

Noroviruses are transmitted primarily through the fecal-oral route, and fewer than 100 norovirus particles are said to be needed to cause infection (MMWR, 2001, June 1).

Transmission occurs either person-to-person or through contamination of food or water. Foodborne norovirus transmission can occur when food is contaminated by an infected food handler (Caceres, et al., 1998; MMWR, 2001, June 1).

Noroviruses are recognized as causing over half of all foodborne illness outbreaks. CDC statistics show that food is the most common vehicle of transmission for noroviruses; of 232 outbreaks of norovirus between July 1997 and June 2000, 57% were foodborne, 16% were spread from person-to-person, and 3% were waterborne (CDC, 2006, August 3).

The virus is shed in large numbers in the vomit and stool of infected individuals, most commonly while they are ill. Some individuals may, however, continue to shed norovirus long after they have recovered from the illness (Patterson, 1993). Aerosolized vomit has also been implicated as a mode of norovirus transmission (Marks, et al., 2000).

As noted by the CDC in its Final Trip Report, “noroviruses can cause extended outbreaks because of their high infectivity, persistence in the environment, resistance to common disinfectants, and difficulty in controlling their transmission through routine sanitary measures” (MMWR, 2001, June 1).
 

Symptoms of Norovirus Infection:

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 (CDC, 2006, August 3). People infected with norovirus usually recover in two to three days without serious or long-term health effects.

In some cases, 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 (Mayo Clinic, 2007, April 5).

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More than 100 food safety reports were submitted by industry to the U.S. Food and Drug Administration’s new electronic portal in its first months of operation, the agency said today.

Mandated by Congress, the Reportable Food Registry (the Registry) is a new system that requires manufacturers, processors, packers and distributors to immediately report to the government safety problems with food and animal feed, including pet food, that are likely to result in serious health consequences.

“The FDA’s new reporting system has already proven itself an invaluable tool to help prevent contaminated food from reaching the public,” said FDA Deputy Commissioner for Foods Michael R. Taylor.

A report summarizing the Registry’s first seven months of operation (September 2009 -March 2010) finds that it logged 125 primary reports – initial reports about a safety concern with a food or animal feed (including food ingredients) – and 1,638 subsequent reports from suppliers or recipients of a food or feed for which a primary report had been submitted, from both domestic and foreign sources. These reports help FDA and the food industry locate hazardous foods in the supply chain and prevent them from reaching consumers.

Two notable reports first identified through the Registry prompted the following:

*  A February 2010 recall of hydrolyzed vegetable protein (HVP), without any report of illness. More than 1,000 industry reports specifically for products containing HVP, resulted in the removal of 177 products from commerce.

*  A November 2009 recall of products containing sulfites but not labeled as such. More than 100 reports regarding the inadvertent use of an ingredient containing sulfites in two nationally distributed prepared side dishes that were not labeled as containing sulfites resulted in their removal without any reports of illness.

Among the 125 primary reports, Salmonella accounted for 37 percent of hazards, undeclared allergens or intolerances accounted for 35 percent, and Listeria monocytogenes accounted for 13 percent. Among the 11 different commodity categories involved were: 14 animal feed or pet food, 12 seafood, 11 spices and seasonings, and 10 dairy products. Because the Registry has been operational for only a short period, it is too early to draw inferences concerning patterns of food and feed adulteration.

“Industry is increasingly detecting contamination incidents through its own testing, and FDA access to this information permits us to better target our inspection resources and verify that appropriate corrective measures have been taken,” Taylor said. “Ensuring that the American food supply is safe is a top priority of the FDA, and the Reportable Food Registry strengthens our ability to help prevent foodborne illness.”

Under legislation enacted in 2007 that created the Registry, industry must report foods or feeds that present a reasonable probability of serious adverse health consequences or death to humans or animals to the FDA within 24 hours. The law does not apply to infant formula or dietary supplements, which are covered by other mandatory reporting systems. The Registry does not receive reports about drugs or other medical products, reports about products under the exclusive jurisdiction of the U.S. Department of Agriculture, or reports from consumers.

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A food poisoning lawsuit was filed yesterday against Di Nolfo’s Banquet Inn and Catering Service after a wedding guest fell seriously ill from contaminated food. Food safety law firm Marler Clark and Newland, Newland and Newland of Arlington Heights filed the lawsuit on behalf of Griffith, Indiana resident Anita Fowler in a Will County Court.

Ms. Fowler attended a wedding reception at the Di Nolfo facility at 9425 W. 191 Street in Mokena, IL on July 17. The next day she began to experience food poisoning symptoms including abdominal cramps, nausea, vomiting, diarrhea, fever and chills. When her symptoms worsened over the next several days, she had to seek medical attention for severe dehydration and other medical problems resulting from her infection. She continues to recover from her illness.

Food poisoning outbreaks sourced from small restaurants, caterers, and home-prepared foods have been underreported for many years. However, the Centers for Disease Control and Prevention (CDC) recently released a study that documented 7,921 outbreaks involving food prepared in a restaurant/deli (101,907 illnesses, 3,309 hospitalizations, and 4 deaths) as well as 833 outbreaks involving food prepared by a caterer (29,738 illnesses, 345 hospitalizations, and 4 deaths). Food prepared in a private home was responsible for 1,546 reported outbreaks (22,600 illnesses, 1395 hospitalizations, 21 deaths).
 

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Steve Mills, a reporter with the Chicago Tribune and frequent contributor to the national food safety dialogue, wrote an excellent analysis of post-recall risks to consumer health for today's edition of the Tribune.  The problem:  equal parts stores not getting recalled products off of shelves, manufacturers not being able to retrieve recalled product, and consumers not getting word that a product has been recalled. 

In addition to the ConAgra pot pie Salmonella outbreak in 2007, Mills highlights several major outbreaks and/or recalls that have occurred in the last several years:

In 2009, for instance, when the U.S. Department of Agriculture was involved in 59 recalls in which the amount of food sought and recovered was known, 56 came up short of the amount they identified as potentially tainted or produced at a time when factory controls were lax.

Two of those efforts highlight how far short recalls can fall. Last July a Denver processor announced a recall of more than 460,000 pounds of ground beef tied to a salmonella outbreak but recovered only 119,000 pounds. In October a New York processor announced a recall of 545,000 pounds of ground beef tied to an outbreak of E. coli; it recovered 795 pounds, according to the USDA.With today's global distribution, this is a problem

To put a finer point on it, in the 2007 ConAgra pot pie salmonella outbreak that ultimately sickened over 400 people with confirmed illnesses, the CDC found that many, many people became ill after the recall was announced.  Here is a chart that shows how many became ill before and after the recall announcement:

Another situation that warrants mention is the 2010 ConAgra (actually, Marie Callendar's brand) cheesy chicken and rice frozen entree Salmonella outbreak and recall.  In a June 2010 press release, the Oregon Department of Health announced concern that retailers had not yet removed all recalled product from store shelves.  The statement read:

Public health officials repeated today that an outbreak of salmonellosis has been linked to a boxed frozen entrée product manufactured by ConAgra Foods, Inc. under the Marie Callender label. The Cheesy Chicken & Rice item has been identified as the likely source of the outbreak, which has sickened at least 30 people in 15 states. Health officials worry that the entrée has not have been removed from grocery store shelves. Consumers may also still have the product in their freezers.

“We’re concerned that people and some retailers may not have gotten this information,” said Emilio DeBess, a senior epidemiologist at the Oregon Public Health Division. “This product was sold at grocery stores throughout Oregon and elsewhere. Consumers who have any of the Cheesy Chicken & Rice entrées in their home freezers need to throw them out or return them to the store. Retailers that have this product in their stores need to get them out of circulation immediately.

"Oregon Department of Agriculture inspectors checked in a number of stores on Tuesday and found the recalled product still available in a limited number of stores," DeBess added. "To protect consumers, store managers need to be vigilant about responding to recall notices."

As with many problems that we currently face in our food supply, this one is particularly potent in large part because of the nature of our production and distribution systems.  But despite the wider audience for these problems due to books like The Omnivore's Dilemma and movies like Food, Inc., it's a problem that's not going away.  Bottom line is that manufacturers and retailers need to improve traceability and their dedication to the public health measure of actually making sure that information about recalls actually reaches consumers. 

Moreover, this is a discussion that is not only long overdue (see 2007 ConAgra pot pie outbreak), but has been raised multiple times before.  Phyllis Entis, at effoodalert.com recently made several recommendations to address the problem:

1.  Provide a retail distribution list for all recalls. The list should include food service outlets, restaurants, cafés, and institutional kitchens – not just retail stores.

2.  Require retail stores to post a prominent recall notice on the store shelf or refrigerator/freezer where the recalled product is typically displayed. This is already done in some countries, including the United Kingdom.

3.  Fine retailers who ignore recall notices and neglect to remove recalled products from sale. This has been done in Australia.

4.  Post on FDA and USDA web sites in a timely fashion the reports for all inspections during which "significant violations" or "significant deviations" were noted (FDA does this selectively, based on its perception of the public's interest in the results of specific inspections).

5.  Post on FDA and USDA web sites in a timely fashion all Warning Letters and other enforcement actions taken (FDA posts Warning Letters, although not always timely).

I would also add a report back requirement for retailers--i.e. that the retailer must report back to (agency/recalling company) within a certain number of days of receiving notice of a recall through dedicated channels, plus fines for each day that the retailer does not report back as required.  Something for the FDA to consider when the Food Safety Modernization Act is finally passed. 

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Pasco Processing Corn and Poblano Peppers Recall:

Pasco Processing, LLC, of Pasco WA, recently recalled 2087 cases of 20lb. bulk packaged Corn and Poblano peppers, (SKU 10071179017738) because the products might be contaminated by Listeria monocytogenes. No illnesses have been reported in association with the recall, and no other products that were manufactured by Pasco Processing, LLC are involved in the recall.

The recall is based upon tests on finished, retail samples that were positive for Listeria.  The recall extends only to products coded 3901741007 and 3901751007 sold to two foodservice distributors in California and one in Arizona and further distributed to Chipotle Mexican Grill Restaurant locations in California, Nevada, and Arizona.

The recalled products are labeled as follows:

Corn and Poblano Blend; 10071179 017738; 20 lbs. Net Wt.; Distributed by J. R. Simplot Co., Boise, Idaho 83707
 

Specialty Farms Sprouts Recall:

Specialty-Farms, LLC recently recalled Specialty Farms brand Organic Alfalfa Sprouts Blend and Organic Sprout Salad, also due to contamination by Listeria monocytogenes. These items both have a "sell-by date of 7/26/2010" and are net weight 4 ounces in plastic containers:

BRAND ITEM DESCRIPTION UPC:

Specialty Farms Organic Alfalfa Sprouts Blend 8192400108
Specialty Farms Organic Sprout Salad 8192400024

Specialty-Farms, LLC voluntarily recalled sprouts on July 23, 2010 after laboratory analysis found positive results from one retail sample.
 

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Public Health Departments in Linn and Johnson counties in Iowa have warned the public not to  eat guacamole, salsa or uncooked tamales prepared by an area Mexican restaurant called La Reyna Supermarket and Taqueria, and served at area farmer's markets.  The products may be contaminated by Salmonella, and are suspected to be associated with approximately 28 recent cases of Salmonellosis. 

The products were sold at farmer's markets in Iowa City, Coralville, Cedar Rapids and Dubuque, as well as the Waterfront Drive Hy-Vee, New Pioneer Co-op in Iowa City and Coralville and the Iowa City Jazz Festival.

According to the health departments' release, the salmonella investigation was initiated by Linn County Public Health and illnesses were traced to the products made by La Reyna. In working with the Johnson County Department of Public Health, officials determined La Reyna's products could be the source of the illness.

Ironic timing for the La Reyna outbreak, given that the CDC very recently announced a study that found that nearly one out of every 25 restaurant-related outbreaks that occurred between 1998 and 2008 was traced back to salsa or guacamole. The CDC also found that there were no salsa or guacamole-linked outbreaks reported before 1984. The CDC reported that:

*  Out of 136 salsa or guacamole outbreaks, 84% occurred in restaurants and delis.

*  Salsa and guacamole outbreaks accounted for 1.5% of all food establishment outbreaks between 1984 and 1987; that figured jumped to 3.9% between 1998 and 2008.

*  Poor storage, such as temperature, were reported in nearly one third of the salsa and guacamole outbreaks.

*  Food workers were the source of contamination in 20% of the restaurant outbreaks.

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At the risk of jinxing the apparent success, it is worthy of note that, excluding the recent problem with bison meat, ground beef and other beef products have been conspicuously absent from the news this summer.  This is a significant step for an industry that collectively recalled millions of pounds of meat products in 2007, 2008, and 2009 due to E. coli O157:H7 contamination.  Hopefully the success is not pure luck or chance, but is instead attributable to meaningful manufacturing advances that have truly helped to reduce the bacterial load on retail meat products. 

To be more specific, the FSIS-USDA website contains reference to only two summer beef product recalls.  The first was a June 22 recall by Crown I Enterprises from NY of about 3,700 pounds of ground beef.  The second was a June 23 recall by South Gate Meat Co from CA of 35,000 pounds of ground beef. 

Compared to recent years, only two summer recalls totalling just under 40,000 pounds of product--particularly when the recalls were not known to be associated with any illnesses--is progress indeed.  In 2007, beef companies recalled over twenty-nine million pounds of meat, including Cargill's recall of nearly one million pounds of hamburger patties, one of which sickened Stephanie Smith. 2008 saw at least sixteen recalls of beef products, totaling at least 2,361,295 pounds of meat. And in 2009, beef companies recalled almost 2 million pounds of meat due to various contamination and processing problems.

(Notably, the year began very poorly for meat.  Winco, Beltex Meat Co, Montclair Meat Co., Huntington Meat Co, and several other businesses recalled over 5,000,000 pounds of meat products from January through May.)

Is the apparent success really progress?  Or is it simply too good to be true?  We've got another month and a half of summer left in Seattle; a little longer most other places.  If the apparent success really is success, maybe Marler Clark will represent no HUS  victims sickened in the summer by ground beef products for the first time in a long time. 

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Don't let another national outbreak be the reason that a final vote on the Food Safety Modernization Act is had.  That's why continued pressure on the powers that be is a good thing.  Congressman John D. Dingell (D-MI) wrote the following letter to Senator Dianne Feinstein (D-CA) calling on her to stop blocking a vote on food safety legislation in the Senate. Dingell is the author of H.R. 2749, the “Food Safety Enhancement Act,” which passed the U.S. House overwhelmingly with bipartisan support almost a year ago.

The Honorable Dianne Feinstein
United States Senate
331 Hart Senate Office Building
Washington, D.C. 20510

Dear Senator Feinstein:

I am writing to express deep concern with the lack of progress being made in the United States Senate on critical food safety legislation. My concern stems from recent press accounts detailing the cause of delay on Senate consideration of S. 510, the Food Safety Modernization Act. Recent press accounts, including a July 11 Washington Post article titled Advocates Run Ads Urging Senate to Pass Food Safety Bill, indicate the cause for delayed consideration is your insistence on adding controversial language to the bill that would ban the use of bisphenol A (BPA) in food and beverage containers. While I am sensitive to your goals and believe that your intentions are virtuous, I respectfully ask that you reconsider your current obstruction on this issue and find a suitable compromise that would allow prompt consideration of critically needed food safety legislation.

As you may know, I am the author of H.R. 2749, the Food Safety Enhancement Act, comprehensive food safety legislation that will grant the Food and Drug Administration (FDA) the authorities necessary to ensure the safety of the nation's food supply. The case for food safety legislation has been made--each year approximately 76 million illnesses occur, more than 300,000 persons are hospitalized, and 5,000 die from foodborne illness. The urgency for a legislative solution is renewed with each new outbreak of illness from bad food. While not a companion measure, S. 510 includes many of the same authorities included in my legislation. H.R. 2749 passed the House in November 2009 overwhelmingly, with bipartisan support. Both bills will make the greatest improvements to food and drug law since 1938 and will save the lives of thousands of Americans.

There has been much debate over the years on the safety of the use of BPA in food and beverage containers. The topic invokes passionate reactions on both ends of the spectrum. FDA, the regulatory agency with the scientific expertise to responsibly weigh the risks and benefits of the use of BPA, has expressed some concern about the potential effects of BPA on the brain, behavior, and prostate gland in fetuses, infants, and young children. FDA is pursuing additional studies and is seeking public input and input from other expert agencies to provide greater clarity on potential health effects of exposure to BPA. I share their concern and worked with my colleagues in the House to include language in H.R. 2749 that reflects this concern.

I implore you to not allow the perfect be the enemy of the good. Time is running out. Our choices are becoming increasingly

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County health officials in Erie, Pennsylvania say that Salmonella was the pathogen that sickened 26 of 42 crew members aboard the U.S. Brig Niagara, a historic sailing ship based on Lake Erie, according to this report:

Health department officials say it's unclear how the ship's crew contracted the bacteria, which often is found in spoiled or undercooked food.The sickness forced the ship to cancel two fundraising events over the weekend and to cut short a visit to a tall ships festival in Cleveland.
 

The crew has  reportedly recovered, however, and set sail for a new tour of the Great Lakes.  The U.S. Niagara is a replica of a ship used in the defeat of British forces in the War of 1812.  There do not currently appear to be any reports of non-crew members falling ill.

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Skokie Country Club in Glencoe, Illinois was the site of a large salmonella outbreak--approximately 45 laboratory confirmed cases--in June 2010.  Katie Okon at Pioneer Local reports that the club kitchen is now open and back in service, having been given the green light to reopen by Cook County health officials in early July.   after a salmonella outbreak that occurred at the end of last month.

Skokie Country Club's salmonella outbreak caused 9 people to be hospitalized, at least amongst the 45 confirmed cases.  At one time in the investigation, health officials indicated that as many as 50 other illnesses were thought to be linked.  Ultimately, Cook County health officials were unable to track the source of the outbreak down to a specific food item. 

Skokie's salmonella outbreak is just one of several major foodpoisoning outbreaks to have hit the State of Illinois in 2010.  In May and early June 2010, Subway restaurants in 28 Illinois counties were linked to 103 confirmed Salmonella illnesses. Of the confirmed illnesses, 26 people had to be hospitalized. The strain of Salmonella involved in the outbreak is called Hvittingfoss, which is an extremely rare strain of Salmonella typically seen in Illinois only once or twice a year.

The 28 counties having Subway restaurants associated with confirmed Salmonella illnesses are Bureau, Cass, Champaign, Christian, Coles, Dekalb, DeWitt, Fulton, Henry, Kane, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Rock Island, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Will and Winnebago. Illnesses are reported to have started between May 14 and May 25 and cases range in age from six-years to 79-years-old.

The CDC estimates that for every confirmed case of Salmonella infection, another 38.6 cases go unreported. In order for a case to be confirmed, a sick person has to visit their health care practitioner and get a stool test. A positive result is then sent on to the health department, which matches the test to the outbreak strain to see if it is part of the outbreak, or a separate case of Salmonella. Many people try to “tough it out”, and don’t get tested, therefore there cases are never counted. The current outbreak of Salmonella Hvittingfoss probably has more than 3000 people sick.

And on March 4, 2010, a Subway restaurant in Lombard, Illinois closed in the midst of a large Shigella outbreak that ultimately caused at least 125 confirmed illnesses, and likely hundreds of other illnesses. The restaurant remained closed for over a month during the Dupage County health department's investigation. The results of Dupage County's investigation have not yet been disclosed, but it is widely suspected that cross-contamination by ill employees was a cause of the outbreak.

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Marler Clark represents several people sickened by Salmonella enteritidis in an outbreak linked to Baker Street Restaurant and Pub in Kenosha, Wisconsin.  The outbreak has reportedly sickened 30 patrons.  A lawsuit will be filed tomorrow against L & K Tricoli, LLC, which owns and operates Baker Street Restaurant and Pub, on behalf of Tanja Dzinovic.

The Kenosha County Health Department has closed Baker Street Restaurant and Pub, pending its investigation into the outbreak.  The health department is also actively testing restaurant employees, before clearing them to return to work.

 

Ms. Dzinovic ate at the Baker Street Restaurant and Pub in Kenosha on Friday, June 18. On Monday, she woke with severe abdominal cramps and diarrhea. By Wednesday, her symptoms were so severe she went to the hospital for treatment, where it was determined that she had been infected with Salmonella enteritidis. Her Salmonella was later linked to the Baker Street Restaurant outbreak. She continues to recover from her illness.

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Nobody likes turbulence at 35,000 feet, but some level of risk is always present when you're in the sky.  But not all risks while flying are beyond the reasonable control of those in charge of our safety.  A few weeks ago, Gary Stoller of the USA Today wrote a piece on airline food safety, focusing on the industry's major carriers, including Gate Gourmet and LSG Sky Chefs:

USA TODAY requested inspection reports since January 2009 for the two biggest airline caterers, LSG Sky Chefs and Gate Gourmet, and a third large caterer, Flying Food Group. Combined, the three companies have 91 kitchens preparing in-flight food for many big U.S. and foreign airlines at U.S. airports.

As of Friday, the FDA's regional offices had sent reports for 46 facilities. At 27 of them, FDA inspectors noticed suspected food-preparation violations or objectionable practices. Among them:

•An FDA inspector spotted a mouse, rodent nesting materials and rodent feces under a pallet of food and in other areas at LSG Sky Chefs' Minneapolis facility during a May 2009 inspection.

•The Dulles, Va., facility of Gate Gourmet, the second-largest caterer in the USA, failed to keep shrimp, filet mignon, Chilean sea bass, chicken and vegetables, and pastrami and cheese sandwiches at the proper temperature during an inspection in August. When an inspector mentioned the unsafe practice to company personnel, the shrimp and the pastrami and cheese sandwiches were not thrown in the garbage.

Employees with "unclean hands" were handling food. A lab report found a "high coliform count" in rice.

•At Gate Gourmet's San Diego facility in November, the director of operations said the company would cook any food to an airline's specification without regard to food safety guidelines, an FDA inspector wrote. He also wrote that a Gate Gourmet official said the company doesn't verify if food is from approved sources or frozen for "parasite destruction." Raw meats aren't cooked to adequate temperatures — a repeat violation that was also cited in 2008.

•A Los Angeles facility of Flying Food Group had a corroded and taped ice-machine door that failed to "hold ingredients in bulk or in suitable containers to protect against contamination," an inspector wrote in an April report
 

More on LSG Sky Chefs:

In December 2009, the FDA issued a warning letter to LSG Sky Chefs concerning its Denver catering facilty.  The letter began by withdrawing the facility's "approved" status, and giving it a "provisional" designation.  The letter also informed LSG that its customers would be notified of the change in status (incidentally, i've probably flown through Denver 10 times since December and have never been informed, but then again, I don't read the small print on my tickets). 

The change in status occurred because of the FDA's findings in a 2009 investigation of the facility.  Among the list of horribles were the following violations:

• Cart wash area - Live and dead roach-like insects too numerous to count (TNTC)
• Silverware station - At least 40 live roaches as well as other insects
• The hot kitchen - At least eight dead and one live roach insects were observed in and around the walls of the hot kitchen
• Repack area - Live roaches (TNTC), as well as ants
• Pots and pans warewashing room - At least four live and dead roaches, flies
• Dish machine wash area - At least 13 dead roaches inside the machine loading area and 31 or more dead nearby the machine
• Wash area - At least four live roaches on walls and floors 

Listeria monocytogenes was also found in a floor drain at the LSG facility. 

Maybe they are comforted by the difficult epidemiological circumstances--i.e. the improbability of airline outbreaks being discovered--posed by people becoming infected and then traveling all over the country, or the world, thus frustrating public health surveillance efforts.  Whatever the case, the reports have not been good on the sanitation at airline catering facilities.  Airline food wasn't very good to begin with, but the companies that provide it certianly need to clean up their acts, quite literally.

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The Boulder County Public Health Department has cleared the Billy Goat Dairy, a Longmont goat dairy that produces and distributes raw milk, to resume business after a recent inspection confirmed that owner Bill Campbell had addressed the County's concerns and/or suggestions.  The dairy was the source of a large E. coli O157:H7 and campylobacter outbreak in June and early July that caused as many as 30 confirmed illnesses.  Two children were sickened critically, requiring hospitalization at Children's Hospital in Aurora. 

John Fryar of the Longmont Times reports as follows:

Carol McInnes, an environmental health specialist with the county department, made an on-site visit Wednesday afternoon to verify that Campbell had completed those steps. Campbell “has done everything he needs to do” to meet the county’s conditions for resuming raw-milk distributions, McInnes said, and she reported finding nothing that caused her to think there’d be any “imminent public health threat.”

“He has the go-ahead from us,” she said.

Campbell, however, said Wednesday night that it will probably be next week — possibly Thursday — before he’ll be ready for people to start picking up their raw-milk supplies again from Billy Goat’s dairy herd. “I have some things of my own I want to get done” first, Campbell said, to be able to assure the 45 households having goat-sharing ownership that the milk they’re getting is safe. He said that includes the final results he’s awaiting from tests he commissioned two independent laboratories to analyze, results he said he’ll post and explain to shareholders.

