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Durand High School May be Facing a Campylobacter Outbreak

According to press reports, there are now eight confirmed cases of the Campylobacteriosis infection.

More tests are pending, and Pepin County Wisconsin health officials hope to have those results by Thursday morning.

We’re told the infection can be contracted by eating or drinking food or water that has come into some type of contact with fecal matter from either an infected person or an animal.

So far more than 50 Durand High School students have been forced to stay home with flu-like symptoms.

The Pepin County Health Department says it will continue to investigate these illnesses.

Campylobacter:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Campylobacter outbreaks. The Campylobacter lawyers of Marler Clark have represented thousands of victims of Campylobacter and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Campylobacter lawyers have litigated Campylobacter cases stemming from outbreaks traced to a variety of sources, such as raw milk and municipal water.

All About Shigella

Shigella

Shigella is the bacterium that causes the disease shigellosis, also known as bacillary dysentery. Shigella is one of the most easily transmitted bacterial diarrheas, since it can occur after fewer than 100 bacteria are ingested. While reported cases of Shigella range between 14,000 and 20,000 annually, with the majority of these cases occurring between July and October. Shigella Sonnei is the most common type of Shigella. It accounts for over two-thirds of cases of shigellosis in the United States.

Shigella bacteria are generally transmitted through a fecal-oral route.  Foods that come into contact with human or animal waste can transmit Shigella. Thus, handling toddlers’ diapers, eating vegetables from a field contaminated with sewage, or drinking pool water are all activities that can lead to shigellosis.

Symptoms of Shigella Food Poisoning

Symptoms of Shigella poisoning most commonly develop one to three days after exposure to Shigella bacteria, and usually go away within five to seven days. It is also possible to get Shigella but experience no symptoms, and still be contagious to others, a condition known as being asymptomatic.

Common Shigella Food Poisoning Symptoms

  • Diarrhea: Diarrhea ranges from mild to severe. It is bloody in 25 to 50 percent of cases and usually contains mucus
  • Fever
  • Stomach cramps
  • Rectal spasms

Complications from Shigella

Complications from shigellosis can include severe dehydration, seizures in small children, rectal bleeding, and invasion of the blood stream by the bacteria. Young children and the elderly are at the highest risk of death. The following is a list of specific complications caused by Shigella.

Proctitis and Rectal Prolapse: The bacteria that causes shingellosis can also cause inflammation of the lining of the rectum or rectal prolapse.

Reactive Arthritis: Approximately 3 percent of patients with Shigella infection, most often those with Shigella flexneri, develop Reactive Arthritis. It occurs when the immune system attempts to combat Shigella but instead attacks the body. Symptoms of Reactive Arthritis include inflammation of the joints, eyes, or reproductive or urinary organs. On average, symptoms appear 18 days after infection.

Toxic Megacolon: In this rare complication, the colon is paralyzed and unable to pass bowel movements or gas. Symptoms of Toxic Megacolon include abdominal pain and swelling, fever, weakness, and disorientation. If this complication goes untreated and the colon ruptures, the patient’s condition can be life-threatening.

Hemolytic Uremic Syndrome, or HUS: Shigella rarely results in HUS, which is more commonly a complication of Shiga toxin-producing E. coli infections. HUS can lead to kidney failure.

Diagnosis of Shigella

A Shigella infection is diagnosed through laboratory testing of a stool sample.

Shigella Food Poisoning Treatment

A Shigella infection usually goes away on its own in five to seven days, although bowel movements may continue to be abnormal for up to a month following infection. Antibiotics, however, can shorten the course of the illness. A doctor can prescribe antibiotics after testing a stool sample for the presence of Shigella bacteria.

Some strains of shigellosis are resistant to antibiotics, meaning that antibiotics might not always be an effective treatment. Antidiarrheal medication should be avoided, as it can actually make the illness worse.

Preventing a Shigella Infection

Frequent hand washing is key to preventing Shigella, since individuals can carry Shigella without noticing symptoms, and Shigella bacteria can remain active for weeks after illness.

Steps for Preventing the Spread of Shigella Infection

  • If a child in diapers has shigellosis, wash your hands after changing their diaper and wipe down the changing area with disinfectant
  • People with Shigella should not prepare food for others for at least two days after diarrhea has stopped
  • Drink only treated or boiled water while traveling and only eat fruits you peel yourself
  • Only swim in pools maintaining a chlorine level of 0.5 parts per million and stay clear of pools where children not yet toilet trained are swimming

Additional Resources for Shigella

About-Shigella.com is a comprehensive site with in-depth information about Shigella bacteria and Shigella infection.

Shigella Blog provides up-to-date news related to Shigella outbreaks, research, and more.

Marler Clark Retained in Botulism Outbreak Linked to VR Green Farms Pine Nut Basil Pesto

California Department of Public Health (CDPH) Director and State Health Officer Dr. Ron Chapman warned consumers today not to eat VR Green Farms jarred food products because they may have been improperly produced, making them susceptible to contamination with Clostridium botulinum.