The Billy Goat Dairy distributes milk under a goat-share, or herd-share, agreement between the dairy and customers, or "owners," because the sale of raw milk is illegal in the State of Colorado.  Distribution by virtue of these legal fictions--legal fictions, according to some--is permissible, however.  Some states have also acted to restrict the distribution of raw milk even through herd-share agreements.

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Earlier today, Fresh Express, an industry leader in food safety, recalled romaine-based salad products due to potential contamination by E. coli O157:H7.  The recall applies largely to products distributed in Canada, but some of the recalled products were also apparently distributed to retail outlets in South Dakota.  The recall was prompted by tests on Fresh Express product that revealed positive tests for E. coli O157:H7. 

Here is a summary of several other produce-related recalls and outbreaks, excluding the current Fresh Express recall, that have occurred since April 2010. 

Fresh Express lettuce and Salmonella

Fresh Express lettuce products caused a Salmonella outbreak in the “Upper-Midwest” in late April or early May 2010. Not much is known about this outbreak, at least publicly, because the health organizations involved in the investigation did not publicly reveal that the outbreak had occurred.

Several weeks after the outbreak, however, Fresh Express recalled several types of ready-to-eat salads after Salmonella was found in a package tested by the U.S. Food and Drug Administration. The recalled products included lettuce mixes, Caesar salad and other salad kits, hearts of romaine and other items. The recall extended to products sold in 26 states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

Organicgirl Baby Spinach Recall:

Also in May 2010, Organicgirl Produce recalled a limited number of cases of 10 oz organicgirl Baby Spinach with an expired Use-by Date of May 22 and Product Code 11A061167 due to potential Salmonella contamination. The recall included only 336 cases of the 10 oz. package size of organicgirl Baby Spinach sold in six states: Alabama, North Carolina, Oregon, Wisconsin, Arizona and California. Like the Fresh Express recall, Organicgirl recalled the baby spinach products due to a positive test for Salmonella in a random sample test collected and conducted by a third-party laboratory for the U.S. Food and Drug Administration.
 

Caldwell Sprouts Salmonella Newport Outbreak:

As of early June, at least 35 individuals had been infected with a matching strain of Salmonella Newport in 11 states after consuming raw alfalfa sprouts manufactured by Caldwell Fresh Foods of Maywood, CA. The number of ill people identified in each state with this strain is as follows: AZ (2), CA (17), CO (1), ID (5), IL (1), MO (1), NM (1), NV (2), OR (2), PA (1), and WI (2). Among those for whom information is available about when symptoms started, illnesses began between March 1, 2010 and May 16, 2010. Case-patients range in age from <1 to 75 years old, and the median age is 36 years. Sixty-six percent of patients are female. Among the 30 patients with available hospitalization information, 7 (23%) were hospitalized. No deaths have been reported.
 

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Yesterday, we reported on a developing Salmonella outbreak in Kenosha County, Wisconsin.  It was reported yesterday that the outbreak was possibly linked to food served at the Baker Street Restaurant and Pub, which the County Health Department has shut down.  Today, the Kenosha County Health Department has reported that the outbreak has caused 26 confirmed Salmonella illnesses, although there has been no official statement on what the cause or source of the outbreak is. 

About Salmonella

Salmonella is a bacterium that causes one of the most common enteric (intestinal) infections in the United States – Salmonellosis. In some states (e.g. Georgia, Maryland), salmonellosis is the most commonly reported cause of enteric disease, and overall it is the second most common bacterial foodborne illness reported (usually slightly less frequent than Campylobacter infection).

The reported incidence of Salmonella illnesses is about 14 cases per each 100,000 persons (MMWR Weekly, 2006), amounting to approximately 30,000 confirmed cases of salmonellosis yearly in the U.S. (CDC, 2005, October 13). In 2005, just over 36,000 cases were reported from public health laboratories across the nation, representing a 12 percent decrease compared with the previous decade, but a 1.5 percent increase over 2004 (CDC, 2007).

As only about 3 percent of Salmonella cases are officially reported nationwide, and many milder cases are never diagnosed, the true incidence is undoubtedly much higher (Mead, 1999). The CDC estimates that 1.4 million cases occur annually (CDC, 2005, October 13). Approximately 600 deaths are caused by Salmonella infections in the U.S. every year, accounting for 31 percent of all food-related deaths (CDC, 2005, October 13; MMWR Weekly, 2001).
 

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The Canadian Food Inspection Agency (CFIA) is warning the public not to consume the Fresh Express brand Romaine-based Salads described below because these products may be contaminated with E. coli O157:H7. This CFIA alert has been initiated in response to a recall by the manufacturer, Fresh Express Incorporated, of Salinas, California in the United States.

The following Fresh Express brand Romaine-based Salads which have Best Before dates of July 9 through July 12 and an "S" in the product code are affected by this alert.  The information below includes a description of the recalled products, product size, UPC code, and best before or "best by" date:

---------------------------------------------------------------------------
0 71279
Double Carrots 340 g 10802 5 S175 July 10, 2010
---------------------------------------------------------------------------
0 71279
Green & Crisp 340 g 10804 9 S175 July 10, 2010
---------------------------------------------------------------------------
0 71279
Premium Romaine 255 g 10808 7 S175 July 10, 2010
---------------------------------------------------------------------------
0 71279
Lettuce Trio 255 g 10809 4 S175 July 10, 2010
---------------------------------------------------------------------------
0 71279 July 10-11,
Italian 283 g 21100 8 S175, S176 2010
---------------------------------------------------------------------------
0 71279 July 9-10,
Fancy Greens 198 g 23201 0 S174, S175 2010
---------------------------------------------------------------------------
0 71279 July 11-12,
American 340 g 24100 5 S175, S176 2010
---------------------------------------------------------------------------
0 71279
5-Lettuce Mix 170 g 25101 1 S175 July 9, 2010
---------------------------------------------------------------------------
0 71279 July 10-11,
Hearts of Romaine 283 g 26102 7 S175, S176 2010
---------------------------------------------------------------------------
0 71279 July 10-11,
Triple Hearts 226 g 26111 9 S175, S176 2010
---------------------------------------------------------------------------
0 71279
Leafy Green Romaine 255 g 26112 6 S175 July 10, 2010
---------------------------------------------------------------------------
0 71279
Veggie Lover's 340 g 28100 1 S175 July 10, 2010
---------------------------------------------------------------------------
212 g + 0 71279 July 10-11,
Caesar Complete Salad 74 mL 30100 6 S175, S176 2010
---------------------------------------------------------------------------
212 g + 0 71279 July 10-11,
CaesarLite Complete Salad 74 mL 30101 3 S175, S176 2010
---------------------------------------------------------------------------
Caesar Supreme Complete 226 g + 0 71279 July 10-11,
Salad 81 mL 30104 4 S175, S176 2010
---------------------------------------------------------------------------
B.L.T. Caesar Complete 226 g + 0 71279
Salad 74 mL 30107 5 S175 July 10, 2010
---------------------------------------------------------------------------
Asian Supreme Complete 323 g + 0 71279 July 10-11,
Salad 74 mL 30201 0 S175, S176 2010
---------------------------------------------------------------------------
Salsa! Ensalada Supreme 326 g + 0 71279
Complete Salad 74 mL 30601 8 S175 July 10, 2010
---------------------------------------------------------------------------

The Use-By Date is found in the upper right hand corner of the package with the product code immediately underneath. These products have been distributed in Alberta, British Columbia, Manitoba, Ontario and Quebec and may have been distributed nationally.

There have been no reported illnesses associated with the consumption of these products.
 

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WISHTV.com reports that two Rush County Indiana children are in critical children after contracting E. coli infections.  Almost certainly these two children are suffering from hemolytic uremic syndrome, or HUS.  There is some suspicion that the two children may have become infected at the Rush County Fair petting zoo in late June, although the proof of that link is not clear based on the reports. 

According to WISH TV:

Kathleen Ragan, 4, is at the Peyton Manning Children's Hospital suffering from Hemolytic Uremic Syndrome. "With the HUS, her kidneys have still not started functioning correctly," says Kathleen's mother, Angel Campbell-Ragan. "She's still on the dialysis."

Kathleen's mother says she did use hand sanitizer as she petted animals there, but her symptoms of fatigue, diarrhea and bloody stools started the day after the fair ended.

The parent of at least one other Rush County child said that her boy is also suffering from HUS, but he wasn't at the fair. 

About hemolytic uremic syndrome

The chain of events leading to HUS begins with ingestion of shiga toxin producing E. coli (including E. coli O157:H7) in contaminated food, beverages, person to person, or animal to person transmission.

These E. coli rapidly multiply in the intestine causing colitis (diarrhea), and tightly bind to cells that line the large intestine. This snug attachment facilitates absorption of the toxin into the intestinal capillaries and into the systemic circulation where it becomes attached to weak receptors on white blood cells (WBC) thus allowing the toxin to “ride piggyback” to the kidneys where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin.

Organ injury is primarily a function of Gb3 receptor location and density. Receptors are probably heterogeneously distributed in the major body organs, and this may explain why some patients develop injury in other organs (e.g., brain, pancreas).
Once Stx attaches to receptors, it moves into the cell’s cytoplasm where it shuts down the cells’ protein machinery resulting in cellular injury and/or death. This cellular injury activates blood platelets and the coagulation cascade, which results in the formation of clots in the very small vessels of the kidney, resulting in acute kidney injury and failure.

The red blood cells undergo hemolytic destruction by Stx and/or damage as they attempt to pass through partially obstructed microvessels. Blood platelets (required for normal blood clotting), are trapped in the tiny blood clots or are damaged and destroyed by the spleen.

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Kenosha News online reports that a Salmonella outbreak has occurred at a County restaurant called the Baker Street Restaurant & Pub at 6208 Green Bay Road.  The health department has temporarily shut the restaurant down.    

Tricoli Restaurants, which owns the Baker Street Restaurant & Pub has taken a novel approach to public relations in the wake of the outbreak . . . apparently complete honesty.  The Kenosha News article quotes Tom Stemple, an employee of Tricoli Restaurants, acknowledging despite the health department's reluctance to say why it has closed the restaurant down, "that 10 to 18 people who ate at the restaurant were sick with the bacterial infection and owner Lou Tricoli was contacting all of his Baker Street employees to get them tested for salmonella poisoning."

My guess is that Tom Stemple's approach will probably save his company some money, earned in goodwill, by preventing his ill customers from calling us.  Stemple also said, referring to Tricoli Restaurant's owner, “He’s gathering everyone together, trying to interview them to help find out the source of this.  He’s trying to sort things out so that he can help protect everyone —his employees and the public.”

My only advice is to also allow the health department to do its job, and investigate the cause of the outbreak on its own.  In any event, and regardless of Tricoli Restaurants PR strategy, this is another in a long list of Salmonella outbreaks that have occurred this year.  See Salmonella:  the year in review . . . so far. 

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The Daily Record today reported on the E. coli illness of a 5 year old Ellensburg, Washington resident named Asher Campbell.  Fortunately, Asher did not develop hemolytic uremic syndrome (HUS), or the story's conclusion may have been much different.  But the young boy's story is testament to what life can be like for a child suffering even an "ordinary" E. coli illness.

Before getting to Asher's story, however, it is worthy of note that Ellensburg, Washington has been the site of a significant outbreak of E. coli illnesses in recent weeks, affecting mostly children and families at area daycares.  Interstingly, it was just announced that the strain of E. coli involved in the outbreak was not the infamous E. coli O157:H7.  It was E. coli O26, which can be equally devastating, and can also cause HUS.  The article is a little vague on whether Asher contracted E. coli O157 or O26; if the latter was the case, clearly the young boy has some relationship to the E. coli outbreak associated with area daycares.

From Chelsea Krotzer at the Daily Record: 

On June 14, the family of four attended a potluck hosted by Central Washington University. The event was hosted off campus.

"What we thought, after thinking about it, was Asher didn't eat that much besides fruit and potato chips," Ian said. Both parents think the fruit was most likely the culprit.

Three days after the event, Asher began having digestive problems. Two days later, what began as minor discomfort transformed into excruciating pain.

"It's the worst pain we've ever seen him in," Ian said. "He was screaming at the top of his lungs."

Health officials haven't officially pinpointed a source of the E. coli, and say they might never know the origin.

After seeking advice from their family doctor, the Campbells took Asher to the hospital, where he was kept overnight. Asher was diagnosed with the O157 strain of E. coli.

The doctor's advice: leave it alone. With no treatment options other than children's Tylenol, doctors told the Campbells they would have to wait it out.

"It was really scary," Erin said. "It was scary when we didn't know what it was and it was scary when we found out what it was."

While in the hospital, doctors hooked Asher up to an IV to keep him hydrated, which helped with the cramping.

Once Asher was released, the cramps came back.

"Every 20 minutes for at least a couple days it was just screams," Erin said. "It was extremely difficult to watch. You know his body shouldn't be doing what it's doing, and he's so young."

Some days, Asher would seem like his old self. Then he would collapse on the floor in pain.

The screams were like clockwork. Every time Asher took a drink, once the liquid reached his inflamed intestines, he would scream in pain. The same response would come about five minutes before he had to use the bathroom.

To be safe, they had to put him in diapers, which Asher didn't take to kindly.
 

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Felice Freyer of the Providence Journal today published a detailed investigative article on the Salmonella Montevideo outbreak linked to Daniele salami, and pepper from Wholesome and Overseas Spice Companies.  The great detail makes you wonder whether she moonlights as an epidemiologist with the CDC.  In any event, the salami and pepper outbreak was one of the largest national Salmonella outbreaks to occur in recent years, sickening hundreds with confirmed illnesses, and likely thousands without positive stool samples.

From Ms. Freyer and the Providence Journal:

On a gray Friday last January, three representatives of the Rhode Island Office of Food Protection drove down a long driveway to a sprawling white building, a meat-processing plant in the backwoods of Burrillville.

They were making an unannounced visit — a surprise in more ways than one — to the headquarters of Daniele Inc., a company that for 34 years has been producing millions of pounds of dry-cured sausage. Daniele favors a low profile. The place doesn’t even have a sign.

The food-protection folks knew Daniele, of course –– but mainly for its pristine record. A full-time employee of the U.S. Department of Agriculture works there, his only job to make sure the meats are safe. But now a troubling e-mail from the West Coast had sent them to Burrillville.

From the car, the inspectors telephoned Michael DeCesare, Daniele’s director of food safety, and told him that Daniele was “a company of interest” in a nationwide outbreak of salmonella.

DeCesare was flabbergasted. For one thing, salmonella is usually associated with chicken and eggs, not beef or pork. For another, he knew all the steps Daniele takes to ensure its meat is safe.

A 10-week investigation would prove him right, but not before following twists and turns so unlikely that Ernest M. Julian, Rhode Island’s chief of food inspection, wondered at one point if the contamination were an act of terrorism.

Happily, no one died. But thousands got sick in 44 states. In the end, the culprit turned out to be something nearly everyone uses and expects to be safe: pepper. And that discovery has drawn new attention to the hazards of hidden ingredients and imported spices.

See A salmonella mystery cracked in Burrilville, R.I.

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With another raw milk outbreak hopefully wrapping up in Colorado, the Morbidity and Mortality Weekly Report from the CDC highlights the Utah raw milk outbreak that occurred between from late April to early June 2010:

On April 29, 2010, the Utah Department of Health (UDOH) was notified of three cases of Salmonella enterica serotype Newport infection. The three patients recently had consumed unpasteurized milk purchased from a store in northern Utah (store A). In Utah, unpasteurized milk can be sold legally at licensed dairies or by licensed dairies at dairy-owned retail stores meeting specific requirements (1). A central Utah dairy licensed to sell unpasteurized milk (dairy A) owns and sells unpasteurized milk at store A and a second northern Utah store (store B). By May 3, 2010, three additional patients with S. Newport infections had been reported; all recently had consumed unpasteurized milk purchased from store A. UDOH notified the Utah Department of Agriculture and Food (UDAF) of the suspected association between illness and unpasteurized milk consumption, and UDAF suspended sales of unpasteurized milk at the two stores on May 3, 2010.

During April 29--June 3, 2010, a total of 10 S. Newport cases were reported to UDOH; all 10 patients had consumed unpasteurized milk from store A (seven patients) or store B (three patients). The patients ranged in age from 2 to 56 years (median: 21 years); six were female. One patient was hospitalized. Isolates from all 10 patients were identified as indistinguishable by two-enzyme pulsed-field gel electrophoresis (PFGE), with pattern combination UTJJPX01.098/UTJJPA26.009, and were sensitive to routinely used antibiotics. Cultures of frozen, unpasteurized milk samples stored at dairy A from batches of milk sold during the outbreak period yielded S. Newport isolates indistinguishable by PFGE from the outbreak strain. An inspection of dairy A on May 7, 2010, did not reveal any obvious sources of contamination.

On May 12, 2010, on the basis of coliform test results within legal limits, the dairy was permitted to resume sales of unpasteurized milk. Ongoing testing includes monthly screening for Salmonella spp. in retail samples of unpasteurized milk. As of June 21, 2010, no additional cases had been reported to UDOH. Consumption of unpasteurized dairy products poses a risk for foodborne illness (2), and consumers of unpasteurized milk should be aware of this risk.
 

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Two E. coli O157:H7 outbreaks have plagued Colorado in recent weeks.  The first is an E. coli O157:H7 outbreak associated with bison meat products from Rocky Mountain Natural Meats, Inc.  The company has recalled over 66,000 pounds of bison products, which have caused, to date, at least 6 confirmed E. coli O157:H7 foodpoisoning illnesses in Colorado and New York.  Rocky Mountain Natural Meats, Inc.'s recalled bison products reached 156 stores in 25 states and Puerto Rico. 

Another E. coli O157:H7 outbreak, with perhaps more devastating effect, has been linked toraw milk from Billy Goat Dairy in Longmont, Boulder County, Colorado.  The Boulder County Health Department, an extremely competent bunch of illness detectives and sanitarians, updated its confirmed case count of E. coli O157:H7 and campylobacter infection in the outbreak to 30 today.  Among the 30 confirmed cases are two children who, according to recent reports, remain hospitalized.   

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Although there have been no new numbers from Colorado, New York, or the Centers for Disease Control and Prevention, the USDA-FSIS just updated its list of retail establishments that received recalled product in the E. coli O157:H7 outbreak and recall linked to Rocky Mountain Natural Meats bison meat.  What was originally just a few stores has turned into approximately 156 stores in 25 states and Puerto Rico that may have bison meat products contaminated with E. coli O157:H7.  66,776 pounds of bison meat have now been recalled. 

To date, there are six known, genetically indistinguishable E. coli O157:H7 illnesses in this outbreak in Colorado and New York.  We filed suit today on behalf of Claudette Murtha, a Colorado Springs resident, who is one of likely many people who suffered an E. coli O157:H7 illness after consuming the recalled, contaminated product, but did not have a stool sample that tested positive. 

Rocky Mountain Natural Meats, the defendant in the Murtha lawsuit, and the source of the recalled meat, needs to now do all it can, including continuing its cooperation with the USDA-FSIS, to make consumers aware that the bison meat they purchased should not be eaten because it might kill them or somebody in their family.  With over 66,000 pounds of bison meat recalled, there are undoubtedly lots of people nationally with possibly contaminated bison meat in their freezers. 

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Boulder County Press Release - A second child has been hospitalized with severe illness after becoming ill from drinking unpasteurized goat milk in June that came from Billy Goat Dairy in Longmont. The first child was hospitalized on June 27 and remains hospitalized. Lab tests have confirmed that the non-pasteurized milk product from the Billy Goat Dairy farm is associated with illness in 30 people.

“The news of these children’s illnesses is heartbreaking,” said Murielle Romine, Boulder County Public Health (BCPH) communicable disease control program coordinator. “My hope is that this helps people to understand how dangerous consuming unpasteurized milk really is - especially for children and people with weakened immune systems.”

Both Campylobacter and E. coli O157 bacteria were identified at the state public health laboratory in lab tests from samples taken at Billy Goat Diary farm. The strain of Campylobacter found in the raw goat milk, and the strain of E. coli found in the goats is an identical match to the strains found in the ill people. These bacteria are found in the intestines of animals and can be passed in their feces to food, water, and milk products that haven't been pasteurized.

“I can’t stress enough how important pasteurization is to protecting yourself and your family. It’s an easy procedure that can be done at home and will destroy bacteria like the one that has made these children so ill,” said Romine.

Pasteurizing milk does not cause lactose intolerance and allergic reactions. Both raw milk and pasteurized milk can cause allergic reactions in people sensitive to milk proteins. Pasteurization also does not reduce milk's nutritional value.

During pasteurization, the temperature of milk is raised to at least 161 degrees Fahrenheit for more than 15 seconds; it is then rapidly cooled. Pasteurization helps to extend milk’s shelf life and destroy many harmful bacteria, including E.coli, Salmonella, Campylobacter, and Listeria.

Campylobacter infection can cause fever, diarrhea, abdominal cramps, nausea, and vomiting and can lead to Guillain-Barré syndrome, permanent paralysis, and possibly death. E. coli infection can cause severe diarrhea, abdominal cramping, and vomiting. Serious cases of E. coli can lead to Hemolytic Uremic Syndrome (HUS), causing kidney failure and possibly death.

The Billy Goat Dairy operates a goat share program in which individuals buy a share of a goat, and in return they receive raw, unpasteurized milk. The sale of unpasteurized milk is illegal in Colorado, but distribution through a goat-share cooperative is permitted.

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Miravalle Foods, Inc., a California company, is recalling 37,318 lbs. of "Miravalle Chile California & Miravalle Chile Nuevo Mexico" Brand Peppers" distributed between March 15th and May 6th 2010 to some customers in CA, CO, UT, NC, NE, ID, OR and NV because they have the potential to be contaminated with Salmonella.

The recalled Peppers were distributed to a small group of customers through direct delivery, distributors and retail stores are in 3oz. (UPC Code: 7 12810-00301 & 7 12810-00304), 6 oz. (UPC Code: 7 12810-60001 & 7 1280-60004), 8oz. (UPC Code: 7 12810-00802 & 7 12810-00803) and 16 oz. (UPC Code: 7 12810-16005 & 7 12810-16007) clear plastic packages under the "Miravalle Chile California & Miravalle Chile Nuevo Mexico" Brand and in bulk 25lb. boxes.

No illnesses have been reported to date in connection with this problem. The potential for contamination was noted after lab analysis of a random sample of the affected product conducted by the U.S. Food and Drug Administration (FDA) revealed the presence of Salmonella.
 

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FSIS Directive 10,010.1 states in part:

Products Not Subject To FSIS Sampling


Ground buffalo or bison is also not a raw ground beef product subject to this FSIS verification sampling.

Not testing Buffalo or Bison seems a bit curious given that we have now had at least two recalls in the past three years, and given that Buffalo and Bison are known carriers of E. coli O157:H7.

In July 2007, Custom Pack, Inc., recalled approximately 5,920 pounds of ground beef and buffalo products because they may be contaminated with E. coli O157:H7. Each package bore the establishment number “Est. 5650” inside the USDA mark of inspection. The ground beef products were produced between June 1 and June 13, 2007, and were distributed to restaurants and institutions in Nebraska. The ground buffalo patties were produced on June 7, 2007, and distributed to restaurants and institutions in Colorado.

Now in July 2010, Rocky Mountain Natural Meats is recalling approximately 66,760 pounds of ground and tenderized steak bison products after FSIS became aware of the problem during the course of an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010. Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 case-patients have been identified in Colorado as well as 1 case-patient in New York with an indistinguishable PFGE pattern. FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado. These products were distributed to retail establishments nationwide and food service distributors in Utah, Arizona, and Nevada and of course Colorado and New York.

The products subject to recall bear the establishment number “EST. 20247” inside the USDA mark of inspection. These products were produced between the dates of May 21, 2010 through May 27, 2010.

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Rocky Mountain Natural Meats has now recalled approximately 66,776 pounds of bison meat products due to E. coli O157:H7 contamination.  The recalls have occurred on two separate dates: the first was announced on July 2, and the second just yesterday. 

To date, the bison meat outbreak has sickened at least 6 residents of Colorado and New York, though those are only the stool sample confirmed cases. Undoubtedly, with over 66,000 pounds of bison meat recalled, many more people are ill.

As always, meat recalls due to E. coli O157:H7 contamination are particularly dangerous; not just because E. coli O157:H7 can be a particularly devastating bug, but also because people often freeze the product, don't know about the recall or see the USDA-FSIS website announcement, and consume the product at a later date. 

Fortunately, the companies involved in the recall appear to be working actively to let consumers know about the recall.  We have been contacted by several people who have heard directly from the retail establishments that sold the contaminated bison meat.

According to Rocky Mountain Natural Meats' website, which links to helpful images of the recalled product packaging, the products subject to the two recalls include: 

One pound packages:

  •Great Range Brand Ground Bison label with the UPC# 016447 10090 6, with “sell or freeze by” dates of June 21, 22, and 24.

  •Natures Rancher Ground Buffalo label with the UPC # 016447 10091 6 with “sell or freeze by” date of June 22.

  •The Buffalo Guys Ground Bison with UPC# 852584 00030 9 and a package date of 0147.

12oz. packages:

  •Great Range Brand Bison Steak Medallion with UPC# 016447 10026 5 and a “sell or freeze by” date of June 23 and 24, 2010.