Ingestion of botulism toxin from improperly processed jarred and canned foods may lead to serious illness and death. CDPH is coordinating with the US Food and Drug Administration and the Ohio Department of Health in the investigation of two cases of suspected food-borne botulism infections that may be associated with consumption of the firm’s Pine Nut Basil Pesto.

VR Green Farms of San Clemente, California, is voluntarily recalling the following varieties of jarred food products: Pine Nut Basil Pesto, Pickled Farm Mix, Old World Tomato Sauce, Sundried Tomatoes in Olive Oil, Tuscan Grilling Sauce, and Pasta Sauce. These food products were sold under the VR Farms label and packaged in Mason-style glass jars with screw-on metal lids. The product labels do not include any coding or “use by” dates. Photographs can be found on Recalled Product Photos Page. The products were sold at the VR Green Farms stand in San Clemente, California and via the Internet to consumers throughout the United States.

Botulism toxin is odorless and colorless. Consumers who have any of these products or any foods made with these products should discard them immediately. Double bag the cans in plastic bags and place in a trash receptacle for non-recyclable trash. Wear gloves when handling these products or wash your hands with soap and running water.

Botulism is a rare but serious paralytic illness caused by a nerve toxin that is produced by the bacterium Clostridium botulinum. The initial symptoms frequently experienced are double or blurred vision, drooping eyelids, and dry or sore throat. Progressive descending paralysis, usually symmetrical, may follow. Infants with botulism appear lethargic, feed poorly, are constipated, have a weak cry and poor muscle tone.

Norovirus Prompts Oyster Recall

Seoul Trading Inc. has removed frozen South Korean oysters from sale in King, Pierce, and Snohomish counties because they may be contaminated with Norovirus. Food establishments that received the oysters include H-Mart locations in Federal Way, Lynnwood, and Lakewood; Asian Pacific Market in Kent; Blue Fin Buffet in Seattle; and Lam Seafood in Seattle.

Salmonella Illnesses Prompt Peanut Butter Recall

nSpired Natural Foods, Inc. is voluntarily recalling certain retail lots of Arrowhead Mills® Peanut Butters, MaraNatha® Almond Butters and Peanut Butters and specific private label nut butters packaged in glass and plastic jars because they have the potential to be contaminated with Salmonella.

The potential risk was brought to the Company’s attention by the U.S. Food and Drug Administration following routine testing. The Company has received reports of four illnesses that may be associated with these specific products.

The use-by date can be found on the top of the jar lid. The Company is currently working with customers and retailers to remove and destroy products with the above use-by dates from store shelves and warehouses.  Products were distributed across the United States, Canada, Hong Kong, United Arab Emirates, and Dominican Republic. The products also were available for purchase on the internet.  A complete list of recalled product is found here.

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and those with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), 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 (i.e., infected aneurysms), endocarditis and arthritis.

Time to Ban Petting Zoos – with E. coli?

Today the Minnesota Department of Health (MDH) has identified at least 13 people who have developed E. coli O157:H7 infections as part of an outbreak associated with Zerebko Zoo Tran traveling petting zoo. All of these cases have infections with E. coli O157:H7 bacteria that have the same DNA fingerprint. Two of these are secondary cases resulting from being exposed to one of the primary cases associated with the petting zoo.  The 13 cases range in age from 2 to 68 years, 10 (77 percent) are female, and they are residents of multiple counties. Seven (54 percent) cases have been hospitalized, including three children. Two of the cases developed a serious complication known as hemolytic uremic syndrome (HUS), which affects kidney function. Currently, one case is hospitalized with HUS.

As I have said before – is it time to ban petting zoos?

I can hear the wailing and gnashing of teeth over such an un-American suggestion.

In 2012, the North Carolina Department of Health and Human Services announced that a two-year-old boy who became ill with an E. coli infection after attending the Cleveland County Fair had died.  101 people who attended the fair—mostly children—have gotten sick with E. coli O157:H7 infections.  Over a dozen are still hospitalized.  Attendance at the fair was the common link among E. coli cases.

This is not the first, or even the second, time an E. coli outbreak has been traced to a North Carolina fair.  The coming months will likely bring the announcement that public health agencies are joining forces to learn from the Cleveland County Fair E. coli outbreak and prevent future outbreaks from happening.

In 2004, 187 people who attended the North Carolina State Fair became ill with E. coli infections; 15 with hemolytic uremic syndrome (HUS), a complication of E. coli infection that can lead to kidney failure, central nervous system impairment, and death.  In response to the E. coli outbreak, Duke University’s Terry Sanford Institute of Public Policy issued an analysis report regarding government regulation of petting zoos.  The authors stated:

In response to the largest outbreak of Escherichia coli (E. coli) in North Carolina history, we recommend that the North Carolina Department of Health and Human Services (DHHS) issue guidelines and pursue legislation that will control public contact with animals, inform the public of risks related to animal contact, provide transition areas, regulate animal care, and license petting zoos.

In 2005, North Carolina adopted new legislation on petting zoo sanitation. The bill, called “Aieden’s Law,” was named after a boy who suffered a severe, life-threatening case of HUS. It stipulated that petting zoos must obtain a permit following a physical inspection in order to operate in the state.

Last year, at least 25 cases of E. coli infection were traced to the N.C. State Fair.  The only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions.

In response to the 2011 N.C. State Fair E. coli outbreak, the North Carolina Department of Health and Human Services and the Centers for Disease Control and Prevention (CDC) created a multiagency task force in North Carolina “to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.”  The recommendations were released on July 23, 2012, with plenty of time for Cleveland County Fair operators to take note and implement similar interventions.

I am sure there will be yet another task force following the Cleveland County Fair outbreak.  But at what point will North Carolina health officials decide that preventing E. coli outbreaks at their fairs and petting zoos is better for public health than responding to them?

In 2009, the CDC and a collection of state veterinarians issued an update to what were already stern guidelines for preventing illness associated with animal exhibits and petting zoos, including:

- Wash hands after contact with animals to reduce the risk of zoonotic disease transmission.

- Do not allow food, drink, or pacifiers in animal areas.

- Include transition areas between animal areas and non-animal areas.

- Educate visitors about disease risk and prevention procedures.

- Properly care for and manage animals.

But, if history is any guide, guidelines are not working very well.  The bottom line is that what fairs and petting zoos are doing – or not doing – is not working.

Perhaps blaming the victims for not washing their hands is wearing thin.  Perhaps, animals should be vaccinated to reduce how much pathogenic E. coli that they carry.  Perhaps, animals could be tested before they arrive at the fair and excluded if they are shedding pathogens.

Something needs to be done.  State and county fairs and petting zoos will get the same results if they continue to do the same thing.  Continued E. coli outbreaks linked to these settings are unacceptable.   Other solutions need to be tried.

Or is it simply time to ban petting zoos?

For more on past petting zoo and fair outbreaks, see www.fair-safety.com.

Mt. Healthy Hatcheries in Ohio Cause of 47 State, 300 Person, Salmonella Outbreak

Friday the CDC updated its ongoing reporting of a Salmonella outbreak linked to baby chickens and ducks.  Now a total of 300 persons infected with the outbreak strains of Salmonella Infantis,Salmonella Newport, or SalmonellaHadar have been reported from 42 states and Puerto Rico. The number of ill persons identified in each state is as follows:  Alabama (8), Arizona (2), Arkansas (3), California (3), Colorado (5), Connecticut (1), Florida (1), Georgia (16), Idaho (4), Illinois (5), Iowa (3), Indiana (4), Kansas (1), Kentucky (11), Maine (9), Maryland (3), Massachusetts (1), Michigan (1), Minnesota (1), Mississippi (2), Missouri (1), Montana (3), Nebraska (3), New Hampshire (3), New Jersey (2), New Mexico (2), New York (30), North Carolina (28), Ohio (24), Oregon (1), Pennsylvania (29), Puerto Rico (1), South Carolina (6), South Dakota (3), Tennessee (17), Texas (2), Utah (1), Vermont (7), Virginia (25), Washington (8), West Virginia (18) Wisconsin (1), and Wyoming (1).

31% of ill persons have been hospitalized, and no deaths have been reported.

Epidemiologic, laboratory, and traceback findings have linked this outbreak of humanSalmonella infections to contact with chicks, ducklings, and other live poultry from Mt. Healthy Hatcheries in Ohio.  80% of ill people reported contact with live poultry in the week before their illness began.

Findings of multiple traceback investigations of live baby poultry from homes of ill persons have identified Mt. Healthy Hatcheries in Ohio as the source of chicks and ducklings. This is the same mail-order hatchery that has been associated with multiple outbreaks of Salmonella infections linked to live poultry in past years, including in 2012 and 2013.

All You Never Wanted to Know about Botulism, but Should

Introduction

Botulism is a rare, life-threatening paralytic illness caused by neurotoxins produced by an anaerobic, gram-positive, spore-forming bacterium, Clostridium botulinum. Unlike Clostridium perfringens, which requires the ingestion of large numbers of viable cells to cause symptoms, the symptoms of botulism are caused by the ingestion of highly toxic, soluble exotoxins produced by C. botulinum while growing in foods.

Overview

These rod-shaped bacteria grow best under anaerobic (or, low oxygen), low-salt, and low-acid conditions. Bacterial growth is inhibited by refrigeration below 4° C., heating above 121° C, and high water-activity or acidity. And although the toxin is destroyed by heating to 85° C. for at least five minutes, the spores formed by the bacteria are not inactivated unless the food is heated under high pressure to 121° C. for at least twenty minutes.

The incidence of foodborne botulism is extremely low. Nonetheless, the extreme danger posed by the bacteria has required that “intensive surveillance is maintained for botulism cases in the United States, and every case is treated as a public health emergency.” This danger includes a mortality rate of up to 65% when victims are not treated immediately and properly. Most of the botulism events that are reported annually in the United States are associated with home-canned foods that have not been safely processed. Very occasionally, however, commercially- processed foods are implicated as the source of a botulism events, including sausages, beef stew, canned vegetables, and seafood products.