  •Great Range Brand Bison Sirloin Steak with UPC# 016447 10226 9 and a “sell or freeze by” date of June 20, 23 and 24, 2010.  

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Ready Pac Foods, Inc. is recalling 702 cases of the Baby Spinach variety of Spinach Temptations 6 oz. bagged salads with Use-by Dates of July 4, and bearing a Product Code of I1707B, IR127121, and July 8 product with Product Code I2007B, IR130373.  Ready Pac has issued the recall because the spinach products may be contaminated by E. coli O157:H7.  The recall extends only to products sold in the California, Washington and Arizona.

I have to admit, I felt a produce recall coming sometime soon, but thought it would be due to Salmonella contamination, not E. coli O157:H7.  Apparently, there's lots of both bugs floating around in our food supply right now.  See Salmonella:  the year in review . . . so far. 

The leafy greens industry has had its share of problems.  "The outbreak" linked to Dole baby spinach in 2006 is but one, albeit very significant, example.  Here is a list of 34 lettuce and other leafy green outbreaks that have happened since 1993:

 

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Today, USDA's Food Safety and Inspection Service announced an expansion of the E. coli O157:H7-related recall of bison meat products by Rocky Mountain Natural Meats, out of Henderson, Colorado.  The original recall was of approximately 66,000 pounds of bison products, including ground meat; the expansion adds an additional 776 pounds of meat to the recall.  Multiple E. coli O157:H7 illnesses in New York and Colorado are linked to the outbreak. 

For now, the list of retail establishments that received potentially contaminated products in the two affected states, if not nationally, reads as follows:

1 Albertsons
2 Giant Food
3 Hannaford's
4 King Soopers's
5 Kroger's
6 Market Basket
7 Price Chopper's
8 Stop & Shop Supermarket
9 Super Valu
10 Whole Foods

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As the latest in a succession of food contamination problems in Pennsylvania, K. Heeps, Inc., an Allentown company, is recalling approximately 17.5 pounds of fully cooked turkey breast products that may be contaminated with Listeria monocytogenes, according to the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS).

The products subject to recall include:

*  17.5-pound package of "K. Heeps Inc. Fully Cooked, Sliced Turkey, Boneless with Broth." The label bears the establishment number "EST. 09379A" inside the USDA mark of inspection.

The sliced turkey breast products were produced on June 28, 2010, and distributed to a restaurant in Reading.  FSIS's release does not identify the restaurant; though hopefully, K. Heeps Inc knows who it is and has already notified the right people. 

The problem was discovered through FSIS microbiological sampling program. FSIS has received no reports of illnesses associated with consumption of this product.

About Listeria:

Consumption of food contaminated with Listeria monocytogenes can cause listeriosis, an uncommon but potentially fatal disease. Healthy people rarely contract listeriosis. However, listeriosis can cause high fever, severe headache, neck stiffness and nausea. Listeriosis can also cause miscarriages and stillbirths, as well as serious and sometimes fatal infections in those with weakened immune systems, such as infants, the elderly and persons with HIV infection or undergoing chemotherapy. Individuals concerned about an illness should contact a health care provider.

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The Pennsylvania Department of Agriculture today advised consumers who purchased aged hard cheddar cheese made with raw milk from Milky Way Farm in Troy, Bradford County, Pennsylvania, to discard the product immediately because of potential bacterial contamination. The Bureau of Food Safety has identified 20 pounds of raw milk cheddar cheese that entered the consumer market.

A Department of Agriculture lab found Staphylococcus aureus and enterotoxin in an aged hard cheese sample made from raw milk that was taken from the Milky Way Farm on June 21. The presence of enterotoxin violates the Milk Sanitation Law and the Food Act. The toxin can cause serious illness.

Cheese producers at Milky Way Farm agreed to stop selling their aged hard cheddar cheese made with raw milk. Additional testing has determined that pasteurized cheeses that are produced and sold on the farm are suitable for human consumption.

Symptoms of staphylococcal food poisoning include nausea, vomiting, abdominal cramping and extreme exhaustion. In more severe cases, headache, muscle cramping and changes in blood pressure and pulse may occur. The symptoms usually appear rapidly and are often serious.

The department is moving to suspend Milky Way Farm's raw milk cheese manufacturing permit until additional aged hard cheddar cheese made from raw milk samples are tested and found to be free of Staphylococcus aureus and other pathogens.

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  Nathan Pipenberg of the Daily Collegian today reported on an apparent case of E. coli O157:H7 infection that may be linked to food served on campus during a tennis camp at Penn State University. 

An East Halls tennis camper left University Park early last week -- then told Penn State this week his doctor had informed him he had contracted E. coli, a serious form of food poisoning.

Penn State spokeswoman Lisa Powers said Penn State officials couldn't confirm that the camper contracted the illness while at Penn State. University officials will meet this afternoon to discuss the situation, she said.

There was an indication that a few other campers reported digestive system problems, Powers said, but none of them reported having E. coli.

Findlay Commons provides food for all participants at Penn State sports camps.

"It would be really unusual because we have so many university food health protocols in place," Powers said.

It would be the first case of food poisoning at Penn State in 31 years, she said.

Read tomorrow's issue of The Daily Collegian for more details.
 

Mr. Pipenberg nicely highlights the fact that "a few other campers reported digestive system problems."  This is obviously a critical epidemiological detail that may mean that there really is a problem at PSU--i.e. that the confirmed case of E. coli from the tennis camper is not isolated. 

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  With annual costs attributable to foodpoisoning outbreaks topping $152 billion, there is little doubt that food-related illnesses are a major public health concern.  Salmonella, just one of many potentially lethal bugs, causes approximately 40,000 confirmed cases of salmonellosis every year in the US, though the number of actual cases is likely more than 30 times higher.  These statistics come as no surprise when you consider that, as one example only, over 7% of broiler chickens sold at retail are contaminated by Salmonella. 

So what of this year's progress, or lack thereof, on the nasty little bug that is one of the most common causes of foodpoisoning?  Here is a selection of major Salmonella outbreaks that have occurred since the beginning of 2010:

ConAgra's Marie Calendar's brand Cheesy Chicken and Rice frozen entrees:  ConAgra is, of course, currently embroiled in a Salmonella chester outbreak linked to its Marie Calendar's brand products.  Though the recall was announced in mid-June, the outbreak may not be over.  In fact, as judged by previous frozen meal Salmonella outbreaks linked to ConAgra products, many consumers may still have the contaminated Cheesy Chicken and Rice meals in their freezer, unaware that the product could kill them.  To date, the CDC counts 37 confirmed illnesses nationally in the outbreak.  The outbreak has spawned two lawsuits, on behalf of Oregon men who ate the product and became ill. 

Skokie Country Club:  The most recent report is that 37 people have suffered confirmed Salmonella infections in the Salmonella outbreak at Skokie Country Club in Glencoe, Illinois. Eight victims have required hospitalization, and two of those victims remain hospitalized. The strain of Salmonella in the Skokie Country Club outbreak is Salmonella enteritidis, which is one of the most common of the 2,000+ different strains of Salmonella. Serotype enteritidis is frequently, though not always, associated with the consumption of undercooked eggs.

Kentucky Salmonella Outbreak: Several county health departments and the state Department for Public Health are investigating an outbreak of salmonella in three Central Kentucky counties.At least six people (and likely many more, based on word that has passed through the grapevine) who live within 5 miles of Berea have contracted the bacterial illness. Cases have been reported in Rockcastle, Madison and Garrard counties.

Caldwell Fresh Foods Sprouts:  As of June 24, 2010, the CDC counted a total of 44 people infected with a matching strain of Salmonella Newport in 11 states since March 1, 2010. The outbreak was caused by raw alfalfa sprouts produced by Caldwell Fresh Foods, a Maywood, California company.  The number of ill people identified in each state with this strain is as follows: AZ (4), CA (19), CO (1), ID (6), IL (1), MO (2), NM (2), NV (4), OR (2), PA (1), and WI (2). Illnesses began between March 1, 2010 and June 1, 2010. Among the 34 patients with available hospitalization information, 7 (19%) were hospitalized.

Utah Raw Milk Outbreak:  Utah health officials have linked two outbreaks—one campylobacter and one salmonella—to the consumption of raw milk. The campylobacter outbreak is linked to raw milk purchased from Ropelato Dairy in Ogden, Utah, and has resulted in at least 9 illnesses in residents of Weber, Davis, and Cache counties. On Monday, the Utah Department of Health suspended Ropelato Dairy’s permit to sell raw milk. Coliform testing done on milk at the dairy showed high coliform counts, which suggest the presence of disease-causing bacteria, like campylobacter, in the milk.

The second raw milk outbreak in Utah (a salmonella outbreak) sickened at least 6 people in late April in Utah, Salt Lake, and Wasatch Counties. The outbreak was linked to raw milk from Redmond Farms in Sevier County. Samples of raw milk produced at the dairy from April 5 to April 22 tested positive for Salmonella.

Casa Lopez in Athens, Ohio:  The Athens City-County Health Department noticed a sharp uptick in Salmonella infection in early May 2010, and were able to trace the outbreak back to Casa Lopez, located at 1017 East State Street in Athens. At least 45 people had confirmed illnesses in the outbreak, with hundreds likely sickened who did not get tested.  We filed suit on behalf of 19 year old Tyler Nay on June 18.

Los Dos Amigos:  Los Dos Amigos, a mexican restaurant in Roseburg, Oregon, was the site of a large salmonella outbreak in April. Douglas County health officials report that at least 30 people suffered culture-confirmed salmonella foodpoisoning illnesses, and that cross-contamination was probably a cause of the outbreak. We filed suit on May 19 on behalf of a Roseburg, Oregon resident sickened in the Los Dos Amigos outbreak. We represent a number of other people sickened in the outbreak as well.

Subway Salmonella in Illinois:  Subway restaurants from across the state of Illinois have been associated with a very large Salmonella Hvittingfoss outbreak that has sickened around 100 people in 28 counties with confirmed foodpoisoning illnesses. The actual number of people sick in the outbreak may be in the thousands, as studies have demonstrated that, in any outbreak of Salmonella, as many as 38.6 times the number of confirmed illnesses are actually ill. Subway, which has issued an apology to its customers, acted quickly on learning of the outbreak to remove many fresh produce items from its Illinois restaurant locations. There has been no official word as to which item in particular was the cause of the outbreak.  We filed suit on behalf of Alicea Bush-Bailey in June for injuries suffered in the outbreak.

Salmonella Montevideo Outbreak linked to Salami and Pepper:  According to the CDC, 272 people were sickened by Salmonella montevideo from since July 2009 after consuming salami that was manufactured using salmonella-contaminated red and black pepper. The salami was manufactured and sold by a Rhode Island company called Daniele Inc. The pepper (both black and red), which has long been known to have been the original source of contamination, was imported and sold by two companies: Wholesome Spice Company and Mincing Oversease Spice Company.  We represent a number of people sickened in the Salmonella Montevideo outbreak, including Ray Cirimile and Lee Hanks, who have pending lawsuits against the companies involved.

Bullock's BBQ in North Carolina:  The Durham County Health Department (DCHD) investigated a foodpoisoning outbreak among persons who ate food prepared at Bullock’s Barbecue, located at 3330 Quebec Drive in Durham, in late April, 2010. Ultimately, the N.C. State Public Health Laboratory was able to determine that the strain of salmonella involved in the outbreak was Salmonella enteritidis, likely introduced into the restaurant environment by contaminated eggs. We represent multiple people for foodpoisoning illnesses suffered in this outbreak.

Chico "Margarita Mix-off" Outbreak:  At least 15 Salmonella illnesses among residents or visitors to Chico, California have been linked to the Margarita Mix-Off event held at Manzanita Place on May 8. Health authorities have been unable, thus far, to pinpoint the precise source of the bacteria; food at the mix-off event was served by at least six separate local restaurants

Salmonella spinach and lettuce outbreaks and recalls in May:  Fresh Express, a subsidiary of Chiquita Brands International, Inc., lettuce products caused a Salmonella outbreak in the “Upper-Midwest” in late April or early May 2010. Not much is known about this outbreak, at least publicly, because the health organizations involved in the investigation did not publicly reveal that the outbreak had occurred.

Several weeks after the outbreak, however, Fresh Express recalled several types of ready-to-eat salads after Salmonella was found in a package tested by the U.S. Food and Drug Administration. The recalled products included lettuce mixes, Caesar salad and other salad kits, hearts of romaine and other items. The recall extended to products sold in 26 states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

Also in May 2010, Organicgirl Produce recalled a limited number of cases of 10 oz organicgirl Baby Spinach with an expired Use-by Date of May 22 and Product Code 11A061167 due to potential Salmonella contamination. The recall included only 336 cases of the 10 oz. package size of organicgirl Baby Spinach sold in six states: Alabama, North Carolina, Oregon, Wisconsin, Arizona and California. Like the Fresh Express recall, Organicgirl recalled the baby spinach products due to a positive test for Salmonella in a random sample test collected and conducted by a third-party laboratory for the U.S. Food and Drug Administration.

Hydrolyzed Vegetable Protein recall from Basic Foods Flavors:  And of course, one of the biggest food recalls in history deserves mention, even though it was a recall only, and there were no reported illnesses linked to the product.  Earlier this year, a Nevada company called Basic Food Flavors recalled its hydrolyzed vegetable protein product, after testing by a customer showed the the HVP was contaminated by Salmonella Tennessee.  HVP is an ingredient in many further processed food products, causing the recall to expand, ultimately, to at least 177 separate food products.  Reports suggest that Basic Food Flavors continued to sell its HVP product for at least a month after learning that the product was potentially contaminated. 

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In addition toE. coli and campylobacter in goat's milk and E. coli in bison meat, Azteca Linda Corp. of Brooklyn, NY, this weekend announced a recall of its Queso Fresco and Queso Hebra cheeses with an expiration date of July 7, 2010.  The recall was announced because the products have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Queso Fresco and Queso Hebra cheeses are made from raw milk. 

The Queso Fresco and Hebra cheeses were distributed within New York State (Brooklyn, Queens, Staten Island, Bronx, Newburgh) and to Bayonne, New Jersey through retail stores between the dates of June 7, 2010 and June 9, 2010.  The Queso Fresco is packed in a hard plastic container or wrapped in aluminum foil labeled with the brand name Queso El Azteca , UPC 0 23986 92692 8, and expiration date July 7, 2010.  the Queso Hebra is packaged in a vacuum sealed plastic bag, Net Weight 14 oz. and Net Weight 5 lbs., and labeled with the brand Queso El Azteca (Queso Oaxaca) with the expiration date of July 7, 2010.

Of course, both of the recalled cheeses are made from raw milk.  Queso Fresco, sometimes called "bathtub cheese" because small-time producers sometimes make it there, has been the cause of many outbreaks and recalls over the years, including in May of this year when it caused a Nevada child to develop a very severe illness.  Because queso fresco is made with unpasteurized milk in unsanitary and unlicensed facilities, it poses a serious health threat to consumers, particularly the elderly, young, pregnant women, and people who have weakened immune systems.

The Azteca Linda recall occurred due to environmental sampling and inspection by the FDA which revealed that certain areas within the facility contained the bacteria.

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At almost the same time that Colorado announced an E. coli O157:H7 and campylobacter outbreak linked to raw goat milk produced by Billy Goat Dairy in Longmont, New York announced that the license to sell raw milk held by Breese Hollow Dairy has been suspended due to positive tests for both campylobacter and listeria monocytogenes. 

Breese Hollow Dairy, located in Hoosick, New York, holds a New York permit to sell raw milk at the farm. A routine sample of milk, taken by a milk inspector from the New York State Department of Agriculture and Markets on June 22, 2010, was subsequently tested by the Department’s Food Laboratory, and tested positive for listeria monocytogenes and campylobacter on June 30, 2010.

Breese Hollow Dairy's products have not been associated with any illnesses to date.  Nevertheless, Breese Hollow's positive tests for campylobacter and listeria are just more bad events in 2010 for raw milk proponents, enthusiasts, and the cause in general. 

In the first six months of 2010, raw milk was the cause of 11 outbreaks of campylobacter, salmonella, and E. coli O157:H7.  The outbreaks have occurred in 9 different states, including Washington, Utah, Minnesota, Nevada, Pennsylvania, New York, Michigan, Indiana and Illinois. Washington and Utah have each seen two raw milk outbreaks since the beginning of the year. Health officials from the affected states have counted over 50 confirmed illnesses from infection by Salmonella, E. coli, and Campylobacter, and one victim of the Pennsylvania outbreak developed Guillain-Barre Syndrome and is still hospitalized.

As for the Billy Goat Dairy raw milk outbreak in Longmont, Boulder County, Colorado , the most up to date information is that there are 24 confirmed illnesses.  A team of state and local health investigators visited the Longmont dairy last Thursday morning to collect samples from the goats.  Epidemiologists continued to contact the 43 households that participate in the dairy's goat-share program to warn of potential health risks and check for symptoms.  Illness counts may increase this week.

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On July 1, 2010 Tri-Union Seafoods announced a recall of Chicken of the Sea 12 ounce cans of solid white tuna packed in water.  The company cited a production error that may have created defective seals during the production process, thus creating a risk for the germination of botulism spores.

These products were distributed in ten states including Wisconsin, Nebraska, Utah, Pennsylvania, New York, Maine, Colorado, Indiana, California and Oregon. The distribution dates were in February and May. The 12 ounce Chicken of the Sea solid white tuna packed in water has a upc code of 4800000262, "Best By Date 2/10/2014" and product code 7OA1E ASWAB, 7OA2E ASWAB, 7OA3E ASWAB, 7OA4E ASWAB, 7OA5E ASWAB, 7OAEE ASWAB or 7OAFE ASWAB. The best by dates and product code numbers are imprinted on the bottom of the cans. No other Chicken of the Sea products are affected by this recall.There have been no reports of sickness identified with the consumption of this product.

Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium called Clostridium botulinum. There are three main kinds of botulism: Foodborne botulism occurs when a person ingests pre-formed toxin that leads to illness within a few hours to days; Infant botulism occurs in a small number of susceptible infants each year who harbor C. botulinum in their intestinal tract; and wound botulism occurs when wounds are infected with C. botulinum that secretes the toxin.

With foodborne botulism, symptoms begin within 6 hours to 10 days (most commonly between 12 and 36 hours) after eating food that contains the toxin. Symptoms of botulism include double vision, blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth, and muscle weakness that moves down the body, usually affecting the shoulders first, then the upper arms, lower arms, thighs, calves, etc. Paralysis of breathing muscles can cause a person to stop breathing and die, unless assistance with breathing (mechanical ventilation) is provided.

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On Friday we learned that Rocky Mountain Natural Meats, a Henderson, Colorado meat business, was recalling approximately 66,000 pounds of bison products due to potential contamination by E. coli O157:H7.  The USDA's Food Safety and Inspection Service became aware of the problem during the course of an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010. Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 cases were been identified in Coloradoand 1 in New York with indistinguishable strains of E. coli. FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado.

Of course, Colorado has seen, or been the source state of, beef E. coli O157:H7 outbreaks before.  In the spring of 2009, a multistate E. coli outbreak was discovered involving ground beef produced by the JBS Swift Company at their Greeley, Colorado location. Most ill persons had consumed ground beef; many reported that it was undercooked. Samples from unopened packages of ground beef recovered from a patient's home were tested by the Michigan Public Health Laboratory. These yielded E. coli O157:H7 that matched the "DNA fingerprint" of the outbreak strain. Twenty three persons had been infected with the strain that matched by standard DNA testing. The beef was sold in the United States and Mexico. Mexican health officials banned further importation of the meat.

And in 2002, the Colorado Department of Health identified an outbreak of E.coli O157:H7 infections in Colorado residents. The strain of E.coli isolated from these ill persons was subsequently found to match strains of E.coli from other cases in Colorado and other states. The initial epidemiological investigation implicated ground beef purchased at Kroger's grocery stores. The ground beef was produced by ConAgra Beef Company. On June 30, independent of the outbreak, the ConAgra Beef Company issued a nationwide recall of 354,200 pounds of ground beef produced on May 31. The recall resulted from routine microbiological testing that had been conducted by the U.S. Department of Agriculture (USDA). The strain of E.coli that had been found in this hamburger matched the strain of E.coli that had been isolated from the ill persons. Subsequent to the detection of this multistate outbreak and the plant inspection, the ground beef recall was expanded nationwide. An additional 18.6 million pounds of fresh and frozen ground beef and beef trimmings were recalled. A report by the U.S. Department of Agriculture's inspector general blamed both federal meat inspectors and ConAgra Beef Company for errors contributing to the outbreak. Evidence of E.coli O157:H7 contamination had been ignored since January, 2001, more than a year before this outbreak was detected.

And in 1997, 15 unlucky Coloradans were felled by E. coli O157:H7 after consuming pre-formed, frozen ground beef patties produced by Hudson Foods Company.  Five patients were hospitalized, but none developed hemolytic uremic syndrome or died. Eleven (79%) of 14 patients reported eating frozen pre-formed ground beef patties or burgers at least once during the 7-day period preceding illness onset; eight specifically recalled eating Hudson Foods brand product, and three, who could not recall a specific brand name, identified package labeling consistent with Hudson Foods brand. Hudson Foods beef burgers collected from the freezers of two of the 15 patients bore the identical lot number (156A7); both yielded E. coli O157:H7 when cultured at the U.S. Department of Agriculture's (USDA's) Food Safety and Inspection Service Laboratory in Athens, Georgia.

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The Gorge Amphitheater in George, Washington is a great place to see a concert.  Unfortunately, a number of concert-goers at the Sasquatch Festival, held over this past Memorial Day weekend, ended up victims of a Salmonella outbreak.

Health officials in Grant County, Washington have reported that 7 cases of salmonella have been confirmed in people who attended the show. 

According to the Seattle Times, health officials have not yet determined what the source of the bacteria was.  There have not been reports of illnesses from subsequent concerts at the site.

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Just in time for the 4th of July, Rocky Mountain Natural Meats, a Colorado company, is recalling approximately 66,000 pounds of ground and tenderized steak bison products due to possible contamination with E. coli O157:H7, a potentially deadly pathogen.

The Food Safety and Inspection Service (FSIS) announced the recall yesterday after an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010.  Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 case-patients have been identified in Colorado as well as 1 case-patient in New York with an indistinguishable PFGE pattern. FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado. FSIS is continuing to work with the CDC, affected state public health partners, and the company on the investigation.

The following products are subject to recall:

• 16-ounce packages of “GREAT RANGE BRAND ALL NATURAL GROUND BISON.” These products have a “sell or freeze by” date of June 21, June 22 or June 24, 2010.
• 16-ounce packages of “NATURE’S RANCHER GROUND BUFFALO.” These products have a “sell or freeze by” date of June 22, 2010.
• 16-ounce packages of “THE BUFFALO GUYS ALL NATURAL GROUND BUFFALO 90% LEAN.” These products have a lot number of 0147.
• 12-ounce packages of “GREAT RANGE BRAND ALL NATURAL BISON STEAK MEDALLIONS.” These products have a “sell or freeze by” date of June 23 and June 24, 2010.
• 12-ounce packages of “GREAT RANGE BRAND ALL NATURAL BISON SIRLOIN STEAKS.” These products have a “sell or freeze by” date of June 20, June 23 and June 24, 2010.
• 15-pound boxes of “ROCKY MOUNTAIN NATURAL MEATS, INC. BISON 10 OZ SIRLOIN STEAK.” These products went to restaurants and bear a Julian Code of 0141.

The products subject to recall bear the establishment number “EST. 20247” inside the USDA mark of inspection. These products were produced between the dates of May 21, 2010 through May 27, 2010, and were distributed to retail establishments nationwide and food service distributors in Utah and Arizona. While the sell-by dates for these products have passed, FSIS and the establishment are aware that consumers may also freeze the product before use and there is concern that some product may still be frozen and in consumers’ freezers.

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Rocky Mountain Natural Meats has recalled approximately 66,000 pounds of bison meat - both ground and steak- in response to at least five linked cases of E. coli O157:H7 in Colorado.   There is another potentially linked illness in New York.

Outbreaks of E. coli O157:H7 in the summer months are nothing new.  Numerous studies have detailed the higher incidence of the potentially lethal bacteria in both humans and animals (ruminants, particularly) in the summer months.  Among these:

Humans:

•  A review of E. coli O157:H7 diarrhea in the US by Slutsker et al (1997) found that E. coli O157:H7 was isolated most frequently from patients during the summer months.
• Results from an epidemiological review of E. coli O157:H7 outbreaks in the US (1982-2002) showed that outbreaks involving ground beef peaked in summer months (Rangel et al, 2005)
• n a review of non-O157 STEC infections in the US from 1983-2002 revealed that these infections also were most frequent during the summer (Brooks et al, 2005)
•  In Scotland, HUS and E. coli O157:H7 infections peaked in patients under 15 years of age in July/August, followed by a plateau from June to September (Douglas et al, 1997). Interestingly, the prevalence in Scottish beef cattle at slaughter was found to be highest during the winter, but the concentration of E. coli O157:H7 (number of bacteria shed in cattle feces) was highest during the warmer months (Ogden et al, 2004).