Symptoms

After their ingestion, botulinum neurotoxins are absorbed primarily in the duodenum and jejunum, and pass into the bloodstream and travel to synapses in the nervous system. There, the neurotoxins cause flaccid paralysis by preventing the release of acetylcholine, a neurotransmitter, at neuromuscular junctions, thereby preventing motor-fiber stimulation. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, and then moving to the throat, chest, and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhibited and, unless the patient is ventilated, death from asphyxia results. Classic symptoms of botulism include nausea, vomiting, fatigue, dizziness, double vision, drooping eyelids, slurred speech, difficulty swallowing, and dryness of skin, mouth, and throat, lack of fever, muscle weakness, and paralysis. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. Throughout all such symptoms, the victims are fully alert and the results of sensory examination are normal.

In foodborne botulism cases, symptoms usually begin anywhere between 12 and 72 hours after the ingestion of toxin-containing food. Longer incubation periods—up to 10 days—are not unknown, however. The duration of the illness is from 1 to 10 (or more) days, depending on host-resistance, the amount of toxin ingested, and other factors. Full recovery often takes from weeks to months. And, as earlier indicated, mortality rate can be from 30% to 65%, with rates generally lower in European countries than in the United States.

Detection and treatment

Although botulism can be diagnosed based on clinical symptoms, its differentiation from other diseases is often difficult—especially in the absence of other known persons affected by the condition. Once suspected, the most direct and effective way to confirm the diagnosis of botulism in the laboratory is testing for the presence of the botulinum toxin in the serum, stool, or gastric secretions of the patient. The food consumed by the patient can also be tested for the presence of toxins. Currently, the most sensitive and widely used method for the detection of the toxins is the mouse neutralization test, which involves injecting serum into mice and looking for signs of botulism. This test typically takes 48 hours, while the direct culturing of specimens takes 5-7 days. Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. The mainstay of therapy is supportive treatment in intensive care, and mechanical ventilation in case of respiratory failure, which is common.

Long-Term and Permanent Injury

Although a minority of botulism patients eventually recovers their pre-infection health, the majority does not. For those who fully recover, the greatest improvement in muscle strength occurs in the first three months after the acute phase of illness. The outside limit for such improvement appears, however, to be one year. Consequently, physical limitations that still exist beyond the one-year mark are more probably than not permanent. Recovery from acute botulism symptoms may also be followed by persistent psychological dysfunction that may require intervention.

According to a recently published study that tracked the long-term outcomes of 217 cases of botulism, a large majority of patients reported “significant health, functional, and psychosocial limitations that are likely the consequences of the illness.” These limitations included: fatigue, weakness, dizziness, dry mouth, and difficulty lifting things. The victims also reported difficulty breathing caused by moderate exertions, such as walking or lifting heavy items. They were also more likely to have limitations in vigorous activities, like running or playing sports, climbing up three flights of stairs, or carrying groceries. Summarizing its finding, the study concluded that:

Even several years after acute illness, patients who had botulism were more likely than control subjects to experience fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and difficulty breathing caused by moderate exertion. In addition, patients reported worse overall psycho-social status than did control subjects, with patients being significantly less likely to report feeling happy, calm and peaceful, or full of pep.

There is, as a result, no question that the damaging effects of botulism are life-long.

Botulism Associated with Commercial Carrot Juice—Georgia and Florida, September 2006

On September 8, 2006, the Georgia Division of Public Health (GDPH) and CDC were notified of three suspected cases of foodborne botulism in Washington County, Georgia. On September 25, the Florida Department of Health and CDC were notified of an additional suspected case in Tampa, Florida. This report describes the joint effort.

On September 8, the three patients from Washington County, Georgia, went to a local hospital with cranial nerve palsies and progressive descending flaccid paralysis resulting in respiratory failure; the patients had shared meals on September 7. On the evening of September 8, physicians suspected foodborne botulism, notified the state health department, and collected clinical specimens for testing at CDC. On the same evening, CDC provided clinical consultation and dispatched botulinum antitoxin, which was administered to each of the patients the following morning. After receiving antitoxin, the patients had no progression of neurologic symptoms, but they remain hospitalized and on ventilators.

On September 9, the Washington County Health Department, Richmond County Health Department, and GDPH launched an investigation. The three patients had consumed several food items during their two meals together on September 7, including juice from a single 1-liter bottle of Bolthouse Farms carrot juice. The bottle had a “best if used by” date of September 18, 2006. Clinical specimens and leftover food and juice were collected and sent to CDC for testing. On September 13, botulinum toxin type A was identified in the serum and stool of all three patients. On September 15, leftover carrot juice recovered from the home of one of the patients also tested positive for botulinum toxin type A.

During September 8-15, FDA, the Georgia Department of Agriculture, the Georgia Hospital Association, and public health officials in all 50 states were notified of the outbreak and the implicated product as information became available. After these notifications, no additional cases of botulism in Georgia were reported to the state and local health departments or to CDC. During this time, FDA launched an investigation of the Bolthouse Farms, Inc., manufacturing plant in Bakersfield, California. FDA and CDC tested other bottles of the implicated brand of carrot juice, including bottles from different lots, and all were negative for botulinum toxin. Because botulinum toxin was found only in the bottle of carrot juice consumed by the three patients, a lapse in refrigeration of the carrot-juice bottle during transport or storage was suspected, which would have allowed for growth of Clostridium botulinum and subsequent production of botulinum toxin. Based on the CDC test results, on September 17, FDA issued a consumer advisory on the importance of keeping carrot juice refrigerated. However, information obtained from patient interviews regarding storage and transport of the carrot juice did not confirm mishandling by the patients.

On September 25, officials at the Florida Department of Health, the Hillsborough County Health Department, and CDC were notified that a patient had been hospitalized in Tampa, Florida, on September 16, with respiratory failure and descending paralysis. On September 28, botulinum toxin type A was identified in the patient’s serum. Circulating toxin persisted more than 10 days after illness onset in this completely paralyzed patient, indicating ingestion of a massive toxin dose. Accordingly, the patient was treated with antitoxin, which prevents binding of circulating botulinum toxin to nerve endings. The patient remains hospitalized, paralyzed, and on a ventilator. The Hillsborough County Health Department collected an open, 450-milliliter bottle of Bolthouse Farms carrot juice, which had been found by a family member in the hotel room where the patient had been staying during the month before being hospitalized. The hotel room had no refrigerator. The bottle, which had a “best if used by” date of September 19, 2006, had a different lot number than the bottle associated with the Georgia cases. On September 29, botulinum toxin was identified in carrot juice from the bottle found in the patient’s hotel room; the toxin was subsequently identified as botulinum toxin type A. The Hillsborough County Health Department and CDC notified FDA, public health officials in all 50 states, and infection-control practitioners in Hillsborough County about the botulism case and implicated product.

The carrot juice consumed by these four patients was manufactured by Bolthouse Farms, Inc., and distributed in all 50 states, Mexico, Canada, and Hong Kong with the labels “Bolthouse Farms 100% Carrot Juice,” “Earthbound Farm Organic Carrot Juice,” and “President’s Choice Organics 100% Pure Carrot Juice.” Investigations of these cases by state and local health departments and investigations of the manufacturer by FDA are ongoing. On September 29, GDPH and the Georgia Department of Agriculture recommended that Georgia residents not purchase or consume Bolthouse Farms carrot juice. The same day, the FDA warned consumers not to drink Bolthouse Farms carrot juice with “best if used by” dates of November 11, 2006 or earlier (i.e., all bottles produced before the date the warning was issued), and Bolthouse Farms issued a voluntary recall of these products.

The 2007 Castleberry Botulism Outbreak

On July 7, 2007, the Centers for Disease Control and Prevention (“CDC”) learned that two siblings in Texas were critically ill with botulism and that their illnesses were likely acquired by eating contaminated food. The two children were admitted to pediatric intensive care, and there required mechanical ventilation. The CDC released doses of botulinum antitoxin, which was administered to the children the next morning.

Four days later on July 11, public health officials in Indiana reported to the CDC that a married couple in Indiana were suspected of having foodborne botulism. Serum samples were collected from each of them on July 10 and then sent to the Botulism Reference Laboratory at the CDC. On July 16, one day after the lab received the serum samples, botulinum toxin type A was detected by mouse bioassay in the man’s serum sample. Botulinum toxin was also detected by mouse bioassay in serum submitted by the wife, but the sample volume was insufficient to determine the toxin type. Investigations conducted by state and local health departments in both Texas and Indiana revealed that all four patients had eaten types of Castleberry’s hot dog chili before symptom onset.

Texas investigators found an unopened can of Castleberry’s Austex Hot dog Chili Sauce Original date stamped with a manufacture date and time of May 7 at 9:41 p.m. at the children’s home and tested it for botulism. The Texas Department of Health Services laboratory tested an aliquot from this can using an enzyme-linked immunosorbent assay (ELISA) for botulinum toxin and did not detect the toxin.

The Indiana couple had an unlabeled, sealed plastic bag of leftover chili mixture in their refrigerator that local health officials collected and sent to the CDC for C. botulinum toxin testing. On July 16 the CDC detected botulinum toxin type A by mouse bioassay in the chili mixture. Empty, well-rinsed cans of Castleberry’s Hot Dog Chili Sauce Original and chili made by another company were found in the couple’s recycling bin. CDC re-rinsed the two cans and tested the rinse water for botulinum toxin by mouse bioassay; both were negative. The label on the can of Castleberry’s Hot Dog Chili Sauce Original indicated a production-date of May 8, and a time of 2:23 AM—less than five hours after the production-time indicated on the can collected from the Texas home.

On July 17, CDC staff provided information regarding the production-dates and times to the FDA. The evidence strongly suggested that brands of Castleberry’s hot dog chili sauce were the common source of the four ill persons with botulism. On July 18, FDA issued a consumer advisory. On that same day, after being informed about the outbreak, and findings from the FDA investigation of the canning facility, Castleberry’s Food Company issued a voluntary recall that included a limited number of production dates of Castleberry’s Hot Dog Chili Sauce Original, Castleberry’s Austex Hot Dog Chili Sauce Original, and Kroger Hot Dog Chili Sauce. The recall was expanded on July 21 to include all production dates for 91 types of canned chili sauce, chili, other meat products, chicken products, and dog food that were manufactured in the same set of cookers, or “retorts” as the hot dog chili sauce at the Castleberry’s facility in Augusta, Georgia.