In ruminants (a mammal that digests plant-based food by initially softening it within the animal's first stomach, then regurgitating the semi-digested mass,  and chewing it again - most commonly cattle, sheep, and goats:

•  Numerous studies in cattle indicate that fecal shedding of E. coli O157:H7 is typically low in the winter, increases in the spring, peaks during the summer and tapers off in the fall (Edrington et al, 2006; Hancock et al, 2001; Hussein et al, 2005, etc.)
• Barkocy-Gallagher et al (2003) found that the prevalence of E. coli O157:H7 in cattle feces peaked in the summer, and prevalence on hides (a known risk factor for beef contamination) was highest from spring through fall.
•  A survey of ground beef samples in the US showed that they were 3x more likely to be contaminated with E. coli O157:H7 from June – September (Chapman, et al 2001)
• A survey in the UK found that the majority of retail meats that tested positive for E. coli O157:H7 were collected between May and September.

In litigation against producers of meat susceptible to contamination with E. coli O157:H7, we seek to determine what extra precautions (if any) the producers take against the bacteria in the summer months.   Seems better to take those precautions than to be explaining their lack of them to a jury after an outbreak.

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Rocky Mountain Natural Meats, a Henderson, Colo. establishment, is recalling approximately 66,000 pounds of ground and tenderized steak bison products.

FSIS became aware of the problem during the course of an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010. Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 case-patients have been identified in Colorado as well as 1 case-patient in New York with an indistinguishable PFGE pattern. FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado. FSIS is continuing to work with the CDC, affected state public health partners, and the company on the investigation. Pack/Codes:

The following products are subject to recall:

· 16-ounce packages of “GREAT RANGE BRAND ALL NATURAL GROUND BISON.” These products have a “sell or freeze by” date of June 21, June 22 or June 24, 2010.

· 16-ounce packages of “NATURE’S RANCHER GROUND BUFFALO.” These products have a “sell or freeze by” date of June 22, 2010.

· 16-ounce packages of “THE BUFFALO GUYS ALL NATURAL GROUND BUFFALO 90% LEAN.” These products have a lot number of 0147.

· 12-ounce packages of “GREAT RANGE BRAND ALL NATURAL BISON STEAK MEDALLIONS.” These products have a “sell or freeze by” date of June 23 and June 24, 2010

· 12-ounce packages of “GREAT RANGE BRAND ALL NATURAL BISON SIRLOIN STEAKS.” These products have a “sell or freeze by” date of June 20, June 23 and June 24, 2010

· 15-pound boxes of “ROCKY MOUNTAIN NATURAL MEATS, INC. BISON 10 OZ SIRLOIN STEAK.” These products went to restaurants and bear a Julian Code of 0141.

The products subject to recall bear the establishment number “EST. 20247” inside the USDA mark of inspection. These products were produced between the dates of May 21, 2010 through May 27, 2010.

These products were distributed to retail establishments nationwide and food service distributors in Utah and Arizona. While the sell-by dates for these products have passed, FSIS and the establishment are aware that consumers may also freeze the product before use and there is concern that some product may still be frozen and in consumers’ freezers.

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The number of those sickened by raw milk in Boulder County Colorado has grown to 24.  Earlier this week, health officials announced that 16 people were suffering from E. coli O157:H7 and campylobacter infections lined to unpasteurized goat's milk from the Billy Goat Dairy in Longmont, Colorado.   Now 8 more illnesses have been identified.   This may not be the final tally:

Epidemiologists continued to contact the 43 households that participate in the dairy's goat-share program to warn of potential health risks and check for symptoms Thursday. They were still waiting on responses from several households.  "As long as we continue to discover new cases, the investigation will continue," said Murielle Romine, of Boulder County Public Health.

Two children have been hospitalized in the outbreak, although one has now been released.  Both E. coli O157:H7 and campylobacter cause severe food poisoning symptoms, and both are associated with the risk of severe complications.   E. coli O157:H7 can cause hemolytic uremic syndrome (HUS), especially in children and the elderly.  HUS is a potentially fatal illness that can also cause permanent kidney injury, pancreatic damage, and brain damage.

Campylobacter is a known cause of Guillain Barre Syndrome (GBS).   GBS is a an autoimmune disorder affecting the peripheral nervous system, usually triggered by an acute infectious process.  It causes nerve paralysis, and can be permanently disabling.

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The most recent report is that 37 people have suffered confirmed Salmonella infections in the Salmonella outbreak at Skokie Country Club in Glencoe, Illinois.  Eight victims have required hospitalization, and two of those victims remain hospitalized. 

The strain of Salmonella in the Skokie Country Club outbreak is Salmonella enteritidis, which is one of the most common of the 2,000+ different strains of Salmonella.  Serotype enteritidis is frequently, though not always, associated with the consumption of undercooked eggs.  We have represented many people in Salmonella enteritidis outbreaks associated with undercooked eggs, and have discovered that, in egg outbreaks, frequently the restaurant involved has engaged in the practice of "pooling" eggs--i.e. cracking a bunch of eggs and holding a dozen or more of the cracked eggs in a large bowl or bucket.  This practice has the potential to cause bacterial proliferation, thus creating quite a dangerous bowl of eggs. 

There has been no official word of what happened at the Skokie Country Club, but the outbreak, which appears to be quite large (80+ suspected illnesses), has many features that suggest breakdowns in proper foodhandling procedures.  Whether the outbreak was in fact linked to eggs, much less pooled eggs, remains to be seen, but certainly there were failures amongst the kitchen and service staff at Skokie. 

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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.

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The Billy Goat Dairy in Longmont, Colorado has been ordered to stop distributing raw milk products after 16 people became ill after drinking the milk, including 2 children who were hospitalized.  Of the people who reported becoming ill from consuming the milk products, lab tests confirmed the presence of Campylobacter and E. coli O157, the Boulder County Health Department announced today.  Both types of bacteria are found in the intestines of animals and can be passed in their feces to food, water, and milk products that haven't been pasteurized.

The Billy Goat Dairy operates a goat share program in which individuals buy a share of a goat and in return receive raw, unpasteurized milk. Health officials are contacting every household who participates in the goat share operation to determine if they became sick and to collect samples.  This is a method of legal maneuvering that is intended to help farmers avoid the requirements and restrictions associated with licensure and the "sale" of raw milk specifically. 

"We strongly advise residents to avoid consuming any raw milk or milk products," said Murielle Romine with the health department. "It can be extremely dangerous, particularly for young children and people with weakened immune systems."

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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.

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The Salmonella outbreak at Skokie Country Club in Cook County, Illinois, continues to grow.  Currently, public health officials count 29 confirmed cases of Salmonella foodpoisoning linked to the Country Club, with 7 hospitalizations.  Officials say they're also checking on more than 50 additional reports of salmonella-like symptoms in people who ate at the club.

Health department official Stephen Martin says club officials have voluntarily closed their kitchen facilities during the investigation.  A good thing, because anytime a large salmonella outbreak happens at a single location (as opposed to the Subway salmonella outbreak, where many different locations are associated with illness), one very likely cause of the outbreak is cross-contamination.  Generally, contaminated ingredients at a single restaurant don't sicken 80 people.  Sick foodworkers, and poor foodhandling practices do. 

Here are a a few rules that apply to all foodservice establishments in the state of Illinois (a/k/a good subjects of inquiry for depositions and trial in the salmonella lawsuits that will arise from this outbreak):

§ 760.410 General--Personal Cleanliness.

Employees shall thoroughly wash their hands and the exposed portions of their arms with soap and warm water before starting work, during work as often as is necessary to keep them clean, and after smoking, eating, drinking, or using the toilet. Employees shall keep their fingernails clean and trimmed.

§ 760.430 General--Employee Practices.

c) Employees shall maintain a high degree of personal cleanliness and shall conform to good hygienic practices during all working periods in the retail food store.

§ 760.500 General--Materials.

Multi-use equipment and utensils shall be constructed and repaired with safe materials, including finishing materials; shall be corrosion resistant and shall be nonabsorbent; and shall be smooth, easily cleanable, and durable under conditions of normal use. Single-service articles shall be made from clean, sanitary, safe materials. Equipment, utensils, and single-service articles shall not impart odors, color, taste, nor contribute to the contamination of food.

§ 760.700 Cleaning Frequency.

a) Utensils and foodcontact surfaces of equipment shall be cleaned and sanitized:

1) Each time there is a change in processing between raw beef, raw pork, raw poultry or raw seafood, or a change in processing from raw to readytoeat foods;

2) After any interruption of operations during which time contamination may have occurred; and

3) After final use each working day.

b) Where equipment and utensils are used for the preparation of potentially hazardous foods on a continuous or productionline basis, utensils and the food-contact surfaces of equipment shall be cleaned and sanitized at intervals throughout the day on a schedule based on food temperature, type of food, and amount of food particle accumulation.

c) The foodcontact surfaces of cooking devices and the cavities and door seals of microwave ovens shall be cleaned at least once each day of use, except that this shall not apply to hot oil cooking equipment and hot oil filtering systems. The foodcontact surfaces of all baking equipment and pans shall be kept free of encrusted grease deposits and other accumulated soil.

d) Nonfoodcontact surfaces of equipment, including transport vehicles, shall be cleaned as often as is necessary to keep the equipment free of accumulation of dust, dirt, food particles, and other debris.
 

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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.

 

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The CDC updated its official case count today in the Salmonella outbreak linked to ConAgra's Marie Callendar's brand Cheesy Chickena and Rice frozen meals.  There are currently 37 confirmed cases of Salmonella Chester foodpoisoning illnesses in the ConAgra outbreak.  

We have filed lawsuits on behalf of Dave Smith and Kevin Taylor, two Oregon residents who consumed the contaminated products, and are among the CDC's official count.

In other national Salmonella news, the Salmonella Hvittingfoss outbreak linked to Illinois Subway restaurants has claimed 97 confirmed victims since early May.  Alicea Bush-Bailey filed suit this week against the Subway restaurant in Aurora, Illinois, where she purchased the sub that made her sick, as well as Doctor's Associates, Subway's parent corporation.  And Tyler Nay filed suit on June 18 against the Athens, Ohio restaurant called Casa Lopez that was also the source of a large Salmonella outbreak in May.

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The Clostridium perfringens outbreak at Central Louisiana State Hospital in Pineville has claimed additional victims.  In a good article on the outbreak and the officials who have resigned, or retired, in its wake,the Town Talk reports as follows:

The administrator and associate administrator at Central Louisiana State Hospital both left the facility this week following investigations into the deaths of three patients from food poisoning at the Pineville facility.

The investigations also revealed what the Louisiana Department of Health and Hospitals termed unacceptable process and management issues, according to a press release.

 

DHH Secretary Alan Levine has appointed Russell Semon, bureau chief of work force development within the DHH Office of Policy Standards and Quality Assurance, to conduct a comprehensive review of the organizational structure, personnel, training protocols, policies and procedures at Central. Semon will make specific recommendations to Levine.

The deadly outbreak over the first weekend in May also sickened 42 other patients and 12 staff members. The cause of the outbreak was traced to improperly stored chicken salad served at the facility that was infected with the third most common form of food poisoning – clostridium perfringens.

The investigations, ordered by Levine, found serious deficiencies in dietary services and concerns with the overall operation of the hospital, according to the release.

The agency’s Office of Health Standards and Quality Assurance, at the request of Levine, conducted a hospital survey of Central and identified deficiencies. Those shortfalls were shared with the Centers for Medicare and Medicaid Services and, as a result, that agency has determined that Central is not in compliance with all the Conditions of Participation for hospitals, something DHH agrees with, the release states.

Patrick Kelly, the hospital’s administrator, resigned earlier this week, DHH reported, and the associate administrator, Paul Benoit, retired Wednesday.

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The State of Oregon's press release today is Exhibit A in our recent commentary on the significant public health threat posed by recalled products remaining on store and consumer shelves.  In summary, the release states that, despite a widely publicized outbreak and recall linked to ConAgra's Marie Callendar brand frozen foods, certain stores in Oregon still have not removed all of the recalled products from its shelves. 

 

 

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Lancaster Foods LLC, of Jessup, Maryland, recalled 10-ounce packages of Krisp-Pak Ready to Eat Hydro-Cooled Fresh Spinach yesterday after tests by the North Carolina Department of Agriculture and Consumer Services confirmed the presence of Listeria monocytogenes in product samples.

The packages have the code: “Best Enjoyed By: 23 Jun 10, Product of USA, 10/158/09:17/1/05.”

State inspectors collected the product from a Farm Fresh store in Elizabeth City.

No illnesses associated with this product have been reported.

The Lancaster Foods recall occurred the same day that the Center for Produce Safety at the University of California, Davis began its Produce Research Symposium.  The first day of the symposium offered presentations and discussion by leaders in academia and industry on a variety of topics, from flies as vectors for the spread of E. coli O157:H7 in leafy greens to the internalization and survivability of E. coli O157 on spinach in field production environments. 

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The folks over at barfblog.com have created the following table showing outbreaks involving pre-cooked microwavable chicken products.  Clearly, the first and best line of defense in outbreaks involving pre-cooked products is for the product manufacturer to not use contaminated ingredients, or ensure that the harmful bacteria are fully eradicated by cooking it thoroughly.

In his expose article on the topic back in 2009, in response to the ConAgra pot pie Salmonella outbreak, Michael Moss of the New York Times reported that:

Federal regulators have pushed companies to beef up their cooking instructions with the detailed “food safety” guides. But the response has been varied, as a review of packaging showed. Some manufacturers fail to list explicit instructions; others include abbreviated guidelines on the side of their boxes in tiny print. A Hungry-Man pot pie asks consumers to ensure that the pie reaches a temperature that is 11 degrees short of the government-established threshold for killing pathogens. Questioned about the discrepancy, Blackstone acknowledged it was using an older industry standard that it would rectify when it printed new cartons
 

Some food safety experts say they do not think the solution should rest with the consumer. Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said companies like ConAgra were asking too much. “I do not believe that it is fair to put this responsibility on the back of the consumer, when there is substantial confusion about what it means to prepare that product,” Dr. Osterholm said.

In fact, the Times article continued:

attempts by The New York Times to follow the directions on several brands of frozen meals, including ConAgra’s Banquet pot pies, failed to achieve the required 165-degree temperature. Some spots in the pies heated to only 140 degrees even as parts of the crust were burnt.

A ConAgra consumer hotline operator said the claims by microwave-oven manufacturers about their wattage power could not be trusted, and that any pies not heated enough should not be eaten. “We definitely want it to reach that 165-degree temperature,” she said. “It’s a safety issue.”

In 2007, the U.S.D.A.’s inspection of the ConAgra plant in Missouri found records that showed some of ConAgra’s own testing of its directions failed to achieve “an adequate lethality” in several products, including its Chicken Fried Beef Steak dinner. Even 18 minutes in a large conventional oven brought the pudding in a Kid Cuisine Chicken Breast Nuggets meal to only 142 degrees, the federal agency found.

Given the difficulty that consumers, and the industry, have in using cooking as a final kill step, the better solution is for pathogens that can kill people to not be in frozen food products in the first place. 

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Ongoing (?) Salmonella outbreaks linked to Subway sandwiches and ConAgra's Marie Calendar's Cheesy Chicken and Rice frozen meals have spawned two law suits against the food companies.  We filed suit on Monday against the Illinois Subway restaurant, and Doctors Associates (the parent corp for Subway), on behalf of Alicea Bush-Bailey, and on Tuesday against ConAgra on behalf of Dave Smith. 

The Illinois Subway Salmonella outbreak has sickened 97 people across the state with confirmed Salmonella Hvittingfoss illnesses.  Marie Calendar's cheesy chicken and rice frozen meals have sickened at least 30 people nationally, though the latest update in this outbreak was on June 18.

The possible long-term consequences of Salmonella infection (primarily reactive and arthritis) afflict as many as 10% of Salmonella outbreak victims. 

Post-infectious IBS

A recently-published study surveyed the extant scientific literature and noted that post-infectious irritable bowel syndrome (PI-IBS) is a common clinical phenomenon first-described over five decades ago. The Walkerton Health Study further notes that:

Between 5% and 30% of patients who suffer an acute episode of infectious gastroenteritis develop chronic gastrointestinal symptoms despite clearance of the inciting pathogens.

In terms of its own data, the “study confirm[ed] a strong and significant relationship between acute enteric infection and subsequent IBS symptoms.” The WHS also identified risk-factors for subsequent IBS, including: younger age; female sex; and four features of the acute enteric illness—diarrhea for > 7days, presence of blood in stools, abdominal cramps, and weight loss of at least ten pounds.

Irritable bowel syndrome (IBS) is a chronic disorder characterized by alternating bouts of constipation and diarrhea, both of which are generally accompanied by abdominal cramping and pain. In one recent study, over one-third of IBS sufferers had had IBS for more than ten years, with their symptoms remaining fairly constant over time. IBS sufferers typically experienced symptoms for an average of 8.1 days per month.

As would be expected from a chronic disorder with symptoms of such persistence, IBS sufferers required more time off work, spent more days in bed, and more often cut down on usual activities, when compared with non-IBS sufferers. And even when able to work, a significant majority (67%), felt less productive at work because of their symptoms. IBS symptoms also have a significantly deleterious impact on social well-being and daily social activities, such as undertaking a long drive, going to a restaurant, or taking a vacation. Finally, although a patient’s psychological state may influence the way in which he or she copes with illness and responds to treatment, there is no evidence that supports the theory that psychological disturbances in fact cause IBS or its symptoms.

Reactive arthritis

The term reactive arthritis refers to an inflammation of one or more joints, following an infection localized at another site distant from the affected joints. The predominant site of the infection is the gastrointestinal tract. Several bacteria, including Salmonella, induce septic arthritis. The resulting joint pain and inflammation can resolve completely over time or permanent joint damage can occur.

The reactive arthritis associated with Reiter’s may develop after a person eats food that has been tainted with bacteria. In a small number of persons, the joint inflammation is accompanied by conjunctivitis (inflammation of the eyes), and uveitis (painful urination). This triad of symptoms is called Reiter's Syndrome. Reiter’s syndrome, a form of reactive arthritis, is an uncommon but debilitating syndrome caused by gastrointestinal or genitourinary infections. The most common gastrointestinal bacteria involved are Salmonella, Campylobacter, Yersinia, and Shigella. Reiter’s syndrome is characterized by a triad of arthritis, conjunctivitis, and urethritis, although not all three symptoms occur in all affected individuals.

Although the initial infection may not be recognized, reactive arthritis can still occur. Reactive arthritis typically involves inflammation of one joint (monoarthritis) or four or fewer joints (oligoarthritis), preferentially affecting those of the lower extremities; the pattern of joint involvement is usually asymmetric. Inflammation is common at enthuses—i.e., the places where ligaments and tendons attach to bone, especially the knee and the ankle.

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South Gate Meat Co., a South Gate, Calif., establishment, is recalling approximately 35,000 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 products subject to recall include:

*20-, 30- and 40-pound bulk packages of "SOUTH GATE MEAT CO. GROUND BEEF."

*30-, 40-, and 50-pound bulk packages of "SOUTH GATE MEAT CO. COARSE GROUND BEEF."

*10- and 20-pound packages of "SOUTH GATE MEAT CO. GROUND BEEF PATTIES."

Each package bears establishment number "EST. 6217" inside the USDA mark of inspection. These ground beef products were produced between the dates of June 7, 2010, through June 21, 2010, and were shipped to restaurants in the Los Angeles and Orange County, Calif. area.

The problem was discovered through FSIS microbiological sampling 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 physician.

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Crown I Enterprises, Inc., a Bay Shore, N.Y., establishment, is recalling approximately 3,700 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 products subject to recall include:

*24, 8-ounce burgers in 12-pound boxes of "W.B. STOCKYARD, KEEP REFRIGERATED, BURGER FRESH, WB HOME STYLE 8 OZ."

*32, 6-ounce burgers in 12-pound boxes of "W.B. STOCKYARD, KEEP REFRIGERATED, BURGER FRESH 6 OZ."

*48, 4-ounce burgers in 12-pound boxes of "W.B. STOCKYARD, KEEP REFRIGERATED, BURGER FRESH, 4 OZ."

*10-pound boxes of "W.B. STOCKYARD, KEEP REFRIGERATED, BEEF GROUND/EXTRA LEAN."

*10- and 20-pound boxes of "W.B. STOCKYARD, KEEP REFRIGERATED, BEEF GROUND 80/20."

Each package bears establishment number "EST. 20889" inside the USDA mark of inspection as well the Julian dates of "10164" and "10166." These ground beef products were produced on June 11, 2010, and June 15, 2010, and were shipped to food service institutions in Conn., N.J., and N.Y.

The problem was discovered through FSIS microbiological sampling 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 physician.

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At least six cases of Salmonella have been reported in people living in or near Berea, Kentucky.   Both County and State health officials are investigating the illness, which covers three Kentucky counties.  According to an online report:

While it's not unusual to see this many cases of salmonella sickness in a year, it's unusual to see them at once, said Christie Green, spokeswoman for the Madison County Health Department.  "To have them in this cluster is what's gotten our attention," she said.

The source of the Salmonella outbreak has not been identified.   Recent Salmonella outbreaks have been linked to Subway restaurants in Illinois, frozen dinners, and to raw milk. 

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Late last week, ConAgra recalled Marie Callendar's brand Cheesy Chicken and Rice frozen entrees due to Salmonella contamination.  The recall occurred because the CDC had notified ConAgra of a possible association between its Marie Callendar's product and at least 8 Salmonella Chester infections in people nationwide.  The CDC has since expanded the case-count in the ConAgra Salmonella outbreak to 30 people nationally.

Frozen food recalls are a different kind of dangerous because people do exactly what ConAgra intends, and purchase the products, put them in the freezer, and forget about them until they need a quick dinner fix.  The problem that this poses, quite clearly, is that consumers may have recalled, contaminated products in their freezers long past the company's recall announcement. 

Thus, it is incumbent on ConAgra and the regulatory bodies that oversee the production of those products (here the USDA's Food Safety and Inspection Service) to use all available means and channels of communication to get the word out about the contaminated product so that consumers don't eat them.  The USDA issued a recall notice on June 17, 2010, which announcement appears to have been timely based on the CDC's information.  And ConAgra itself has published a statement on its website about the recall (although the statement equivocates a little too much, saying "there is no definitive link between the recalled product and any illness," which is of course wrong since the Minnesota Department of Agriculture isolated Salmonella Chester from an unopened package of the recalled product taken from a consumer's home).

But who honestly knows about the recall, and the public health threat that the Marie Callendar's Cheesy Chicken and Rice entrees present?  Unless you've got a news aggregator set to detect any Google reference to salmonella or recall or outbreak--and most consumers don't--you'd never know that the product had been recalled, much less poses a serious public health risk.

What other actions has ConAgra taken to warn the public?  Newspaper ads?  TV commercials?  Anything?  And what about traceability?  Certain grocery retailers, like Costco, are able to promptly notify consumers who have purchased a recalled product.  Does ConAgra require this of the retailers that sell its products?  With the globalization and de-centralization of our food supply, absolute traceability from manufacturer through to the consumer is a daunting and challenging thing.  But doesn't consumer safety warrant it, particularly when actual and thorough traceability is the only sure way to make sure that vital health and recall information reaches consumers in a timely fashion?

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Today, along with Gary Newland of the Chicago-area firm Newland, Newland, and Newland, we filed suit on behalf of Alicea Bush-Bailey, who was sickened at an Aurora Illinois Subway restaurant.  Ms. Bush-Bailey is one of many victims of the Salmonella outbreak linked to Subway restaurants in Illinois statewide. 

TheIllinois Department of Public Health updated their case-count today in the outbreak as well.  Their release reads as follows:

Confirmed cases of Salmonella serotype Hvittingfoss – 97.

Age range of confirmed cases: 2 to 79.

Cases have reported eating at Subway restaurants located in 28 counties -- Bureau, Cass, Champaign, Christian, Coles, Dekalb, DeWitt, Ford, Fulton, Henry, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Rock Island, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Will and Winnebago.

Investigation is ongoing. Numbers will be updated June 22, if additional cases are identified.

Still no word on the precise cause of the outbreak--i.e. which contaminated item was initially responsible for introducing Salmonella bacteria into Illinois Subway restaurants.  There are widespread concerns, however, that the risk of illness is not yet over, despite the fact that many of the recognized cases in the outbreak were sickened over a month ago.  There is a significant risk that foodworkers may have become infected as well--and may be either symptomatic or asymptomatic (no symptoms)--and thus represent an ongoing risk of Salmonella infection to patrons of Illinois Subway restaurants. 

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As the count of those sickened in the Illinois Subway Restaurant Salmonella outbreak hit 97, a Salmonella lawsuit was filed against Doctor’s Associates, Inc., the restaurant chain’s parent company. The lawsuit was filed on behalf of Will County resident Alicea Bush-Bailey by Drew Falkenstein of food safety law firm Marler Clark and by Gary A. Newland of the Illinois firm Newland, Newland, & Newland.

On May 12, Ms. Bush-Bailey bought a sandwich from the Subway restaurant at 1248 N. Lake Street in Aurora, IL. By that evening, she was experiencing symptoms including nausea, abdominal cramping and diarrhea, all of which worsened quickly and required her to seek medical care at the emergency room. She was treated for dehydration, severe abdominal pain and nausea, and returned home with medication.