By August 24, eight cases of botulism had been reported to the CDC. In addition to the Indiana couple, the mother of the children in Texas had developed symptoms of botulism, which brought the total number of Castleberry-associated cases in Texas to three. There was also three unrelated residents of Ohio who had developed botulism consuming Castleberry’s hot dog chili sauce in the week before symptom onsets. Botulinum toxin was identified in leftover chili sauce collected from the refrigerator belonging to one of the Ohio cases.

The Castleberry’s manufacturing facility in Georgia produces products regulated both by the FDA and USDA-FSIS. Initial reports of illnesses were linked to meatless hot dog chili sauce and thus, fell under the jurisdiction of the FDA. The agency’s Atlanta District Office took the lead in the investigation of facilities.

The inspection started on the evening of July 17. FDA investigators requested company maintenance records, which were not immediately available because they were stored on a laptop of a vacationing employee. Finally, three days later, under threat of severe penalty, the company produced some of the requested records. Included in records provided to federal investigators was a 42-page report written by a consultant hired by Castleberry’s to investigate swollen cans of stew, chili, and hash produced in April and May 2007. The consultant had attributed spoilage to post-process handling operations in one of the plant’s cooking equipment. Reports by two other company-hired consultants would also implicate post processing as the reason for swollen cans. Unfortunately, Castleberry’s had not investigated the issues further.

On July 18 and 19, a team of federal investigators were sent to the firm’s warehouse. Samples of Castleberry’s Austex and Castleberry’s brand Hot Dog Chili Sauce with the “best by May 7, 2009” and “best by May 8, 2009” lot codes were collected and sent to FDA laboratories for testing.[42] FDA testing of sample 428113, consisting of 17 swollen cans, found C. Botulinum toxin in 16 of the cans. This sample included the same time-stamp and lot code from the May 8, 2007 production as the can found in the Indiana home. FDA testing of sample 420352, consisting of six swollen cans, found C. Botulinum in four cans. FDA sample 420353 included one swollen can, and its contents tested positive for C. Botulinum toxin.

Federal investigators conducted extensive tests on Castleberry equipment. The findings are presented in an FDA report issued on August 10, 2007, Attachment No. 1, FDA Inspectional Observations dated 08/10/2007, (Summary pages only). Noted observations include:

The system, equipment, and procedures used for thermal processing of foods in hermetically sealed containers were not operated and administered in a manner that ensures commercial sterility is achieved.

Each retort did not have an accurate temperature records device.

Failure to supply a suitable water valve used for water cooling to prevent leakage of water into the retort during processing.

The condensate bleeder was not checked with sufficient frequency to ensure removal of condensate or equipped with an automatic alarm system for the continuous monitoring of condensate bleeder functioning.

Required information was not entered on designated forms at the time the observation was made by the retort or processing system operator or designated person.

Failure to maintain fixtures in repair sufficient to prevent food from becoming adulterated.

Failure to properly adjust the temperature-recording device. The temperature recorded on the temperature-recording device chart was higher than the mercury-in-glass thermometer during processing.

The report ultimately placed blame on Castleberry management saying there was no commitment from employees in making the products and there was not adequate management oversight. As one Castleberry employee noted: “Two years ago the [implicated retorts] were maintained very well, but they are maintained poorly now.” The FDA plainly agreed, citing Castleberry’s for the “failure to maintain fixtures in repair sufficient to prevent food from becoming adulterated.”

Castleberry made substantial fixes at its plant and then reopened in the fall of 2007. The company re-branded its line to American Originals, and redesigned product labels. But in March, 2008, the plant was forced to close again after a February 27 joint-inspection by the FDA and USDA revealed deviations in some equipment operations on the processing line. The line was not related to deficiencies noted in the summer of 2007 but because under-processing caused the botulism outbreak, the plant’s operating permit was suspended.

Some background information on canning

The canning process dates back to the late 18th century in France when the Emperor Napoleon Bonaparte, concerned about keeping his armies fed, offered a cash prize to whoever could develop a reliable method of food preservation. Nicholas Appert conceived the idea of preserving food in bottles, like wine. After fifteen years of experimentation, he realized if food is sufficiently heated and sealed in an airtight container, it would not spoil. More than fifty years later, Louis Pasteur provided the explanation for effectiveness of canning when he was able to demonstrate that the growth of microorganisms is the cause of food spoilage.

An Englishman, Peter Durand, took the idea one step further and replaced the breakable glass bottles with cylindrical tinplate canisters (later shortened to “cans”). Durand did not can foods himself, but sold his patent to two other Englishmen, Bryan Donkin and John Hall, who set up a commercial canning factory. By 1813, Donkin and Hall were busily producing their first canned goods for the British army, thus continuing the connection of canning to the military.

The basic principles of canning have not changed dramatically since Nicholas Appert and Peter Durand developed the process. Heat sufficient to destroy microorganisms is applied to foods packed into sealed, or “airtight” containers. The canned foods are then heated under steam pressure at temperatures of 240-250°F (116-121°C). The amount of time needed for processing is different for each food, depending on the food’s acidity, density and ability to transfer heat.

Processing conditions are chosen and designed to be the minimum needed to ensure that the foods are made “commercially sterile,” while still retaining the greatest flavor and nutrition. The U.S. Food and Drug Administration must first approve all canning-processes. Once the cans are sealed and heat processed, the resulting canned food must maintain its high eating quality for more than two years and be safe to eat as long as the can is not damaged in any way. Historically, commercially canned food has a near-perfect track record, having caused only four outbreaks in over forty years. The last outbreak occurred in 1974 and involving beef stew.

References

Bleck, supra note 15, at 2547. See also P. Wilcox, et al., Recovery of Ventilatory and Upper Airway Muscles and Exercise Performance After Type-A Botulism, Chest, 98:620-26 (1990); J. Mann, et al., Patient Recovery From Type-A Botulism: Morbidity Assessment Following a Large Outbreak, Am. J. Public Health, 71 (3): 266-69 (Mar. 1981).

Bleck, supra note 15, at 2547. See also F. Cohen, et al., Physical and Psychosocial Health Status 3 Years After Catastrophic Illness—Botulism, Issues Mental Health Nurs., 9:387098 (1988).

S. Gottlieb, et al., Long-Term Outcomes of 217 Botulism Cases in the Republic of Georgia, Clin. Infectious Disease, 45: 174-80, at 180 (220).

St Louis ME, Peck SH, Bowering D, et al. Botulism from chopped garlic: delayed recognition of a major outbreak. Ann Intern Med 1998;108:363.

Morse DL, Pickard LK, Guzewich JJ, et al. Garlic-in-oil associated botulism: episode leads to product modification. Am J Public Health 1990; 80:1372.

See J. Sobel, et al., Foodborne Botulism in the United States, 1990-2000, Emerging Infectious Diseases, Vol. 10, No. 9, at 1606 (Sept. 2004).

James M. Jay, MODERN FOOD MICROBIOLOGY, 466 (6th Ed. 2000).

Id. at 469-71; see also Sobel, supra note 2, at 1606.

Jay, supra note 3, at 467-69. See also, generally H. Houschild, Clostridium Botulinum, in FOODBORNE BACTERIAL PATHOGENS, at 112-89 (M. Doyle Ed. 1989). With botulism, the broader term “event” is used to encompass both outbreaks—i.e., two or more cases of botulism caused by a common-source, as well as individual (or sporadic) cases.

Thomas P. Bleck, Clostridium botulinum (Botulism), in MANDELL, DOUGLAS AND BENNETT’S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASE 2543, 2544 (5th ed. 2000). see also BOTULISM FACT SHEET, National Agricultural Bio-Security Center, Kansas State University, online at http://nabc.ksu.edu/content/factsheets/category/Botulism#f26.

R. Shapiro, et al., Botulism in the United States: A Clinical and Epidemiologic Review, Ann. Intern. Med. 1998; 129:221-28.

FDA/CFSAN Bad Bug Book, Clostridium Botulinum, available at http://vm.cfsan.fda.gov/~mow/chap2.html

The following introductory material is based on information from the Wikipedia entry on canning, online at http://en.wikipedia.org/wiki/Canning, and the sources there cited.

Tony Baird-Packer, The Production of Microbiologically Safe and Stable Foods, in Volume 1 of THE MICROBIOLOGICAL SAFETY AND QUALITY OF FOOD, 4 (B. Lund, et al. Eds. 2000).

See, e.g. MMWWR, supra note 1, at 3 (citing P. Blake, et al., Type A Botulism from Commercially-Canned Beef Stew, South. Med. J. 1977; 70:5-7).

The information about the outbreak comes primarily from the CDC-published report issued July 30, 2007. See MMWR, supra note 1, at 1-2.

Botulism:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Botulism outbreaks. The Botulism lawyers of Marler Clark have represented thousands of victims of Botulism and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Botulism lawyers have litigated Botulism cases stemming from outbreaks traced to carrot juice and chili.

If you or a family member became ill with Botulism after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Botulism attorneys for a free case evaluation.

Lawsuit Filed on Behalf of Spokane Resident Sickened By E. Coli Tainted Clover Sprouts After Consuming a Sandwich from Pita Pit

This is third lawsuit filed against Evergreen Sprouts after 18 were infected with E. coli

Attorney Bill Marler of Marler Clark, the nation’s only law firm dedicated to representing victims of foodborne illness, has filed a lawsuit in the United States District Court for the Eastern District of Washington at Spokane on behalf of Wilson R. Criscione, a Spokane County resident sickened with Shiga toxin-producing Escherichia coli O121. The infection is linked to the recent E. coli outbreak due to raw clover sprouts produced by Evergreen Sprouts LLC of Moyie Springs, Idaho.