I’m not surprised that the number of ill in this outbreak keeps climbing,” Mr. Falkenstein said. “The CDC estimates that for every confirmed Salmonella illness in an outbreak, another 38.6 are never counted. In order for someone to be listed as an outbreak illness, they have to go to the doctor and get tested. Many people stay home and just try to get through their illness on their own, and never know that they have Salmonella or that they are part of an outbreak.”

Mr. Falkenstein and Marler Clark recently represented over 80 victims of the outbreak of Shigella at a Chicago-area Subway restaurant earlier this year.

“It’s unusual to see two outbreaks at the same chain in the same area in so short a time frame,” continued Falkenstein. “Ms. Bush-Bailey and many other customers entrusted their health and safety to these restaurants, and that trust was not honored.”

Consumer Resource: Downloadable Family Food Safety Guide for Salmonella (PDF)

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In light of the large recall of Conagra's Marie Callender’s Cheesy Chicken and Rice Frozen Meals due to its link to at least 30 Salmonella Chester illnesses in 15 states, grocery stores across the country are scouring their freezers to ensure it is pulled off the shelf.  Two stores, Grocers Giant Food LLC and Stop & Shop Supermarket Co., have announced that all of the recalled frozen dinners have been removed.

Because it of the long shelf life of the frozen meals, it is important for consumers to check their freezers.

ConAgra said it was informed by the U.S. Centers for Disease Control and Prevention of a possible association between the product and eight people in the United States who were infected with the Salmonella bacteria.

A ConAgra spokeswoman said there are about 100,000 cases of the product in the market and that each case has about 8 packages.

Symptoms of Salmonella gastroenteritis include diarrhea, abdominal cramps, fever, nausea, and/or vomiting. In mild cases diarrhea may be non-bloody, occur several times per day, and not be very voluminous; in severe cases it may be frequent, bloody and/or mucoid, and of high volume.

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From an Illinois Department of Public Health press release.

To help prevent a secondary outbreak of Salmonella serotype Hvittingfoss associated with SUBWAY® restaurants in the state, the Illinois Department of Public Health (IDPH) is requiring food handlers in 46 restaurants currently linked to the outbreak, to have two consecutive test results that are negative for Salmonella serotype Hvittingfoss before being allowed to return to work. Food handlers infected with salmonellosis (illness caused by Salmonella bacteria), can inadvertently pass the bacteria to restaurant patrons, causing them to become sick.

“The Illinois Department of Public Health is working closely with local health departments to help protect the people of Illinois from becoming sick from Salmonella,” state public health director Dr. Damon T. Arnold said. “In an effort to prevent a secondary outbreak, the Department is taking precautions by requiring food handlers at certain SUBWAY® restaurants in Illinois to be tested and cleared before being allowed to handle food.”

IDPH today reported several food handlers at certain SUBWAY® restaurant locations in Illinois have tested positive for Salmonella serotype Hvittingfoss. As part of the ongoing investigation of Salmonella illness among customers who report eating at certain SUBWAY® restaurants in Illinois, IDPH has been working closely with local health departments across the state and the SUBWAY® restaurant chain to test employees working at the 46 locations where illness has currently been linked.

"The SUBWAY® brand has stringent hand washing and sanitation procedures; as well as requirements for store staff to use gloves during food preparation and handling. As soon as the SUBWAY® brand learned of the IDPH investigation, the brand voluntarily removed all produce suspected by the health department from each store. The brand is committed to cooperating with IDPH as it works to pinpoint the exact cause of the outbreak,” said Thomas J. Coba, Chief Operations Officer, SUBWAY® restaurant chain.

As of today, IDPH is reporting 90 cases of Salmonella serotype Hvittingfoss associated with the outbreak linked to Subway. All 90 people are recovering, including 25 who had been hospitalized. At this point in the investigation, Salmonella cases identified in this outbreak reported eating at SUBWAY® locations in 28 counties, including Bureau, Cass, Champaign, Christian, Coles, DeKalb, DeWitt, Ford, Fulton, Henry, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Rock Island, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren , Will and Winnebago.

Confirmed cases have reported eating at restaurants between May 5 and June 4, 2010. Cases range in age from two-years to 79-years-old.

A specific food source has not been identified in association with this outbreak. The Department continues to work closely with the Food and Drug Administration, the U.S. Centers for Disease Control and Prevention, the SUBWAY® Corporation and local health departments throughout the state to identify the source and prevent future illness.

The specific type of Salmonella involved in this outbreak is an uncommon serotype called Hvittingfoss. Typically, only one or two cases of this type of Salmonella are seen in Illinois each year.

Symptoms of salmonellosis (illness caused by Salmonella bacteria) include diarrhea, vomiting, fever and/or stomach cramps. Illness usually develops within six to 72 hours after being exposed to Salmonella bacteria, however, the onset of illness in this outbreak has occurred after 72 hours in some cases. Illness generally lasts three to seven days. Some individuals who are infected may have no symptoms, but may still transmit the Salmonella bacteria to others. The spread of Salmonella from person to person may be avoided by careful hand washing with soap and water, particularly after using the bathroom.

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15 million pounds of SpagettiOs and all Marie Callender’s Cheesy Chicken and Rice frozen meals being recalled.

Congresswoman Rosa L. DeLauro (CT-03) issued the following statement today in reaction to two major recalls announced by the USDA today.

One focuses on the Campbell Soup Supply Company, LLC, of Paris, Texas, and approximately 15,000,000 pounds of "SpaghettiOs with Meatballs" which may have been under-cooked and could pose a health hazard. These products were produced between December 2008 and June 2010, and were distributed nationwide. The second recall is of Marie Callender's brand Cheesy Chicken and Rice frozen meals, produced by ConAgra Foods Packaged Foods, LLC, of Council Bluffs, Iowa, due to a potential link to 29 people in 14 states who have contracted a strain of Salmonella. Though the investigation is still ongoing, eight of those sickened reported eating this product.

“These recalls are very disturbing considering that the timeframe in which the SpaghettiOs were produced spans nearly two years. The volume of potentially dangerous products is significant, and it is frightening that millions of children may have unknowingly consumed these recalled products given the popularity of SpaghettiOs among kids. While these recalls and investigations are still ongoing, I look forward to learning from USDA about the circumstances that allowed two years of potentially dangerous foods to enter the market place.

“This recall, combined with the recall of the Marie Callender’s frozen meals that have sickened over two dozen people in 14 states, serves as a reminder that after we must begin the process of reviewing how the food safety system at USDA should be reformed.”

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CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA/FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella serotype Chester infections.

As of June 18, information had been collected on 14 ill and 21 well persons. Preliminary analysis of this study suggests eating a Marie Callender’s frozen meal as a possible source of illness. Ill persons (86 percent) were significantly more likely than well persons (10 percent) to report eating a frozen meal. All ill persons (100 percent) who ate frozen meals reported eating a Marie Callender’s frozen meal. None (0 percent) of the well persons who ate a frozen meal reported eating a Marie Callender’s frozen meal. At this time there are insufficient data to implicate a specific frozen meal type. However, many of the ill persons have reported eating a Marie Callender’s cheesy chicken and rice frozen entrée in the week before becoming ill.

Today, the Minnesota Department of Agriculture Laboratory reported to CDC that it has isolated Salmonella Chester from an unopened package of Marie Callender’s Cheesy Chicken & Rice single-serve frozen entrée collected from a case patient. Subtyping of the Salmonella strain is under way.

As of June 18, 2010, a total of 30 individuals infected with a matching strain of Salmonella Chester have been reported from 15 states since April 11, 2010. The number of ill people identified in each state with this strain is as follows: CA (4), CO (2), GA (6), IL (1), KY (1), MA (2), MN (2), MO (1), NC (1), OK (1), OR (2), SC (2), TN (1), UT (1), and VA (3). Among those for whom information is available about when symptoms started, illnesses began between April 5, 2010 and May 29, 2010. Case-patients range in age from <1 to 88 years old, and the median age is 37 years. Fifty-four percent of patients are female. Among the 15 patients with available hospitalization information, 6 (40%) were hospitalized. No deaths have been reported.

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Oregon and Minnesota's state health departments and departments of agriculture have again provided some of the critical epidemiological data in cracking the Salmonella outbreak linked yesterday to ConAgra's Marie Calendar brand cheesy chicken and rice frozen entrees.  There are only two recognized illnesses in each state, but Minnesota generated the positive test result for Salmonella Chester on the recalled product. 

The CDC's statement today on the outbreak states as follows:

CDC is collaborating with public health officials in many states, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA/FSIS), and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella serotype Chester infections. Investigators are using DNA analysis of Salmonella bacteria obtained through diagnostic testing to identify cases of illness that may be part of this outbreak.

As of 9:00 AM EDT on June 18, 2010, a total of 30 individuals infected with a matching strain of Salmonella Chester have been reported from 15 states since April 11, 2010. The number of ill people identified in each state with this strain is as follows: CA (4), CO (2), GA (6), IL (1), KY (1), MA (2), MN (2), MO (1), NC (1), OK (1), OR (2), SC (2), TN (1), UT (1), and VA (3). 

The CDC's description of the outbreak so far:

Beginning on June 14, 2010, CDC and public health officials in multiple states began conducting an epidemiologic study by comparing foods eaten by ill and well persons. As of June 18, information had been collected on 14 ill and 21 well persons. Preliminary analysis of this study suggests eating a Marie Callender’s frozen meal as a possible source of illness. Ill persons (86 percent) were significantly more likely than well persons (10 percent) to report eating a frozen meal. All ill persons (100 percent) who ate frozen meals reported eating a Marie Callender’s frozen meal. None (0 percent) of the well persons who ate a frozen meal reported eating a Marie Callender’s frozen meal. At this time there are insufficient data to implicate a specific frozen meal type. However, many of the ill persons have reported eating a Marie Callender’s cheesy chicken and rice frozen entrée in the week before becoming ill.

Today, the Minnesota Department of Agriculture Laboratory reported to CDC that it has isolated Salmonella Chester from an unopened package of Marie Callender’s Cheesy Chicken & Rice single-serve frozen entrée collected from a case patient. Subtyping of the Salmonella strain is under way.

ConAgra needs to help get the message out to their customers.  In addition to illnesses that happen before an outbreak is announced, another major public health concern is illnesses that have yet to happen, especially when the contaminated product is a frozen item that might stay in a freezer for months.  Below is a chart from another ConAgra outbreak; again linked to a frozen food product, pot pies.  It shows how many people became ill after the outbreak was announced.

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Young Man One of 45 Sickened in the Outbreak

The first lawsuit stemming from an outbreak of Salmonella at Casa Lopez Restaurant in Athens, OH was filed today in the Court of Common Pleas. The lawsuit was filed on behalf of Athens County resident Tyler Nay by his attorneys: Bill Marler of food safety law firm Marler Clark and Kate Ryan of Cincinnati-based Ulmer-Berne.

On April 30, nineteen-year-old Tyler Nay ate at Casa Lopez with his mother, who was visiting him for Ohio University Mom’s weekend. By early the next morning, he was suffering from nausea, vomiting, diarrhea, stomach cramps, chills, muscle aches, and headache. He sought medical help at the ER of Camden-Clark Memorial Hospital, and was treated and released. When his symptoms continued to worsen, he returned to the hospital and was admitted. A culture done while he was in the hospital revealed that he was infected with Salmonella. He remained hospitalized for four days.

The Athens City-County Health Department noticed a sharp uptick in Salmonella infection in early May 2010, and were able to trace the outbreak back to Casa Lopez, located at 1017 East State Street in Athens. At least 45 people had confirmed illnesses in the outbreak, with hundreds likely sickened who did not get tested.

“The CDC estimates that for every confirmed Salmonella illness in an outbreak, another 38.6 are never culture-confirmed,” said Mr. Nye’s attorney, Bill Marler. “Most people with Salmonella never know they have it, and try to ‘tough it out’ as a stomach flu, but it’s important to get tested so that you know what you are dealing with. Salmonella can have some very serious long-term consequences.”

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Salmonella is one of the most frequent causes of bacterial foodpoisoning in the United States, causing 40,000 confirmed cases every year, and probably millions of unconfirmed illnesses.  2010 has been no different.  We have seen outbreak after outbreak, and recall after recall.  Here is a short summary of many prominent Salmonella outbreaks and recalls over the last several months:

ConAgra, Salmonella Chester, and Marie Calendar's frozen entrees

ConAgra has issued a recall of Marie Calendars Cheesy Chicken and Rice Frozen Entrees due to potential contamination by Salmonella Chester. The products were distributed nationally. At least 29 people were sickened in the in April and May, including several residents of Oregon and Minnesota--the only states for which this information is currently available. 

The Minnesota Department of Agriculture isolated Salmonella Chester from an intact package of Marie Callender’s Cheesy Chicken and Rice collected from the home of one of the ill people. This package was purchased at the same time as a similar package that was consumed just prior to the case’s onset of illness.

Illinois Subway Salmonella outbreak

Subway restaurants from across the state of Illinois have been associated with a very large Salmonella Hvittingfoss outbreak that has sickened 90 people in 28 counties with confirmed foodpoisoning illnesses.  The actual number of people sick in the outbreak may be in the thousands, as studies have demonstrated that, in any outbreak of Salmonella, as many as 38.6 times the number of confirmed illnesses are actually ill.  Subway, which has issued an apology to its customers, acted quickly on learning of the outbreak to remove many fresh produce items from its Illinois restaurant locations.  There has been no official word as to which item in particular was the cause of the outbreak.

Fresh Express lettuce and Salmonella

Fresh Express, a subsidiary of Chiquita Brands International, Inc., lettuce products caused a Salmonella outbreak in the “Upper-Midwest” in late April or early May 2010.  Not much is known about this outbreak, at least publicly, because the health organizations involved in the investigation did not publicly reveal that the outbreak had occurred.  

Several weeks after the outbreak, however, Fresh Express recalled several types of ready-to-eat salads after Salmonella was found in a package tested by the U.S. Food and Drug Administration. The recalled products included lettuce mixes, Caesar salad and other salad kits, hearts of romaine and other items. The recall extended to products sold in 26 states: Alaska, Arizona, Arkansas, California, Colorado, Hawaii, Idaho, Iowa, Kansas, Louisiana, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Texas, Utah, Washington, Wisconsin and Wyoming.

Organicgirl Baby Spinach Recall:

Also in May 2010, Organicgirl Produce recalled a limited number of cases of 10 oz organicgirl Baby Spinach with an expired Use-by Date of May 22 and Product Code 11A061167 due to potential Salmonella contamination. The recall included only 336 cases of the 10 oz. package size of organicgirl Baby Spinach sold in six states: Alabama, North Carolina, Oregon, Wisconsin, Arizona and California.  Like the Fresh Express recall, Organicgirl recalled the baby spinach products due to a positive test for Salmonella in a random sample test collected and conducted by a third-party laboratory for the U.S. Food and Drug Administration.

Caldwell Sprouts Salmonella Newport Outbreak:

As of early June, at least 35 individuals had been infected with a matching strain of Salmonella Newport in 11 states after consuming raw alfalfa sprouts manufactured by Caldwell Fresh Foods of Maywood, CA.  The number of ill people identified in each state with this strain is as follows: AZ (2), CA (17), CO (1), ID (5), IL (1), MO (1), NM (1), NV (2), OR (2), PA (1), and WI (2). Among those for whom information is available about when symptoms started, illnesses began between March 1, 2010 and May 16, 2010. Case-patients range in age from <1 to 75 years old, and the median age is 36 years. Sixty-six percent of patients are female. Among the 30 patients with available hospitalization information, 7 (23%) were hospitalized. No deaths have been reported.

Los Dos Amigos Salmonella Outbreak:

Los Dos Amigos, a mexican restaurant in Roseburg, Oregon, was the site of a large salmonella outbreak in April. Douglas County health officials report that at least 30 people suffered culture-confirmed salmonella foodpoisoning illnesses, and that cross-contamination was probably a cause of the outbreak.  We filed suit on May 19 on behalf of a Roseburg, Oregon resident sickened in the Los Dos Amigos outbreak. We represent a number of other people sickened in the outbreak as well.

Casa Lopez Salmonella Outbreak:

The Athens City-County Health Department noticed a sharp uptick in Salmonella infection in early May 2010, and were able to trace the outbreak back to Casa Lopez, located at 1017 East State Street in Athens. At least 45 people had confirmed illnesses in the outbreak, with hundreds likely sickened who did not get tested.

Today, June 18, we filed suit on behalf of a victim of the outbreak, nineteen-year-old Tyler Nay, who ate at Casa Lopez on April 30 with his mother, who was visiting him for Ohio University Mom’s weekend. By early the next morning, he was suffering from nausea, vomiting, diarrhea, stomach cramps, chills, muscle aches, and headache. He sought medical help at the ER of Camden-Clark Memorial Hospital, and was treated and released. When his symptoms continued to worsen, he returned to the hospital and was admitted. A culture done while he was in the hospital revealed that he was infected with Salmonella. He remained hospitalized for four days.

Bullock's BBQ Salmonella Outbreak:

The Durham County Health Department (DCHD) investigated a foodpoisoning outbreak among persons who ate food prepared at Bullock’s Barbecue, located at 3330 Quebec Drive in Durham, in late April, 2010.  Ultimately, the N.C. State Public Health Laboratory was able to determine that the strain of salmonella involved in the outbreak was Salmonella enteritidis, likely introduced into the restaurant environment by contaminated eggs.  We represent multiple people for foodpoisoning illnesses suffered in this outbreak. 

Kentucky Salmonella Cluster:

And just today, the Madison County Health Department in Kentucky has announced an investigation into a cluster of Salmonella illnesses that has occurred over the past week and a half in the county.  Health Department spokesperson Christie Green says that the county has seen six cases recently that are all of the same strain.  “Epidemiologists believe the cases may be a cluster with a common source of infection,” Green said. “However, the source remains unidentified,” and health officials continue to investigate.

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The Illinois Subway Salmonella outbreak has claimed 90 confirmed foodpoisoning victims.  The 90 victims are from 28 separate counties, including Rock Island and Kane Counties, which are new additions to the Illinois Department of Public Health's list. 

Rock Island County Health Department issued this release today:

Rock Island County Health Department learned on Friday, June 18, that an East Moline Subway Restaurant may be involved in the recent Salmonella outbreak which has been occurring in other central Illinois counties in recent weeks. The individual ate at the Subway located at 681 42nd Ave, East Moline.

An individual who resides in Kane County has tested positive for Salmonella serotype Hvittingfoss, the type of Salmonella which has been diagnosed in 90 other individuals who consumed food in restaurants located in 28 Illinois counties. Those illnesses began after eating at certain Subway restaurants on or after May 10, 2010.

This Kane County resident ate at a Subway in East Moline, and also at a subway in Rochelle, IL, located in Ogle County. It is not possible to determine from which restaurant the illness originated. Therefore, steps are being taken to test staff from East Moline and Rochelle Subway locations for additional salmonella infection.

Rock Island County Health Department has not received any other reports of positive Salmonella cases, either of Rock Island County residents or of residents of other counties who ate at Subways located in Rock Island County.
 

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ConAgra Banquet Pot Pie 2007

In early June, 2007, four infections sharing a pulsed-field gel electrophoresis (PFGE) pattern were identified by the Pennsylvania Department of Health. As additional cases were reported, the initial investigation did not reveal the cause of the infections. A multistate, case-control study conducted in early October indicated that illness was associated with consumption of Banquet brand frozen, not ready-to-eat, pot pies. Further investigation determined that 77% of patients who ate these pies had microwaved them. Consumer confusion might have resulted in a failure to cook the product properly.

A voluntary recall was issued by ConAgra, the manufacturer on October 11, 2007, for all nine brands of pot pies produced at the implicated plant. The outbreak strain was isolated from at least thirteen samples of unopened Banquet pot pies collected from the homes of patients. All pies that tested positive were turkey pot pies. Two of the pies underwent separate testing of filling and crust. The filling tested positive and the crust tested negative for both pies. Cooking instructions were not validated to account for variability in microwave wattage and common misconceptions among consumers regarding the nature of not-ready-to-eat foods.

The involved plant had produced one million pies per day under various store brands. Frozen, not-ready-to-eat microwavable meals have been reported previously as vehicles in salmonellosis outbreaks. Despite an intensive investigation of the production plant and the ingredient suppliers, the source of the

Peter Pan and Great Value Peanut Butter Salmonella Outbreak

On February 14, 2007, the Centers for Disease Control and Prevention (CDC) and Food and Drug Administration (FDA) announced that there had been 290 cases of Salmonella infection in 39 states that were linked to the consumption of Peter Pan and Great Value brand peanut butter that was manufactured in ConAgra’s Georgia peanut butter plant. Any Peter Pan or Great Value brand peanut butter beginning with product code 2111 was recalled in response to the outbreak investigation.  Ultimately, over 700 confirmed illnesses occurred in the outbreak, and the outbreak strain of Salmonella Tennessee was isolated from several opened and unopened jars of ConAgra produced Peter Pan and Great Value peanut butter and from two environmental samples obtained from the Sylvester, Georgia ConAgra plant.

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ConAgra has issued a recall of Marie Calendars Cheesy Chicken and Rice Frozen Entrees due to potential contamination by Salmonella Chester.  The products were distributed nationally.  The recall is based on notification by the CDC of a possible association between the ConAgra product and eight people in the United States who have been diagnosed with salmonellosis linked to Salmonella Chester.  CDC interviews have identified individuals who reported eating this product in April and May, 2010. The last reported illness was reported on May 22.

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As the investigation continues into the cause of the 80 (and counting) Salmonella Hvittingfoss illnesses associated with Illinois Subway restaurants, the question arises of the possible role each Subway restaurant could have played in furthering the spread of the bacteria. 

With that in mind, a recent article by Nicole Norfleet caught my attention for its insight into the way that outbreaks such as Subway's can be made exponentially worse by poor food safety practices at the restaurant.

Her report details a study by Ben Chapman, an assistant professor and food safety specialist who used video cameras in eight restaurant kitchens to monitor worker food safety habits.  He found that a typical kitchen worker cross-contaminates food with potentially dangerous pathogens about once per hour.  "Among the risky behaviors cited were workers using aprons and other garments to dry hands, as well as using the same utensils and surfaces to prepare both raw and cooked foods, according to a review by a North Carolina State University researcher."  The article continues:

Joan McGlockton, a food policy representative for the National Restaurant Association, said that while the study is disconcerting, the association doesn't feel it is representative of the entire restaurant industry.

"We apply strong emphasis on employee training in areas of food safety to ensure that proper practices in hygiene, food handling and sanitation are in place in every food service outlet," she said in an e-mail.

Americans experience about 76 million foodborne illnesses a year. While most of these cases are mild and don't have long-term symptoms, foodborne illnesses cause about 5,000 deaths annually, according to the Centers for Disease Control and Prevention. From 1998 to 2004, the latest figures available, more than 50 percent of foodborne disease outbreaks reported to the CDC were associated with restaurants or delicatessens.

Cross-contamination happens when pathogens, such as salmonella and E. coli, are transferred from raw food or contaminated source to already prepared food. For example, when a cook uses the same knife to first cut raw chicken and then to slice a sandwich.

Chapman says the risky behaviors were most prevalent during busy periods. For example, some employees didn't attempt to wash their hands during lunch and breakfast rushes. Multiple workers using the same tools caused many of the cross-contaminations, according to the review published in the June issue of the Journal of Food Protection.

There was also some good news: Chapman found that posting information about food safety in kitchens and break rooms that gives employees examples of the consequences of poor food handling significantly reduced risky behaviors.

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No new cases to report in the Illinois Subway salmonella outbreak.  The official count of confirmed illnesses remains at 80.  Subway did step up to the plate though and apologized to sickened customers.  In a statement released today, Subway said:

We sincerely apologize to all Subway customers, those who have fallen ill, and those who now may hesitate to come back for a while," spokesman Kevin Kane noted. "We are truly sorry for the difficulty this situation has caused you, our customer, and are working diligently to solve this mystery and to regain your trust.

Also, Shannon Dininny wrote a great AP article today on the fight to regulate other strains of shiga-toxin producing e. coli than O157:H7 as adulterants in the meat supply.  Shannon highlighted the sad case of Shiloh Johnson, one of our clients sickened in E. coli O111 linked to the Country Cottage outbreak in Locust, Oklahoma in 2008. 

They're motivated by what has happened to people such as Shiloh Johnson, who two years ago picked at a roll, fried chicken, sunflower seeds and olives from a restaurant buffet. Within days, the 10-year-old was hooked to a ventilator in an Oklahoma hospital, one of 341 victims of an E. coli outbreak. She remained hospitalized for six weeks.

Investigators tied the outbreak to one of the six less common E. coli strains, and her mother, Belinda Johnson, has endorsed a petition that includes their story in urging the U.S. Department of Agriculture to test for additional E. coli strains.

The agency is reviewing the petition, filed by a Seattle law firm that represents Shiloh Johnson and is known for food-illness lawsuits.

"I was so shocked then. I thought that everything was tested for," Belinda Johnson said. "I want there to be a safe food supply. I don't want any other kids or anyone to have to go through this."
 

Traditional Foods Minnesota has halted operations while the Minnesota Department of Agriculture investigates potential violations of state law. One would naturally think of the potential link to the Hartmann Dairy raw milk E. coli O157:H7 outbreak when Minnesota and the state's natural foods movement appear in the same sentence. But Mike Hughlett, frequent food safety contributor for the Minneapolis Star Tribune, wrote today that, although raw milk appears to be a mainstay at Traditional Foods Minnesota, the Department of Agriculture says "there's no indication at this time of a link between the Agriculture Department's investigation of Traditional Foods and its investigation of Hartmann Dairy." Traditional Foods' alleged violations relate to licensing issues.

And finally, the Pennsylvania Department of Agriculture today suspended the liscense of Alvin J. Stoltzfus, who operates a farm in Paradise, Lancaster County, to sell raw milk. The suspension occurred due to tests by the Department of Ag that found Listeria monocytogenes bacteria in raw milk from the farm, prompting the Department of Ag to also issue an advisory to the public to discard any milk purchased from Stoltzfus's farm:

The Department of Agriculture today advised consumers who purchased raw milk from Alvin J. Stoltzfus, of Paradise, Lancaster County, to discard the product immediately because of potential bacterial contamination.

Raw milk is milk that has not been pasteurized.

A Department of Agriculture lab found Listeria monocytogenese in a milk sample taken from the dairy on June 7. The bacteria’s presence violates the Milk Sanitation Law.

Mr. Stoltzfus agreed with the department’s request to stop selling raw milk for human consumption.

Officials said Stoltzfus agreed to stop selling raw milk for human consumption. The department is moving to suspend his raw milk permit until additional samples are tested and found to be safe.
Also, the AP ran a great article today on the ongoing fight to . .  .

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In a surprising, but certainly commendable move, Subway today issued an apology to the 80 plus Illinois citizens sickened in a state-wide Salmonella Hvittingfoss outbreak.

"We sincerely apologize to all Subway customers, those who have fallen ill, and those who now may hesitate to come back for a while," spokesman Kevin Kane noted. "We are truly sorry for the difficulty this situation has caused you, our customer, and are working diligently to solve this mystery and to regain your trust."

Hopefully this means Subway will not be fighting its duty to pay for the medical bills and lost wages of those sickened after eating at its restaurant.

The Illinois Department of Public Health says people began getting sick after eating in Subway restaurants beginning May 11.

As of Tuesday, citizens from the following counties have been confirmed as part of this outbreak: Bureau, Cass, Champaign, Christian, Coles, DeKalb, DeWitt, Fulton, Henry, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Will and Winnebago.

The Hvittingfoss strain of Salmonella involved in the outbreak is an uncommon variety called Hvittingfoss. Typically, only 1 or 2 cases of this type appear in Illinois each year.

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The Pennsylvania Department of Agriculture today suspended the liscense of Alvin J. Stoltzfus, who operates a farm in Paradise, Lancaster County, to sell raw milk.  The suspension occurred due to tests by the Department of Ag that found Listeria monocytogenes bacteria in raw milk from the farm, prompting the Department of Ag to also issue an advisory to the public to discard any milk purchased from Stoltzfus's farm:

The Department of Agriculture today advised consumers who purchased raw milk from Alvin J. Stoltzfus, of Paradise, Lancaster County, to discard the product immediately because of potential bacterial contamination.

Raw milk is milk that has not been pasteurized.

A Department of Agriculture lab found Listeria monocytogenese in a milk sample taken from the dairy on June 7. The bacteria’s presence violates the Milk Sanitation Law.

Mr. Stoltzfus agreed with the department’s request to stop selling raw milk for human consumption.

Officials said Stoltzfus agreed to stop selling raw milk for human consumption. The department is moving to suspend his raw milk permit until additional samples are tested and found to be safe.

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The Illinois Department of Public Health (IDPH) now counts 80 cases in the Illinois Salmonella outbreak linked to Subway restaurants in 26 different counties.  The IDPH's web update states as follows:

Confirmed cases of Salmonella serotype Hvittingfoss – 80.

Age range of confirmed cases: 2 to 79.

Cases have reported eating at Subway restaurants located in 26 counties -- Bureau, Cass, Champaign, Christian, Coles, Dekalb, DeWitt, Fulton, Henry, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Will and Winnebago.

Investigation is ongoing. Numbers will be updated June 16, if additional cases are identified.
 

Foodpoisoning illnesses in Illinois have been rampant this year . . . particularly at Subway restaurants.  See Large Illinois Foodpoisoning Outbreaks in Recent Years.  So have the foodpoisoning lawsuits that inevitably follow the outbreaks.  No public announcement from Subway yet on the company's willingness to pay outbreak victim's medical expenses, which are undoubtedly substantial given the high rate of hospitalizations in this outbreak. 

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The salmonella outbreak at Illinois Subway restaurants has caused hundreds, if not thousands, of foodpoisoning cases.  The Illinois Department of Public Health currently counts 79 confirmed cases, 27 of whom had to be hospitalized for treatment (as of June 10, 7 remained hospitalized).  And if widely accepted estimates--in fact, CDC estimates--of true case counts in salmonella outbreaks are accurate (79 x 38.5), applying the same hospitalization rate (roughly 1/3) would mean that, of the approximately 3000 people who may have been infected in the outbreak, possibly one thousand people have been hospitalized for treatment in the outbreak.  (See, AC Voetsch, “FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States,”Clinical Infectious Diseases 2004;38 (Suppl 3):S127-34).

This is admittedly just speculation at this point, but it is speculation that is grounded in the most thorough studies ever done on the true scope, and cost, of foodpoisoning outbreaks, particularly salmonella.  Another recent study estimates that each salmonella illness (non-typhoidal, which includes Salmonella Hvittingfoss, the Subway outbreak strain) costs an average of $318 in medical expenses.  Thus, if the estimates in these studies are accurate, costs of treatment incurred to date in the Subway salmonella outbreak may total $954,000 ($318 x 3,000). 

Who will pay these costs?  The possibilities, of course, are private insurance carriers, state and federal governments (i.e. taxpayers), uninsured individuals who can ill-afford to be hit with thousands in medical costs, and Subway and/or the produce companies who sold Subway the contaminated produce item responsible for this outbreak.  Has Subway yet responded to our call, on behalf of outbreak victims, to pay these costs?

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The Chippewa Herald reports that a judge in Dane County Wisconsin has postponed ruling on a motion that "that could blow a hole through Wisconsin’s ban on raw milk sales."  Dane County Circuit Judge Patrick Fiedler was scheduled to rule in the case on Tuesday involving Grassway Organic Farm’s claim that the state has no right to stop them from selling raw milk to customers who have become part-owners of the farm.

 

Maybe the judge was waiting to see the Farm to Consumer Legal Defense Fund's response to the FDA's motion to dismiss the Fund's suit for declaratory and injunctive relief against the FDA's ban on interstate sale of raw milk.  This is a separate case in federal court in Iowa.  The Fund was granted additional time to respond to the FDA's motion to dismiss, and had until June 14, I believe (have not checked filings in the last couple of days). 

The Fund describes its suit as follows:

The Farm-to-Consumer Legal Defense Fund has filed suit against the U.S. Food and Drug Administration (FDA) and its parent agency, Health and Human Services (HHS), claiming that FDA's regulation banning the interstate transport of raw milk and raw dairy products for direct human consumption constitutes several violations of the United States Constitution and federal law. FDA has responded by filing a motion to dismiss, arguing, among other things, that there is no fundamental right to travel across state lines with raw milk in one's possession, and that there is no fundamental right to consume the food of one's choice or to give one's family members the food of one's choice. The Fund is in the process of responding to FDA's motion. Once the matter is fully briefed to the court, a decision will be issued on whether the Fund's case should or should not be dismissed. The Fund anticipates its case will not be dismissed and that the next phase of the case will go forward.

The Fund's response actually has nothing to do with the Judge's postponement in Dane County Wisconsin.  It will be interesting to monitor both suits though. 

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The Salmonella Hvittingfoss outbreak linked to Illinois Subway restaurants has sickened 79 people with confirmed foodpoioning illnesses.  Of course, 79 confirmed cases meanspossibly thousands of unconfirmed illnesses.  The Illinois Department of Public Health's update today states as follows:

Confirmed cases of Salmonella serotype Hvittingfoss – 79.

Age range of confirmed cases: 2 to 79.

Cases have reported eating at Subway restaurants located in 26 counties -- Bureau, Cass, Champaign, Christian, Coles, Dekalb, DeWitt, Fulton, Henry, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Will and Winnebago.

Investigation is ongoing. Numbers will be updated June 15, if additional cases are identified.
 

Sheila Shelton of the Pontiac Daily Leader reported on a newly found outbreak case in Livingston County, Illinois, quoting the County's Public Health and Education Director Linda Rhodes, "“We have a confirmed case of this type of salmonella and, yes, it is the same type that is being reported from around the state associated with Subway restaurants."  Rhodes was also careful to point out that further testing on the stool isolate of the infected individual had not yet been done, and that the case couldn't yet be counted as confirmed as a result.  But in a state that sees Salmonella Hvittingfoss only a time or two a year, odds are that any Salmonella Hvittingfoss illnesses in the state right now are as a result of infection, or secondary infection, at a Subway restaurant. 

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Additional testing of environmental, animal samples finds outbreak strain

State health officials have identified three additional cases of E. coli O157:H7 illness in Minnesotans linked to consumption of raw milk or other dairy products from a dairy farm in Gibbon, Minnesota.

Since May 26, including the new cases, a total of eight E. coli O157:H7 cases in seven different homes have been linked to products from the Hartmann Dairy Farm.

Two of the newly identified cases occurred in school-aged children who consumed milk from the Hartmann Dairy Farm. Both cases had E. coli O157:H7 with the same DNA fingerprint as five earlier cases associated with dairy products from the Hartmann farm. The other newly reported case occurred in an infant living in the same household as one of the earlier five cases. The infant had a confirmed case of E. coli O157:H7, but no stool sample was available for genetic fingerprinting in the MDH lab.

Symptoms of E. coli O157:H7 illness include stomach cramps and diarrhea, which may be bloody. People typically become ill two to five days after eating contaminated food. E. coli O157:H7 disease sometimes leads to a serious complication called hemolytic uremic syndrome (HUS), which can cause kidney failure and other severe problems, including death. HUS can occur a week or more after the onset of diarrhea. Those most at risk of developing complications from E. coli include the very young, the elderly, and people with weakened immune systems.

Health officials said today that 28 environmental and animal samples obtained by the Minnesota Department of Health from the Hartmann farm have now tested positive for E. coli O157:H7. Twenty-six samples had the same DNA fingerprint as the outbreak strain of E. coli O157:H7. These additional positive samples include environmental samples from the dairy barn where the cows are milked. The DNA fingerprint is unique among the more than 3,000 isolates of E. coli 0157:H7 tested at the Minnesota Department of Health since 1993. This strain of E. coli O157:H7 has not previously been found in Minnesota.

Consumption of raw milk and other raw dairy products has been associated with outbreaks in Minnesota as well as in other states. Raw milk-related illnesses have been caused by E. coli, Campylobacter, Salmonella and Listeria.

Anyone who has experienced illness after consuming raw dairy products should consult their health care provider.

-MDH-

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According to the Illinois Department of Health:

Confirmed cases of Salmonella serotype Hvittingfoss – 71.

Age range of confirmed cases: 2 to 88.

Cases have reported eating at Subway restaurants located in 22 counties -- Bureau, Cass, Champaign, Christian, Coles, Dewitt, Fulton, Knox, La Salle, Macon, Marshall, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Winnebago, and Will.

Investigation is ongoing. Numbers will be updated June 11, if additional cases are identified.

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Senator Durbin's statement today hit the nail on the head with regard to food safety:

Assistant Senate Majority Leader Dick Durbin (D-IL) said today that the recently released National Academy of Sciences report, “Enhancing Food Safety: The Role of the FDA” highlights the need for an overhaul of the nation’s current food safety system.

The 500-page report highlights several shortcomings at Food and Drug Administration (FDA), including:

* outdated legal authority for the agency – specifically no mandatory recall authority or ability to ban food imports from foreign countries when there is a risk of contamination;

* failure to employ a risk-based approach to identify the greatest threats for food contamination;

* too few inspections of food processing facilities and an inefficient use of inspection resources; and

* failure to effectively co-ordinate with states to conduct facility inspections.

Durbin and Sen. Herb Kohl (D-WI) led the effort to require the National Academy of Science’s Institute of Medicine to conduct a comprehensive review of FDA’s food safety system and report to Congress on its findings.

“In recent years, we’ve seen a growing number of major threats to our food safety system –from peanut butter spiked with salmonella to spinach laced with e-coli and chili loaded with botulism. These are not isolated incidents, and this National Academy of Sciences report reveals a food safety system that is outdated, inefficient and overwhelmed,” said Durbin. “Congress must give the FDA the necessary tools and resources to bring food safety oversight into the 21st Century.”

Durbin is the co-author of the FDA Food Safety Modernization Act, legislation that will provide a comprehensive approach to food safety in order to prevent future illness and death due to food-borne illness. The bill addresses head-on some of the issues surrounding food recalls by increasing the frequency of inspections at all food facilities; giving the FDA expanded access to records and testing results, and allowing the FDA to recall dangerous food products in the event a company fails to recall a product at the FDA’s request.

“This report is one of the clearest statements we have seen that the FDA’s approach to keeping our nation’s food supply safe is in desperate need of a thorough overhaul. Food-borne illnesses caused by salmonella and e-coli contamination contribute to more than 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States each year,” said Durbin. “We cannot allow that to continue.”

Durbin teamed up with Senators Judd Gregg (R-NH), Richard Burr (R-NC) and the late Ted Kennedy (D-MA) to introduce bipartisan legislation last year to revamp the Food and Drug Administration’s food safety system. The bill is also cosponsored by Senators Chris Dodd (D-CT), Lamar Alexander (R-TN), Amy Klobuchar (D-MN), Mike Enzi (D-WY), Tom Harkin (D-IA), Orrin Hatch (R-UT), Jeff Bingaman (D-NM), John Isakson (R-GA), Roland Burris (D-IL), Kristin Gillibrand (D-NY), Tom Udall (D-NM), David Vitter (R-LA) and Saxby Chambliss (R-GA). Action on the bill is slated for later this summer.
 

Durbin has a vested interest, politically and otherwise, in this important piece of legislation.  His home state of Illinois has been battered by two large outbreaks, one due to Shigella bacteria and the other still being investigated, due to Salmonella, at Subway restaurants statewide.  See:

Illinois Subway Salmonella outbreak case count up to 68; and

Shigella outbreak at Lombard, Illinois Subway

 

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The Salmonella outbreak at Subway restaurants around the state of Illinois has claimed 68 confirmed victims--a number that will probably continue to grow as more and more illnesses are identified as part of the Subway Salmonella outbreak.

The Illinois Department of Public Health's updated announcement states as follows:

Salmonella Update
(as of 12 p.m., June 9, 2010)

Confirmed cases of Salmonella serotype Hvittingfoss – 68.

Age range of confirmed cases: 2 to 88.

Cases have reported eating at 30 Subway restaurants located in 24 counties - Bureau, Cass, Champaign, Christian, Coles, DeWitt, Fulton, Knox, LaSalle, Lee, Livingston, Macon, Marshall, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Winnebago and Will.

The investigation is ongoing. Numbers will be updated Thursday, June 10. 

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Below is the genetic fingerprinting analysis (PFGE patterns) of the E. coli O157:H7 samples that tested positive in humans involved in the Hartmann Dairy E. coli O157:H7 outbreak, as well as cows (though, according to Hartmann'statements, not cows that contributed milk to the batch linked to the outbreak), and environmental samples at the farm.

The Minnesota Department of Health, in connection with the Department of Agriculture's investigation, has laid out the case against Hartmann Dairy in the outbreak, addressing pretty much relevant epidemiological question about the outbreak. 

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The Hartmann Dairy Farm, which has been linked by Minnesota Public Health officials to an outbreak of E. coli O157:H7 that has sickened 5 people, at least one critically, released a statement today:

"As of today, there is no evidence of any harmful bacteria in any raw milk, cheese, meat or other product sampled from the Hartmann Farm," the statement said. "The State has engaged in a serious regulatory and potentially criminal action in a grossly negligent manner with total disregard for the defamatory content of their media campaign."

A better statement would have been, "As of today, we remain deeply apologetic and feel great remorse that a product from our farm has caused human suffering, particularly for the young child who developed hemolytic uremic syndrome. While we feel health officials have unfairly treated our farm, we recognize that there was a problem with a product that we sold, and we pledge to analyze our production, bottling, and handling practices to ensure that the same problem never happens again."

Perhaps a major reason for the deep division between the opposing sides on the raw milk issue is the deny, deny, deny approach that many of the product's most vocal proponents (including the Weston A Price Foundation) have encouraged in retrospective analysis of raw milk outbreaks. They haven't said much lately, but the Hartmann Dairy's PR blunder today is reminiscent of this myopic, uneducated, and most of all totally insensitive approach (particularly to the families of children whose kidneys are failing) to analyzing a problem within the raw dairy industry.

Sometimes the weight of the epidemiological evidence is insurmountable, and although the final reports have not yet been released on this outbreak, the Minnesota Departments of Health and Agriculture employ some of the most talented disease sleuths in the world. Take umbrage with the different treatment of raw milk and other products, but don't offend the families of those who are ill and may suffer from lifelong kidney problems by saying "it wasn't us."  Yes it was.
 

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The Illinois Department of Health's very brief situation update today gives the impression that we do not yet know the full scope of what may become a very major outbreak.  IDPH latest announcement on the Subway salmonella outbreak states as follows: 

"Confirmed cases of Salmonella serotype Hvittingfoss – 60. Age range of confirmed cases: 2 to 88. Cases have reported eating at Subway restaurants located in 22 counties -- Bureau, Cass, Champaign, Christian, Coles, DeWitt, Fulton, Knox, LaSalle, Macon, Marshall, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Winnebago and Will. "

The resemblance to this year's Shigella outbreak at a Subway restaurant in Lombard Illinois is strikingly similar . . . and not just because it involves Subway restaurants in Illinois again.  Subway sandwiches, with so many common ingredients eaten raw at so many different locations, are the perfect recipe for widespread foodpoisoning outbreaks where lots of people fall ill.  The Lombard Subway shigella outbreak was almost certainly caused by general lack of sanitation and handwashing, which caused the shigella bacteria present in the restaurant environment to proliferate.  Multiple lawsuits are currently pending in Dupage County Courts as a result of the first Illinois Subway outbreak.

In the current Subway Salmonella outbreak, the distribution of cases would indicate that the problem is a common ingredient, not necessarily improper sanitation or food handling procedures.  Whatever the case, the convenient sandwiches serve as effective mediums for the transmission of disease-causing organisms, and they are once again implicated in a major foodpoisoning outbreak.

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Food safety experts and the public have criticized the FDA’s food safety system and questioned whether it properly safeguards Americans from foodborne
diseases. Thus, Congress asked the Institute of Medicine (IOM) to examine the gaps in the current food safety system under the purview of the FDA and to identify the tools needed to improve food safety. Although the FDA recently created the Office of Foods to oversee and coordinate all food policy efforts within the agency, the FDA’s approach to food safety continues to be reactive, lacking a systematic focus on prevention. The IOM committee’s report, Enhancing Food Safety: The Role of the Food and Drug Administration, suggests that the FDA lacks a comprehensive vision for food safety and says it should change its approach in order to properly protect the nation’s food.

Loosely translated, the Institute of Medicine's consensus report finds that the FDA simply cannot protect this country's food supply in the modern world, and that the approach needs to change before things get worse . . . or just stay the same.  Some of the IOM's specific findings and suggestions:

1.  The agency should use a risk-based approach to evaluate food safety problems rather than its current reactive approach to food safety.

2.  The FDA should define the roles of all responsible parties, including suppliers, farmers, retailers, consumers, and government agencies among others. The FDA also should develop a comprehensive, transparent strategy for choosing the level and intensity of policy interventions, which can range from setting standards to educating the public.

3.  The FDA has limited analytical expertise and lacks the infrastructure to collect, analyze, interpret, manage, and share data, thus precluding the FDA from using data to support decision making. It is critical that the FDA evaluate its food safety data needs including surveillance, behavioral, economic, food production, and other data based on a risk approach. The FDA reports that sharing data among government agencies is difficult; therefore, the committee recommends that the FDA review the data sharing statutes and policies and develop plans to improve the sharing of data in a timelier manner by all federal, state, and local food safety agencies.

4.  Food safety activities, such as inspections, surveillance, and outbreak investigations, are divided between the states and the federal government. The states are responsible for foods produced or sold within their borders and the federal government shares jurisdiction with the state and local governments for food transferred across state borders. However,these systems are not well integrated; a more integrated system would minimize duplication of food safety activities by leveraging the efforts of the state and local governments. In an effort to normalize and integrate food safety practices across the nation, the FDA should provide
standards to states and localities and oversee their implementation.

5.  The FDA’s Office of Foods needs direct authority over the inspectors who work in the field, to minimize substantial delays in policy implementation that affect how inspections are conducted. Also, to increase efficiency, the FDA should streamline inspections to ensure that the amount of time and rigor used to inspect a facility is based on risks to the public’s health and should set minimum standards for the frequency and intensity of the inspections of all facilities. Since a number of food safety inspections already are conducted at the state and local levels, the committee recommends that, once their food safety programs and activities meet federal standards, the FDA conduct fewer inspections and instead delegate them to the states and localities. A small group of inspectors should remain within the FDA to audit inspections, provide specialty expertise, develop training material for inspectors, and conduct inspections in situations of special need.

6.  In order for the FDA to better ensure food safety, legislative and organizational
changes are necessary. Most notably, Congress should consider taking legislative action to provide the FDA with the authority it needs to fulfill its food safety mission. Within the FDA, authority over field activities should shift from its Office of Regulatory Affairs to its Office of Foods. Such a change will ensure that responsibility lies with well-trained personnel with specialized expertise in food safety and risk-based principles of food safety management.

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Though some Saratoga Springs residents have continued to report illness in recent weeks, the campylobacter outbreak widely believed to have been linked to contaminated water appears to be coming to an end.  Joy Holbrook, a nurse epidemiologist with the Utah County Department of Health, reports that "We're thinking that the outbreak is decreasing out there; It has been several days since we've had any new cases from Saratoga Springs."  Most illnesses in the outbreak occurred in the month of May, causing a boil water order to be issued on May 14 and rescinded several days later.

Nevertheless, as Justin Ritter at the Deseret News reports, some Saratoga Springs residents are still reporting illness. Because the health department only receives cases of Campylobacter confirmed in a laboratory, Holbrook said there "may be some people who are sick that we are not aware of, who have not been tested."

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The Illinois Department of Public Health (IDPH) today reported 48 cases of Salmonella ser. Hvittingfoss associated with the ongoing investigation of illnesses among customers who ate at certain Subway restaurants in Illinois. All cases are recovering, of which 17 had been hospitalized.

As of today, Salmonella cases identified in this outbreak reported eating at Subway locations in 18 counties, including Bureau, Cass, Champaign, Christian, Coles, Fulton, LaSalle, Macon, Marshall, Moultrie, Ogle, Peoria, Sangamon, Schuyler, Shelby, Tazewell, Warren, and Will. At this point in the investigation, no cases have reported eating at Subway restaurants in the southernmost portion of Illinois. Illnesses are reported to have started between May 11 and May 25 and cases range in age from three-years to 88-years-old.

At this time, a specific food source has not been identified in association with this outbreak. The Illinois Department of Public health is working closely with the Food and Drug Administration, the Centers for Disease Control and Prevention, the Subway restaurant chain and local health departments throughout the state to identify the source of illness.

The specific type of Salmonella involved in this outbreak is an uncommon serotype called Hvittingfoss. Typically, only one to two cases of this type of Salmonella are seen in Illinois per year.

 

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Illinois has been no stranger to large foodpoisoning outbreaks in recent years.  Currently, the Illinois Department of Public Health is investigating a major salmonella hvittingfoss outbreak likely linked to a produce item served at Subway restaurants in 14 Illinois counties.  To date, there are 34 confirmed illnesses in the outbreak.  Here are several other examples of major foodpoisoning outbreaks in Illinois since 2003:

Subway, Lombard, Illinois 2010

On March 4, 2010, a Subway restaurant in Lombard, Illinois closed in the midst of a large Shigella outbreak that ultimately caused at least 125 confirmed illnesses, and likely hundreds of other illnesses. The restaurant remained closed for over a month during the Dupage County health department's investigation. The results of Dupage County's investigation have not yet been disclosed, but it is widely suspected that cross-contamination by ill employees was a cause of the outbreak.

Pars Cove, Taste of Chicago, 2007

According to the Chicago Department of Health, over 700 people became ill after they ate food purchased from the Pars Cove booth at the 2007 Taste of Chicago festival.  The strain of Salmonella involved in the outbreak was Salmonella Heidelberg, which is a far more common strain than the Salmonella hvittingfoss strain involved in the current Subway outbreak.  Many people in the Pars Cove outbreak required hospitalization, and a few continue to suffer from either irritable bowel syndrome or reactive arthritis as a result of their infections. 

Chili's, Vernon Hills 2003

And In June 2003, a large Salmonella outbreak occurred in Vernon Hills, Illinois, a Chicago suburb. The outbreak occurred at a Chili's restaurant, and the conditions found at the restaurant were memorably appalling. Here is a short summary of the 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.
 

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As of Monday morning, June 7, the case-count in the Illinois Subway Salmonella outbreak remains at 34 people.  The 34 cases reported eating at Subway restaurants in 14 Illinois counties, including Sangamon, Schuyler, Christian, Bureau, LaSalle, Cass, Champaign, Peoria, Shelby, Warren, Macon, Ogle, Fulton and Tazewell. Subway restaurants in the northeastern and southernmost portions of Illinois do not seem to be associated with the outbreak, as none of the 34 confirmed cases report having eaten at Subway restaurants in those areas.  Illnesses are reported to have started between May 14 and May 25 and cases range in age from six-years to 88-years-old.

The specific type of Salmonella involved in this outbreak is a rare serotype called Hvittingfoss. Typically, only one to two cases of this type of Salmonella are seen in Illinois per year.  Although there has been no positive or confirmed association with a specific product, the SUBWAY® restaurant chain has voluntarily withdrawn all lettuce, green peppers, red onion and tomatoes, from the suspected dates from its restaurants and has replaced the product with new, fresh produce.

Case-counts in Salmonella outbreaks are often a poor indicator of how large an outbreak really is.  For Salmonella specifically, the CDC estimates that the number of actual illnesses--as opposed to only "confirmed" illnesses (i.e. persons having a positive stool sample matching the outbreak strain of bacteria)--is as many as 38.6 times the number of confirmed illnesses.  Thus, on the high end, possibly a more accurate estimate of the number of ill people in the Illinois Subway Salmonella outbreak is over 1,300 people, as there are many reasons--including no medical treatment, no stool sample, or a false negative result from a tested stool sample--why ill people may not be counted as confirmed cases.

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State of Illinois health officials say that the 7th street Subway location in Rochelle is being investigated because of two cases of Salmonella reported in Ogle County. Health officials are investigating the foodpoisoning reports, trying to determine whether they are linked to the Salmonella outbreak linked to Illinois Subway restaurant locations. 

The attorney for this shop issued a statement, according to Kimberly Brown at WIFR.com, stating that the Rochelle location has taken precautionary measures by destroying lettuce, green peppers, red onions, and tomatoes that are suspected ingredients for the outbreak. Ms. Brown further reports that Subway corporate managers said all Subway locations have done this, issuing a statement today explaining that Subway has high standards for produce vendors, and that all produce is checked by Subway and by third party auditors.

Ms. Brown also reports on a suspected victim of the outbreak named Candy Johnstone.  Ms Johnstone ate a veggie sub from the 7th street Subway restaurant in Rochelle several weeks ago--during the heart of the outbreak.  She thereafter fell ill with gastrointestinal symptoms suggestive of a Salmonella infection.  She recalls, “I was either sleeping or in the bathroom. It was just terrible pains, and by Sunday I realized it was worse than a flu or common cold or something so I went to the emergency room."  

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As of 11:00 PM EDT on June 2, 2010, a total of 35 individuals infected with a matching strain of Salmonella Newport have been reported from 11 states since March 1, 2010. The number of ill people identified in each state with this strain is as follows: AZ (2), CA (17), CO (1), ID (5), IL (1), MO (1), NM (1), NV (2), OR (2), PA (1), and WI (2). Among those for whom information is available about when symptoms started, illnesses began between March 1, 2010 and May 16, 2010. Case-patients range in age from <1 to 75 years old, and the median age is 36 years. Sixty-six percent of patients are female. Among the 30 patients with available hospitalization information, 7 (23%) were hospitalized. No deaths have been reported.

Collaborative investigative efforts of many local, state, and federal public health, agriculture, and regulatory agencies have linked this outbreak to eating raw alfalfa sprouts. Interviews of case-patients found that most reported eating raw alfalfa sprouts before becoming ill. Some case-patients reported eating sprouts at restaurants; others purchased sprouts at grocery stores. The initial investigation traced the implicated raw alfalfa sprouts to a single sprout processor, JH Caldwell and Sons Inc., in Maywood, California. Investigations are currently ongoing at the sprout processor.

 

 

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The Subway foodpoisoning outbreak that caused at least 34 confirmed Salmonella illnesses has left 14 people hospitalized.  Fortunately, all were discharged and there are no known deaths, but 14 of 34 is a high hospitalization rate for Salmonella.  Incidentally, the strain of bacteria involved in the outbreak is extremely rare; it is one of some 2,000 different strains of Salmonella, and is called Salmonella Hvittingfoss. 

                              

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The Illinois Salmonella outbreak at Subway restaurants is certainly the beneficiary of multiple epidemiological factors that have helped the Illinois health department identify the outbreak, and hopefully stop the spread of illness.

1.  The strain of Salmonella involved in the Subway Salmonella outbreak is called Salmonella Hvittingfoss.  This is a rare strain of Salmonella; in fact, it is one of approximately 2,000 different strains of Salmonella.  Hvittingfoss is seen only a couple of times annually in the State of Illinois, according to health officials.  Thus, when a bunch of people began testing positive for the rare strain of Salmonella at roughly the same time and in many different counties throughout the central part of the state, health officials knew that an outbreak was underway. 

2.  Another circumstance that was surely helpful to investigating health officials in the Subway salmonella outbreak is that, for now at least, the outbreak appears to have been limited to only Subway restaurants.  Had people been exposed to the rare strain of bacteria at multiple different restaurants, it would have been much more difficult to contain the spread of disease, as there would have been a less defined pattern of illness. 

3.  Confirmed Salmonella illnesses in this outbreak occurred between May 14 and 25, when health officials nationally, and particularly in the upper midwest, were undoubtedly on alert for Salmonella and other foodpoisoning outbreaks linked to produce.  Other states in Illinois' neighborhood, including Michigan and Ohio, had recently been embroiled in a large E. coli outbreak linked to romaine lettuce; in early May, Fresh Express lettuce products caused an undisclosed number of illnesses in the "upper midwest"; and on May 24, Fresh Express announced a recall of romaine-based lettuce and salad products due to potential Salmonella contamination.

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Subway.  Foodpoisoning.  Illinois.  Again.  It seems like we were just talking about a major foodpoisoning outbreak linked to a Subway restaurant in Illinois.  Today, the Illinois Department of Public Health issued a press release stating that it is investigating at least 34 different Salmonella illnesses in 14 different counties.  Notably, the Department's press release states that Subway, who has been cooperative thus far, "has voluntarily withdrawn all lettuce, green peppers, red onion and tomatoes, from the suspected dates from its restaurants and has replaced the product with new, fresh produce."

Another produce outbreak underway?  The distribution of outbreak cases, not to mention recent lettuce recalls and other events, certainly make it seem so. 

Residents of Illinois, and the Subway restaurants that they frequent, have had a rough year when it comes to major foodpoisoning outbreaks.  On March 4, 2010, a Subway restaurant in Lombard, Illinois closed in the midst of a large Shigella outbreak that ultimately caused at least 125 confirmed illnesses, and likely hundreds of other illnesses.  The restaurant remained closed for over a month during the Dupage County health department's investigation.  The results of Dupage County's investigation have not yet been disclosed, but it is widely suspected that cross-contamination by ill employees was a cause of the outbreak. 

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The Illinois Department of Public Health and local health departments throughout the state are investigating the cause of Salmonella illnesses among customers who ate at certain Subway restaurants in Illinois. To date, 34 cases of Salmonella have been confirmed with this outbreak and all are recovering, of which 14 had been hospitalized.

Salmonella cases identified in this outbreak reported eating at Subway locations in 14 counties, including Sangamon, Schuyler, Christian, Bureau, LaSalle, Cass, Champaign, Peoria, Shelby, Warren, Macon, Ogle, Fulton and Tazewell. At this point in the investigation, no cases have reported eating at Subway restaurants in either northeastern or southernmost portions of Illinois. Illnesses are reported to have started between May 14 and May 25 and cases range in age from six-years to 88-years-old.

The specific type of Salmonella involved in this outbreak is a rare serotype called Hvittingfoss. Typically, only one to two cases of this type of Salmonella are seen in Illinois per year.

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Last week, Minnesota Department of Health announced an E. coli O157:H7 outbreak linked to raw milk produced at the Hartmann Dairy in Gibbon, Minnesota.  At least 5 people from across the state with confirmed E. coli O157:H7 infections had reported recent consumption of raw milk from Hartmann Dairy.  The DNA from the E. coli positive stool samples indicated a common source as well.  Together, these circumstances provided already strong epidemiological evidence that the dairy's milk was the source of infection. 

Today, the Minnesota Department of Agriculture (MDA) confirmed that earlier conclusions about the source of this outbreak were, in fact, correct.  In a press release, the MDA states as follows:

This strong epidemiological link is now reinforced by the laboratory confirmation that the specific strain of E. coli O157:H7 found in the ill patients has also been found in multiple animals and at multiple sites on the Hartmann farm. This strain of E. coli has not previously been found in Minnesota. Furthermore, laboratory tests confirmed that cheese samples collected last week from the farm contained another form of Shiga toxin-producing E. coli, demonstrating that an ongoing pathway of contamination existed on the farm.

The test results underscore the dangers of consuming milk that has not been pasteurized to eliminate E. coli and other potentially deadly bacteria. Leading public health organizations such as the Food and Drug Administration, the Centers for Disease Control and Prevention, the American Medical Association, the World Health Organization and the American Academy of Pediatrics all advocate pasteurization as a standard public health practice.

“Raw milk presents a serious health risk,” said Minnesota Health Commissioner Dr. Sanne Magnan. “This risk isn’t a matter of personal opinion; it’s an established scientific fact. Drinking raw milk or eating products made from raw milk can expose consumers to a variety of organisms that can result in anything from a few days of diarrhea to kidney failure and death. Raw milk is especially dangerous for children, whose immune systems can’t fight off infection as well as healthy adults.”

In addition to the cases linked to the Hartmann farm, MDH is investigating several other illnesses with a connection to products from the farm. MDA has embargoed dairy products on the Hartmann farm, prohibiting movement or release of the products off the farm.
 

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At least 15 Salmonella illnesses among residents or visitors to Chico, California have been linked to the Margarita Mix-Off event held at Manzanita Place on May 8.  Health authorities have been unable, thus far, to pinpoint the precise source of the bacteria; food at the mix-off event was served by at least six separate local restaurants. 

It was originally suspected, both here and by local health officials, that the Chico salmonella illnesses were part of the national sprouts outbreak that occurred in May, sickenening at least 11 California residents and prompting a large recall by Caldwell Fresh Foods, of Maywood California.  Genetic testing on bacteria isolated from several of the Chico salmonella victims' stool, however, showed that the strain involved in Chico was different than the strain involved in the sprouts outbreak. 

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The Benton-Franklin Health District is investigating a report of an adult who became sick from salmonella about a week ago, health officials said.  Investigators have not yet discovered the source of the salmonella, but are actively investigating any possible links between this Salmonella case and any other likely foodpoisoning cases recently.  

In other words, the epidemiological investigation into this salmonella illness is underway.  In addition to investigating whether any other confirmed Salmonella cases had similar food exposures to the infected individual, health officials will examine the actual DNA fingerprint of the particular strain of Salmonella involved.  This will allow them to better gauge the individual's relationship not only to local outbreaks of foodborne or waterborne disease, but also outbreaks that are national in scope. 

Epidemiology is the study of factors affecting the health and illness of populations, and serves as the foundation and logic of interventions made in the interest of public health and preventive medicine. It is considered a cornerstone methodology of public health research, and is highly regarded in evidence-based medicine for identifying risk factors for disease and determining optimal treatment approaches to clinical practice. In the study of communicable and non-communicable diseases, the work of epidemiologists ranges from outbreak investigation to study design, data collection and analysis including the development of statistical models to test hypotheses and the documentation of results for submission to peer-reviewed journals. Epidemiologists also study the interaction of diseases in a population, a condition known as a syndemic. Epidemiologists rely on a number of other scientific disciplines such as biology (to better understand disease processes), biostatistics (the current raw information available), Geographic Information Science (to store data and map disease patterns) and social science disciplines (to better understand proximate and distal risk factors).

See http://en.wikipedia.org/wiki/Epidemiology

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After a decade making great progress in the control of E. coli and other bad bugs in its products, the beef industry has seen its progress eroded over the last several years.  Beef companies recalled over twenty-nine million pounds of meat in 2007. 2008 saw at least sixteen recalls of beef products, totaling at least 2,361,295 pounds of meat. And in 2009, beef companies recalled almost 2 million pounds of meat due to various contamination and processing problems.  

It is almost summer, even in Seattle, and foodpoisoning illnesses do not generally slow down during summer months--particularly E. coli O157:H7 infections from ground beef.  "The theory is that animals are carrying higher levels of E. coli during the summer months, and sometimes they may overwhelm the systems in place to control pathogen contamination in (processing) plants," said James Marsden, a professor of food safety and security at Kansas State University, in a February 2010 USA Today article by Elizabeth Weise.  What will summer 2010 bring?

Escherichia coli (E. coli) are members of a large group of bacterial germs that inhabit the intestinal tract of humans and other warm-blooded animals (mammals, birds). Newborns have a sterile alimentary tract, which within two days becomes colonized with E. coli.  Between 5 and 10% of E. coli infections ultimately cause hemolytic uremic syndrome (HUS).

Post-diarrheal hemolytic uremic syndrome (D+HUS) is a severe, life-threatening complication that occurs in about 10 percent of those infected with E. coli O157:H7 or other Shiga toxin- (Stx-) producing E. coli. D+HUS was first described in 1955, but was not known to be secondary to E. coli infections until 1982. It is now recognized as the most common cause of acute kidney failure in infants and young children. Adolescents and adults are also susceptible, as are the elderly, who often succumb to the disease.

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Stir Fry 88, a small Chinese food establishment in The Lakes Mall in Muskegon County, Tennessee had its food service license revoked last week by Muskegon County’s three-person hearing board.  The restaurant had a history of repeat violations related to sanitation, cleanliness, and food handling procedures.  The restaurant lacked any institutional control, for which it was rewarded with closure, hopefully on a permanent basis.

Among the specific violationsthat health inspectors repeatedly found throughout the enforcement process dating back to 2007 were temperature abuses — not keeping cold items cold enough or not getting hot items hot enough — not properly sanitizing dishes, failure to “exert active managerial control” of its food safety management system, failure to correct critical violations and failure to submit a risk control plan. 

Good riddance.

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With enough on our plates already (Freshway lettuce, salmonella sprouts, petition on non-O157 E. coli, etc.), we don't report too much on international food poisoning and food safety events . . . with a few exceptions of course (e.g. listeria in Canada and China food safety).  But since global markets have global consequences, it's good to know what's going on elsewhere too.

Registering on Barfblog recently was a Salmonella outbreak in France linked to dry sausage. 

The institute for sanitary surveillance is now investigating an outbreak of salmonellosis from Salmonella 4,12 :i :-, in collaboration with the concerned partners: the National Center for Salmonella Reference, The Laboratory for studies and research on food quality and processing from the French Food Safety Agency (AFSSA), the General Management of Health, and the General Management of Food. As of May 28, 2010, 88 cases of salmonellosis tied to this outbreak have been identified, of which 46 women and 42 men, aged from 1 to 89 years old (median age 8 years old). These cases are from 49 departments in France (Figure 1, below, left).

Forty-four cases have been investigated to date. Among these, 18 people have been hospitalized and have since returned home.

For the investigated cases, the symptoms appeared between March 15 and May 9, 2010.

The questioning of patients about the food they consumed during the 7 days preceding their illness showed a high frequency of consumption of dry sausage bought from the same brand.

Of course, this outbreak hits close to home because of the recent Salmonella newport and montevideo outbreak linked to sausage manufactured by Daniele Inc., and red and black pepper from Mincing Overseas and Wholesome Spice companies.  The Daniele, Mincing, and Wholesome outbreak ultimately caused 272 confirmed cases of foodpoisoning--i.e. Salmonella infection, sickening people from July 2009 through April 2010.  The outbreak resulted in a widespread recall of salami and pepper products. 

No word yet as to the specific cause of the French outbreak, and it appears, using a little epidemiological logic, that the outbreak only concerns sausage products from one company, rather than there being a problem with one of the sausages' constituent ingredients, like in the Daniele, Mincing, and Wholesome outbreak. 

 

A traceback showed that these sausages came from the same batch produced in a single firm in France, distributed nationally during the first two weeks of March 2010. The best by date for this batch extends from June 1 to 15, 2010.

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Clostridium perfringens.  Unless you're a microbiologist, doctor, or foodpoisoning lawyer, you may not have even heard of Clostridium perfringens, which is the third leading cause of foodpoisoning in the United States, and recently caused a devastating outbreak at Central Louisiana State Hospital in which 40 were sickened and 3 died after eating contaminated chicken salad.

What is it?

Clostridium perfringens is an anaerobic, Gram-positive, sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution.

What is the illness typically like?

Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. A more serious but rare illness is also caused by ingesting food contaminated with Type C strains. The latter illness is known as enteritis necroticans or pig-bel disease.

The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of those C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks. A few deaths have been reported as a result of dehydration and other complications.

Necrotic enteritis (pig-bel) caused by C. perfringens is often fatal. This disease also begins as a result of ingesting large numbers of the causative bacteria in contaminated foods. Deaths from necrotic enteritis (pig-bel syndrome) are caused by infection and necrosis of the intestines and from resulting septicemia. This disease is very rare in the U.S.

Infective dose--The symptoms are caused by ingestion of large numbers (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation. This disease is a food infection; only one episode has ever implied the possibility of intoxication (i.e., disease from preformed toxin).

How is Clostridium perfringens illness diagnosed?

Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. Diagnosis is confirmed by detecting the toxin in the feces of patients. Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients.

What foods are most often implicated in Clostridium perfringens outbreaks?

In most instances, the actual cause of poisoning by C. perfringens is temperature abuse of prepared foods. Small numbers of the organisms are often present after cooking and multiply to food poisoning levels during cool down and storage of prepared foods. Meats, meat products, and gravy are the foods most frequently implicated.

How common is Clostridium perfringens foodpoisoning?

Perfringens poisoning is one of the most commonly reported foodborne illnesses in the U.S. There were 1,162 cases in 1981, in 28 separate outbreaks. At least 10-20 outbreaks have been reported annually in the U.S. for the past 2 decades. Typically, dozens or even hundreds of person are affected. It is probable that many outbreaks go unreported because the implicated foods or patient feces are not tested routinely for C. perfringens or its toxin. CDC estimates that about 10,000 actual cases occur annually in the U.S.

Target Populations:

Institutional feeding (such as school cafeterias, hospitals, nursing homes, prisons, etc.) where large quantities of food are prepared several hours before serving is the most common circumstance in which perfringens poisoning occurs. The young and elderly are the most frequent victims of perfringens poisoning. Except in the case of pig-bel syndrome, complications are few in persons under 30 years of age. Elderly persons are more likely to experience prolonged or severe symptoms.
 

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Clostridium perfringens outbreaks, like the one that caused 40 illnesses and 3 deaths in Louisiana earlier this month, are all too common in institutional settings where the preparation of large volumes of food means increased likelihood of foodhandling errors.  Unfortunately, residents in institutional settings like hospitals, long-term care facilities, and assisted living centers can often ill afford a severe foodpoisoning illness.  For this reason, it has long been recognized that foodhandlers in institutional settings need to exercise great caution and care in food preparation, storage, and service.

Several examples:

Of course, there is the sad outbreak that occurred at Central Louisiana State Hospital earlier this month.  Test results recently confirmed that clostridium perfringens was, in fact, the bacterial agent that caused the outbreak.  Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health, stated that the contaminated food item appears to have been chicken salad served to both patients and staff.  Those who had the chicken salad at that time were 23 times more likely to show symptoms, which is a good indicator that the dish was the culprit.  Although environmental findings from the outbreak have not yet been released, it is probable that foodhandling errors--likely improper cooling--played a role in causing the outbreak. 

Another large C. perfringens outbreak occurred In November 1995 at a juvenile detention facility in California.  In a report on the outbreak, investigators concluded as follows:

Factors that may have contributed to the growth of C perfringens in the turkey and gravy included the inadequate cooking of large pieces of meat, slow cooling, and insufficient reheating. This outbreak may have been prevented if the following precautions had been taken:

* Using a thermometer to check that the turkey had been cooked and reheated (600-C) and cooled (4°C) to the optimal temperatures;

* Slicing the turkey into smaller portions, as opposed to piling large pieces in one stock pot, to facilitate rapid and evenly distributed cooling; and

* Cooling the gravy in smaller, shallower pots.

This outbreak illustrates the need for diligent precautions during food preparation, especially when handling foods of animal origin. The report is a reminder of the importance of ongoing food safety programs in institutional settings because of the potential for large outbreaks. It is recommended that food handler training include the prevention of food-borne illness and that such training be given regularly.

See (Parikh Al, Jay MT, Kassam D, Kociemba T, Dworkis B, Bradley PD, et al. Clostridium perfringens outbreak at a juvenile detention facility linked to a Thanksgiving holiday meal. West J Med 1997 June; 166:417-419)

Another large Clostridium perfringens outbreak occurred in Cedar Falls, Iowa linked to a Thanksgiving meal prepared by a Hy Vee store for Cedar Falls Church.  The meal was then delivered to senior citizens outside the church in a meals on wheels program.  Ultimately, the investigation into the large outbreak, which killed one person, concluded:

“The most plausible hypothesis for the Business A outbreak is that the turkey was cooked and stored at inappropriate temperature, which allowed for rapid development of Clostridium perfringens.”  

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The Clostridium perfringens outbreak that occurred in early May at Central Louisianna State Hospital was recently linked to contaminated chicken salad. 40 people were sickened in the outbreak, and three people died.  So what went wrong?  Environmental health findings--i.e. the investigation at the hospital's kitchen--have not yet been released, but the outbreak almost certainly occurred as a result of improper food handling procedures. 

Clostridium perfringens is a very common pathogen in foodpoisoning outbreaks; some estimates set clostridium perfringens as the third most common cause of foodpoisoning illnesses. Most clostridium perfringens outbreaks are ultimately linked to contaminated meat, and many such outbreaks occur after holiday meals.  The reason?  The cooking of whole fowl species, such as chicken and turkeys, that are cooled improperly after cooking.  For instance, the CDC reported on a clostridium perfringens outbreak in 2008 that occurred at a Wisconsin jail, stating as follows regarding the environmental investigation at the jail's kitchen:

On August 8, the environmental health sanitarian from the local health department met with jail kitchen supervisors and employees of the food distribution company to assess food preparation and employee health and hygiene practices. The macaroni and ground beef in the implicated casserole were cooked the day before. The sanitarian determined that food temperatures had not been obtained or recorded consistently, and documentation of cooling temperatures for both the ground beef and macaroni, where cooling from 70°F to 41°F (39°C to 23°C) is a vital step, could not be provided. An inspection of the cooler revealed improper handling and cooling of taco meat, which was being prepared for a future meal and was not implicated in this outbreak; some containers of meat were cooled with ice paddles and other containers were not. 

It has not yet been publicly disclosed how the chicken in the chicken salad at the Louisianna hospital was prepared . . . or cooled.  It is possible that the chickens were cooked whole, and cooled improperly, or that the chicken salad was cooled improperly after it was assembled.  It is unlikely that the mayonnaise, vegetables, or spices that were included in the chicken salad were contaminated prior to assembly.

Whatever the case, somehow the clostridium perfringens bacteria--more specifically, the bacterial spores that release the illness-causing toxins--in the bad chicken was allowed to grow or replicate, leading to the bacterial proliferation that was surely the cause of this widespread outbreak.  An abstract from a recent article on the growth of clostridium perfringens bacteria during improper cooling states as follows:

Many meat-based food products are cooked to temperatures sufficient to inactivate vegetative cells of Clostridium perfringens, but spores of this bacterium can survive, germinate, and grow in these products if sufficient time, temperature, and other variables exist. Because ingestion of large numbers of vegetative cells can lead to concomitant sporulation, enterotoxin release in the gastrointestinal tract, and diarrhea-like illness, a necessary food safety objective is to ensure that not more than acceptable levels of C. perfringens are in finished products. As cooked meat items cool they will pass through the growth temperature range of C. perfringens (50 to 15 degrees C). Therefore, an important step in determining the likely level of C. perfringens in the final product is the estimation of growth of the pathogen during cooling of the cooked product.

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The outbreak of illnesses that sickened more than 40 people and killed three patients at Central Louisiana State Hospital in Pineville appears to be connected to bacteria from chicken salad served at the facility.  Tests done on the chicken salad were positive for Clostridium perfringens, which is a frequent cause of foodpoisoning illnesses. 

C. perfringens is a naturally occurring organism, but it can spread to unsafe levels with improper food storage and handling.  Some strains of Clostridium perfringens cause mild to moderate disease that gets better without treatment, whereas other strains cause severe gastroenteritis that can damage the small intestine and sometimes lead to death. Contaminated meat is usually responsible for outbreaks of Clostridium perfringens food poisoning. Some strains cannot be destroyed by cooking the food thoroughly, whereas others can.

The gastroenteritis starts about 6 to 24 hours after contaminated food is eaten. The most common symptoms are watery diarrhea and abdominal cramps. Although usually mild, the infection also can cause abdominal pain, abdominal expansion (distention) from gas, severe diarrhea, dehydration, and a severe decrease in blood pressure (shock).

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The CDC just reported on the safety of pools in America and it reminded me of the summer of 1998 when 26 children became ill from E. coli O157:H7 contracted while playing in the kiddie pool at White Water Park, a commercial water park in suburban Atlanta. Seven of those children were hospitalized and a 2-year-old girl died from Hemolytic Uremic Syndrome, a kidney disorder caused by E. coli O157:H7.

Operators of the pool initially denied responsibility for the E. coli outbreak, but investigators determined that the chlorine level in the pool was well below the local health standard on the days when the water was contaminated, greatly increasing the risk of infection. The incident increased national awareness of the hazards of water contamination, prompting the industry to pay closer attention to pool cleaning and chlorine.

Read the report:

Continue Reading...

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The sprouts salmonella outbreak's case count has increased by six to 28 confirmed cases of Salmonella Newport.  AP reports as follows:

Federal officials have identified six additional cases of salmonella poisoning linked to raw alfalfa sprouts, bringing the total to 28 people sickened in 10 states.

The Centers for Disease Control and Prevention said Thursday that three more people were sickened in California, for a total of 14 cases there. Caldwell Fresh Foods of Maywood, Calif., announced a nationwide recall of its alfalfa sprouts last week.

Other new cases were found in Arizona and Idaho. Nevada, Wisconsin, Oregon, Illinois, Missouri, New Mexico and Colorado also identified cases linked to the outbreak. The sprouts were sold to more than 400 Wal-Mart stores in 15 states.

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The following article--topical, given recent raw milk events--has appeared on the National Law Review and at foodsafetynews.com.

One need not look far to grasp the scope of this country’s food safety problems, and the personal devastation that can happen when somebody is infected by E. coli, Salmonella, Campylobacter, or any other foodborne pathogen. Stephanie Smith, who, at the time of her illness, was a 19-year-old dance instructor from Cold Springs, Minnesota, suffered an E. coli O157:H7-hemolytic uremic syndrome illness so severe that it left her paralyzed. And Linda Rivera, who was sickened from contaminated Nestle cookie dough, was just flown from a Las Vegas Hospital to a long-term rehabilitation center after almost a year-long hospitalization from her own E. coli O157:H7 infection.

But there is one particular food product that has become as much a political issue as it is an issue of food safety. It has been the source of fierce legislative battles throughout the country; an endlessly interesting topic for bloggers and traditional media alike; and the ultimate source of a number of major personal injury cases. It is raw milk—an unpasteurized, back-to-our-roots fluid milk product that, despite its seemingly benign persona, has raised questions about unwarranted and unconstitutional government intrusion into private affairs, and how best to spite the government’s regulatory efforts.[1]

Continue Reading...

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Yesterday's announcement of another E. coli O157:H7 outbreak linked to raw milk will surely set off another round of debate about the virtues, dangers, legality, and even constitutionality of state and federal regulation of raw milk.  Many states disallow raw milk sales; some allow it from properly licensed dairies; and in some states, such as Minnesota, allow only occasional sales of raw milk at the farm that produces it--i.e. you cannot buy it in grocery stores or other retail locations. 

The federal government does not permit sales or distribution of raw milk across state lines, which derives from Congress's power to regulate "interstate commerce."  The reason that states and the federal government regulate raw milk so heavily is that the unpasteurized product is not subjected to heat treatment sufficient to kill any pathogenic bacteria present in the milk, and is thus thought to present an unnecessary risk of illness to consumers. 

Realrawmilkfacts.com identifies at least 38 outbreaks of E. coli O157:H7, campylobacter, or salmonella linked to raw milk between 1998 and 2008.  And more recently, raw milk outbreaks have been linked to dairies in Pennsylvania, Utah, and Minnesota, just to name a few.  According to realrawmilkfacts.com:

According to CDC, between 1998 and 2008, there were 85 outbreaks of human infections resulting from consumption of raw milk reported to CDC, including a total of 1,614 reported illnesses, 187 hospitalizations and two deaths. Illnesses and deaths have also been linked to the consumption of fresh cheese made from raw (unpasteurized milk), especially the Mexican-style queso fresco cheeses. Since many millions of people drink pasteurized milk every day in the United States, and only about 1-3% of the population drinks raw milk, the number of illnesses reported show that the actual risk of getting sick from drinking raw milk is tremendously higher than drinking pasteurized milk.

As a result of the heavy regulation of raw milk, consumers and organizations who encourage the ability to buy and consume raw milk have devised schemes to avoid the state and federal regulations.  Buying clubs have sprung up in many of the states, including Minnesota, that allow raw milk sales only at the farm that produced the product.  In an article earlier this month, Southcoasttoday.com reported on raw milk buying clubs in Massachussetts:

Raw milk refers to milk that's not pasteurized, making the product — depending on who you ask — either an untapped source of healthy living or unsafe to drink. Rising popularity and the fact that raw milk in Massachusetts can only be sold on the farms where it's produced have led to the rise of buyers clubs. These are groups that enable people to save gas and driving time through bulk pickups and off-site distribution.

In an interview with The Standard-Times last Thursday, Department of Agricultural Resources Commissioner Scott J. Soares said four buying clubs in the Bay State were issued cease-and-desist orders in recent months because they're not licensed for off-the-farm raw milk distribution.

Cow or herd-share agreements are another method often used by raw milk consumers in states where they can't purchase the product at retail.  These agreements seek to insulate purveyors of raw milk from state and federal regulation by allowing consumers to purchase shares in a specific cow or herd instead of paying money directly for milk. The logic, of course, is that state and federal regulation cannot reach this conduct because it does not involve the specific sale of raw milk.

I have addressed these agreements before, concluding:

Truly, to call a cow share agreement a species of legal maneuvering may be giving too much credit to an effort that is designed either to flout the law entirely, or at the very least avoid the often stringent requirements associated with licensure. In reality, cow shares are poorly disguised attempts to accomplish something that is, in most states, patently criminal. As a result, when judging whether such conduct constitutes the sale or distribution of raw milk, courts are likely to approach these cases with a healthy dose of realism in determining what the parties' true intent was, whether the forum be civil or criminal court.

See Cow Share Agreements: Fooling Nobody, Food Safety News, Nov. 9, 2009

Many states have confronted cow and herd-share agreements head-on, and most have closed the legislative loophole by specifically outlawing the practice. But not even that has deterred proponents of raw milk; it has, in fact, forced some into ever-more-dangerous, and highly illegal, distributive schemes, including placing a "pet food only" label on raw milk that they know, or have reason to know, will or may be consumed by human beings. Alaska, Colorado, and North Carolina require raw milk to be dyed before being marketed as pet food in order to address this problem specifically.

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In the Minnesota E. coli O157:H7 outbreak linked to raw milk from the Hartman Dairy Farm, state health officials have identified four outbreak cases, all of whom were hospitalized for treatment of their injuries.  Sadly, as Mike Hughlett reported in the Minnesota Star Tribune today, an area toddler, one of the victims, remains hospitalized, having developed hemolytic uremic syndrome (HUS). 

Hemolytic uremic syndrome:

The chain of events leading to HUS begins with ingestion of Stx-producing E. coli (e.g., E. coli O157: H7) in contaminated food, beverages, animal to person, or person-to-person transmission.  These E. coli rapidly multiply in the intestine causing colitis (diarrhea), and tightly bind to cells that line the large intestine. This snug attachment facilitates absorption of the toxin into the intestinal capillaries and into the systemic circulation where it becomes attached to weak receptors on white blood cells (WBC) thus allowing the toxin to “ride piggyback” to the kidneys where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin.

Organ injury is primarily a function of Gb3 receptor location and density. Receptors are probably heterogeneously distributed in the major body organs, and this may explain why some patients develop injury in other organs (e.g., brain, pancreas).

Once Stx attaches to receptors, it moves into the cell’s cytoplasm where it shuts down the cells’ protein machinery resulting in cellular injury and/or death. This cellular injury activates blood platelets and the coagulation cascade, which results in the formation of clots in the very small vessels of the kidney, resulting in acute kidney injury and failure.

The red blood cells undergo hemolytic destruction by Stx and/or damage as they attempt to pass through partially obstructed microvessels. Blood platelets (required for normal blood clotting), are trapped in the tiny blood clots or are damaged and destroyed by the spleen.

Minnesota law on the sale of raw milk:

Minnesota law prohibits most raw milk sales, except for occasional purchases directly at the farm where the milk is produced. The Minnesota Department of Agriculture investigates complaints and cases of food-borne illness associated with the sale of raw milk. Enforcement actions can be taken in cases when sales of raw milk are identified and people become ill from consuming the raw milk.

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The April 2010 E. coli O145 outbreak linked to Freshway romaine lettuce grown by Andrew Smith Company sickened 33 people (26 confirmed and 7 probable cases) from 5 states.  The number of ill persons identified in each state with this strain is: MI (11 confirmed and 2 probable), NY (5 confirmed and 2 probable), OH (8 confirmed and 3 probable), PA (1 confirmed), and TN (1 confirmed).  Many of the outbreak cases were college kids at the University of Michigan, Ohio State University, and Daemon College in New York.  At least 3 people developed hemolytic uremic syndrome (HUS) as a result of their E. coli infections. 

Will any good come of the Freshway lettuce E. coli O145 outbreak?  For the sake of people like Emily Grabowski, a New York college student who developed HUS as a result of her illness, at the very least the government should declare that E. coli O145 and other shiga-toxin producing strains of E. coli are "adulterants," and thus illegal, when present in our food supply.  

And there's another issue worthy of note, and maybe some action, that arises from the Freshway E. coli outbreak.  The FDA has never named the farm where the contaminated lettuce was grown; for that matter, neither have any of the other entities known to be involved (Freshway and Andrew Smith Company). 

Congress made BP release streaming video of the oil "leak" for no better reason than we deserve to know.  The public demanded it.  So why doesn't the same logic apply?  Don't we have a right to know who is producing food products that are sickening and killing us?  Whatever the answer to that question specifically, we will soon find out in the discovery process in the pending lawsuit against Freshway. 

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Sprouts from Caldwell Fresh Foods, of Maywood, California, have caused approximately 22 illnesses in multiple states, including 11 in its home state of California. The outbreak strain of Salmonella is Salmonella Newport, and the implicated sprouts, which were widely distributed to retailers nationally, have been recalled. 

Since May 14, the Butte County Public Health Depeartment has confirmed seven cases of salmonella poisoning, all in Chico.  Dr. Mark Lundberg, the county's health officer, said three people have been hospitalized. He said public health staff is working to determining the source of the outbreak and stop its spread.  Dr. Lundberg also said Butte County typically has 32 cases of salmonella poisoning in an entire year.

Is it the sprouts?  Although California's public health laboratory has been one casualty of the State's budget woes, and is not operational on a daily basis (as i understand it), the health department should be able to eventually determine whether the DNA fingerprint associated with the Butte County outbreak matches the Caldwell sprout outbreak, which, again, has sickened 11 in California alone.  Time will tell.   

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Consumers warned against consuming unpasteurized dairy products

State health officials have linked three cases of E. coli O157:H7 illness with raw milk from a dairy farm in Gibbon, Minn. The Minnesota Department of Health urges anyone who may have recently purchased milk from the Hartmann Dairy Farm, also known as M.O.M.’s, to discard the product and not consume it. The milk may be labeled organic and consumers may be unaware that the milk has not been pasteurized. In addition, consumers should not eat cheese, ice cream or other dairy products from the farm, which also may have been made from raw, unpasteurized milk.

Symptoms of E. coli O157:H7 illness typically include stomach cramps and diarrhea, including bloody diarrhea.People typically become ill two to five days after eating contaminated food. E. coli O157:H7 disease sometimes leads to a serious complication called hemolytic uremic syndrome (HUS), which can cause kidney failure and can occur a week or more after the onset of diarrhea. People who have developed symptoms after consuming unpasteurized milk should seek immediate medical attention. Those most at risk of developing complications from E. coli infection include the very young, the elderly, and people with weakened immune systems.

The Minnesota Department of Health and the Minnesota Department of Agriculture are continuing to investigate a cluster of four E. coli O157:H7 illnesses that all have the same “pulsed field gel electrophoresis” (PFGE) patterns, or DNA fingerprint. Three of the four cases report a link to milk from Hartmann Farm; the fourth case is under investigation. Three of the four people were hospitalized as a result of their illness; one case has developed HUS.

Minnesota law prohibits most raw milk sales, except for occasional purchases directly at the farm where the milk is produced. The Minnesota Department of Agriculture investigates complaints and cases of food-borne illness associated with the sale of raw milk. Enforcement actions can be taken in cases when sales of raw milk are identified and people become ill from consuming the raw milk.

Officials from both agencies warn the public against drinking raw milk because it may contain harmful bacteria that can cause life-threatening illnesses. Raw milk is not treated or pasteurized to remove disease-causing bacteria.

Pasteurization is the only effective method for eliminating the bacteria in raw milk and milk products. Pasteurization uses heat applied for a length of time sufficient to destroy harmful bacteria such as E. coli O157:H7 without significantly changing milk's nutritional value. Despite claims to the contrary, the body of scientific evidence shows no meaningful difference in the nutritional value of pasteurized and unpasteurized milk. Pasteurization prevents a variety of infections that can be spread by consumption of milk. All milk shipped between states is required, by law, to be pasteurized.

Between 1973 and 1992, 46 outbreaks associated with raw milk consumption were reported to the Centers for Disease Control and Prevention. An additional 45 outbreaks were reported to CDC between 1998 and May 2005, accounting for 1,007 illnesses, 104 hospitalizations, and two deaths.

Anyone who has experienced illness after consuming dairy products from Hartmann’s Farm should consult their health care provider. In addition, the Minnesota Department of Health is requesting that these individuals call the agency at 651-201-5414.

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Caldwell sprouts salmonella outbreak:

Sprouts from Caldwell Fresh Foods, of Maywood, California, have caused approximately 22 illnesses in multiple states, including 11 in its home state of California. The outbreak strain of Salmonella is Salmonella Newport, and the implicated sprouts, which were widely distributed to retailers nationally, have been recalled.

Fresh Express salmonella outbreak:

Health departments in the “Upper-Midwest” investigated and confirmed a link between several Salmonella illnesses and the consumption of lettuce products from Fresh Express, a subsidiary of Chiquita Brands International Inc.

Freshway O145 outbreak:

In the last month, the FDA, CDC, and state health departments nationally have been investigating an E. coli O145 outbreak that has sickened some 30 people in Michigan (11 confirmed and 2 probable), New York (5 confirmed and 2 probable), Ohio (8 confirmed and 3 probable), Pennsylvania (1 confirmed), and Tennessee (1 confirmed). The outbreak has been linked to Fresh Way Foods, which purchased romaine lettuce from Andrew Smith Co., who distributed the romaine lettuce from a Yuma, Arizona farm, which has not been named.

Los Dos Amigos:

Los Dos Amigos, a mexican restaurant in Roseburg, Oregon, was the site of a large salmonella outbreak in April. Douglas County health officials report that at least 30 people suffered culture-confirmed salmonella foodpoisoning illnesses, and that cross-contamination was probably a cause of the outbreak.

Casa Lopez:

The salmonella outbreak at an "Athens Ohio restaurant" is reported to be Casa Lopez on East State Street. WSAZ reported today that at least 41 people have "come down with salmonella poisoning after eating at [Casa Lopez," and that health officials are waiting on test results from 15 other cases.

Utah raw milk outbreaks:

Utah health officials have linked two outbreaks—one campylobacter and one salmonella—to the consumption of raw milk. The campylobacter outbreak is linked to raw milk purchased from Ropelato Dairy in Ogden, Utah, and has resulted in at least 9 illnesses in residents of Weber, Davis, and Cache counties. On Monday, the Utah Department of Health suspended Ropelato Dairy’s permit to sell raw milk. Coliform testing done on milk at the dairy showed high coliform counts, which suggest the presence of disease-causing bacteria, like campylobacter, in the milk.

The second raw milk outbreak in Utah (a salmonella outbreak) sickened at least 6 people in late April in Utah, Salt Lake, and Wasatch Counties. The outbreak was linked to raw milk from Redmond Farms in Sevier County. Samples of raw milk produced at the dairy from April 5 to April 22 tested positive for Salmonella.

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The salmonella outbreak at an "Athens Ohio restaurant" is reported to be Casa Lopez on East State Street.  We represent several people who ate at Casa Lopez and were sickened by Salmonella in early May.  WSAZ reported today that at least 41 people have "come down with salmonella poisoning after eating at [Casa Lopez," and that health officials are waiting on test results from 15 other cases.

May was a bad month for food nationally.  In addition to the Casa Lopez salmonella outbreak in Ohio, a mexican restaurant called Los Dos Amigos in Roseburg, Oregon has also recently caused a large salmonella outbreak.  Together, these two mexican restaurants have caused over 60 confirmed salmonella illnesses, and likely well over one hundred total illnesses.  In addition, a large scale sprouts recall occurred after sprouts from Caldwell Fresh Foods was identified as the source of a salmonella outbreak that has sickened at least 22; and of course there is the ongoing saga over the safety of other fresh produce, primarily lettuce.  What will happen in June?

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April's E. coli O145 outbreak linked to Freshway romaine lettuce caused a lot of suffering, but it may also be a necessary impetus for change . . . or at least a vote, by the Senate, on S 510 a/k/a "Food Safety Modernization Act."  Congressman John Dingell, D-Mich., who recently conducted a telephone briefing involving several victims of the Freshway outbreak and the Dole baby spinach outbreak, said that the Freshway E. coli O145 outbreak underscores the critical need for food safety reform--more specifically, giving the FDA the resources to act preventatively, rather than just responsively, in its approach to foodpoisoning outbreaks.  

The illness of Andrew Lekas was front and center on Congressman Dingell's telephone breifing.  According to the Katreas Stafford at the Eastern Echo, Andrew Lekas, a recent graduate of the University of Michigan,

became sick after consuming a burrito containing lettuce at a restaurant in Ann Arbor. He refused to name the restaurant and said the Washtenaw County Health Department is conducting an investigation into the situation.

Lekas said he wasn’t aware of how serious and necessary food reform is.

“It was only a few weeks ago that I became aware of how outdated our food safety system is,” he said.

The restaurant he ate at was a regular place him and his friends attended.

“The week I got sick, I had eaten twice at that same restaurant,” Lekas said.

When he was sick, he missed classes and was unable to leave his dorm room.

“If it weren’t for taking extra credits in previous semesters, the illness could have jeopardized my academic career,” Lekas said.

One of the other participants at Congressman Dingell's briefing was Elizabeth Armstrong, mother of Ashley Armstrong, a young girl who developed hemolytic uremic syndrome (HUS) after being infected by E. coli O157:H7 in the Dole baby spinach outbreak.  We represented the Armstrong family for Ashley's injuries.  Below is a short video about her illness.   

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Los Dos Amigos, a mexican restaurant in Roseburg, Oregon, was the site of a large salmonella outbreak in April.  Douglas County health officials report that at least 30 people suffered culture-confirmed salmonella foodpoisoning illnesses, and that cross-contamination was probably a cause of the outbreak. 

Los Dos Amigos recently issued a public apology to the victims of the outbreak, which is a measure that we see taken far too infrequently in situations like this.  For that step, the restaurant should certainly be applauded. 

What is, or may ultimately be, striking about the Los Dos Amigos salmonella outbreak is its potential size.  30 confirmed salmonella illnesses means that many more were sickened but, for any of many different reasons, did not have a stool sample test positive for Salmonella bacteria. 

One leading study suggests that, in any foodpoisoning outbreak, the number of people who are actually ill is 10, 20, even 30 times the number of "confirmed cases."  The Los Dos Amigos outbreak likely is no exception, and Douglas County's conclusion that cross-contamination was a factor in the outbreak means that contamination may have truly proliferated at the restaurant.  Many more people that the 30 reported cases were certainly sickened in this large outbreak. 

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Sprouts from Caldwell Fresh Foods, of Maywood, California, have caused approximately 22 illnesses in multiple states, including 11 in its home state of California.  The outbreak strain of Salmonella is Salmonella Newport, and the implicated sprouts, which were widely distributed to retailers nationally, have been recalled. 

Notably, Caldwell should know the recall drill.  On March 3, 2008, the San Francisco Chornicle reported that multiple Contra Costa County and San Francisco residents had been sickened by Salmonella after consuming sprouts manufactured by JH Caldwell and Son's, Inc.  Caldwell subsequently recalled its product in that outbreak too. 

Also, are any of the sprout illnesses in the Caldwell Fresh Foods sprouts outbreak in Butte County, California?  This release was issued by Butte County on Thursday, May 20:

Butte County Public Health Department has recently seen an increase in the number of reported Salmonella cases. The cause of the increase has yet to be determined, and an ongoing investigation is taking place. “Although we usually see an increase in foodborne illnesses this time of year, the recent increase in Salmonella cases is higher than expected,” stated Mark Lundberg, M.D., Health Officer at Butte County Public Health Department. “We want the public to be aware of the risk, and to take preventative steps to protect themselves from foodborne illness.”

Butte County is north of Sacramento, and has over 200,000 residents.  There has been no official word whether the increase in Salmonella cases is as a result of the national sprouts outbreak.  Suspicious timing though. 

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Today's announcement of another salmonella outbreak linked to sprouts will inevitably end in litigation on behalf of outbreak victims, the focus of which will largely be on what Caldwell Fresh Foods did, or did not, do with regard to pathogen reduction (i.e. getting the contaminated animal feces off of the seeds before growing the sprouts).  Here is a summary of the FDA's guidance, issued in 1999, to the sprouts industry to achieve pathogen reduction on sprout seeds, followed by the specific measures that it encouraged sprouters, and other business in the chain of distribution of sprout seeds, to take. 

Guidance background and summary

Since 1995, raw sprouts have been increasingly implicated in foodborne outbreaks. Between January 1995 and May 1999, there were 11 reported outbreaks in the United States associated with sprouts from commercial growers, 9 of which were due to various Salmonella serotypes and 2 to Escherichia coli O157. The number of culture-confirmed cases in each of these outbreaks ranged from 8 to more than 500, and more than 1,300 cases have been reported overall.  And in total, since 1990, sprouts have been associated with at least 37 outbreaks, causing over 2,000 confirmed cases of foodpoisoning.   

Sprouted seeds represent a food safety problem because the conditions under which sprouts are produced (time, temperature, water activity, pH, and nutrients) are ideal for the exponential growth of bacteria. If bacterial pathogens are present on or in the seed, sprouting conditions are likely to encourage their proliferation.

Traceback investigations reveal that most of the firms associated with recent outbreaks were not using approved seed disinfection treatments, or were not using them consistently, and were not testing for microbial contamination during sprout production. Although currently approved treatments can significantly reduce pathogen levels in or on seeds, they have not been shown to completely eliminate pathogens.  Consequently, outbreaks continue to occur.

On July 9, 1999, FDA issued a consumer advisory advising all consumers to be aware of the risks associated with eating any variety of raw sprouts, and advising persons at high risk of developing serious illness due to foodborne disease (children, the elderly, and persons with weakened immune systems) not to eat raw sprouts. The advisory was updated from a previous advisory issued August 31, 1998, and was prompted by information from clover and alfalfa sprout-associated salmonellosis outbreaks that occurred from January 1999 through May 1999.

Specific guidance:

1.  Seed Production: Seeds for sprout production should be grown under good agricultural practices (GAPs) in order to minimize the likelihood that they will contain pathogenic bacteria.

2.  Seed Conditioning, Storage, and Transportation: Seeds that may be used for sprouting should be conditioned, stored, and transported in a manner that minimizes the likelihood that the seeds will be contaminated with pathogens. For example, seed should be stored in closed or covered containers in a clean dry area dedicated to seed storage. Containers should be positioned off the floor and away from walls to reduce the possibility of contamination by rodents or other pests and to facilitate regular monitoring for pest problems.

3.  Sprout Production: Sprouters should implement appropriate practices to ensure that sprouts are not produced in violation of the act which prohibits the production of food under insanitary conditions which may render food injurious to health (21 U.S.C. 342(a)(4)). In addition to seed treatment and testing for pathogens, sprouters should maintain facilities and equipment in a condition that will protect against contamination. Facilities with poor sanitation can significantly increase the risk of contaminating product. Sprouters should employ good sanitation practices as a standard operating procedure to maintain control throughout all stages of sprout production. Inadequate water quality and poor health and hygienic practices can all increase the risk of food becoming contaminated with pathogens. Sprouters may wish to review 21 CFR Part 110 which sets forth good manufacturing practices (GMPs) in manufacturing, packaging, or holding human food that cover these aspects of food production.

4.  Seed Treatment: Seeds for sprouting should be treated with one or more treatments (such as 20,000 ppm calcium hypochlorite) that have been approved for reduction of pathogens in seeds or
sprouts. Some treatments can be applied at the sprouting facility while others will have to be applied earlier in the seed production process. However, at least one approved antimicrobial treatment should be applied immediately before sprouting. Sprouters should carefully follow all label directions when mixing and using antimicrobial chemicals.

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