According to the Center for Disease Control and Prevention (CDC), a total of 18 persons infected with the outbreak strain of Shiga toxin-producing Escherichia coli O121 have been reported from five states. The number of ill persons identified in each state is as follows: Idaho (3), Michigan (1), Montana (2), Utah (1), and Washington (11). Forty-four percent of ill persons have been hospitalized.

Epidemiologic investigation has shown that the contaminated clover sprouts were served at multiple restaurant locations, including Jimmy John’s Gourmet Sandwiches, Daanen’s Delicatessen, and Pita Pit, from which the plaintiff was infected. The FDA conducted an inspection of the Evergreen Fresh Sprouts facility and observed a number of unsanitary conditions. Health officials from the Washington State Department of Health and the Idaho Department of Health and Welfare have advised people not to consume raw clover sprouts manufactured and distributed by Evergreen Fresh Sprouts, located in Idaho.

On or about May 1, 2014, Wilson R. Criscione purchased and consumed a sandwich at the Pita Pit in Spokane, WA. On or about May 8, 2014, he also purchased and consumed a sandwich at the Jimmy John’s in Spokane. The sandwiches contained E. coli O121 tainted clover sprouts that had been manufactured and sold by Evergreen Sprouts.

The onset of Mr. Criscione’s symptoms occurred on or about May 9, 2014. Symptoms included excruciating stomach cramps, diarrhea, which eventually turned bloody, and other gastrointestinal problems. When he sought medical treatment, a stool sample was submitted and ultimately tested positive for E. coli. Mr. Criscione is currently continuing in his recovery from this illness.

“According to the FDA’s own 1999 advisory, Recommendations on Sprouted Seeds, sprouts have been increasingly implicated in foodborne outbreaks,” says Marler. “The time has come to label sprouts as potentially hazardous.”

As far back as September 1998, the FDA and CDC issued a warning against sprouts urging children, pregnant women, and the elderly that they should not eat alfalfa sprouts until growers find a way to reduce the risk of E. coli. They also warned that any people with weakened immune systems should avoid eating sprouts as well.

Although sprouts are often considered a “health food,” the warm, humid conditions needed for growing sprouts from seeds are also ideal for bacteria to flourish. Salmonella, E. coli, and other bacteria can grow to high levels without affecting the appearance of the sprouts.

Researchers have treated both seeds and sprouts with heat or washed them in solutions of chlorine, alcohol, and other chemicals. Some of these disinfectants reduced the levels of bacteria, but a potential hazard remained, especially for persons with weak immune systems. High temperatures that would kill the bacteria on the seeds would also keep them from sprouting.

“Until an effective way is found to prevent illness from sprouts, they should be eaten with caution, if at all,” says Marler. “In my experience, it is safest just to rid them from your diet altogether.”

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

 

Shigella Lawsuit Filed against Salsarita’s Restaurant in Wal-Mart

Wife of active duty U.S. Navy diver is one of 275 people who became ill with Shigellosis 

Attorneys Bill Marler and Drew Falkenstein of Marler Clark, the nation’s only law firm dedicated to representing victims of foodborne illness, have filed a lawsuit in the Circuit Court of Benton County, Arkansas on behalf of married couple Delida Groom and James Groom. Mrs. Groom was visiting the area when she was sickened with Shigellosis after consuming food from Salsarita’s Restaurant located in the Wal-Mart Home Office Café in Bentonville, Arkansas. Case number is V 14-1029-1 in the Circuit Court of Benton County, Arkansas, Civil Division.

In late June 2014, the Arkansas State Health Department announced that an outbreak of Shigella had occurred at the Wal-Mart Home Office in Bentonville, Arkansas. At or about the time of the announcement, Salsarita’s restaurant had temporarily closed its doors. The health department has stated that 275 cases of Shigellosis have occurred in nine states as part of this outbreak. After investigation, health officials indicated that Salsarita’s restaurant was the source of the outbreak. The outbreak stemmed from a few simple and preventable violations; some of which included employees not washing their hands and employees touching ready-to-eat food without wearing gloves.

In June 2014, Mrs. Groom traveled to Bentonville, Arkansas to visit her parents. While in Arkansas, on Friday, June 13, 2014, she attended a luncheon that included multiple foods from the Wal-Mart Home Office Café, including chips, salsa, and other items produced at the Salsarita’s restaurant located in the Café. The following evening, June 14, 2014, Mrs. Groom began to feel slightly fevered, light-headed, and nauseated. Over the next several days, her symptoms spiraled and included bloody diarrhea and severe gastrointestinal issues. She was later given treatment for metabolic disturbances given her immense gastrointestinal losses and hospitalized in the ICU for several days receiving critical care. Mrs. Groom developed long-term complications and continues to suffer from the effects of the Shigellosis illness.

“After thousands of cases, I am still amazed at how these outbreaks start,” said Marler. “Washing your hands and putting on gloves is not rocket science and it only takes a minute or two.”

Shigellosis is an infectious disease caused by a group of bacteria called Shigella. Most who are infected with Shigella develop diarrhea, fever, and stomach cramps starting a day or two after they are exposed to the bacteria. The diarrhea is often bloody. Shigellosis usually resolves in 5 to 7 days. Persons with Shigellosis in the United States rarely require hospitalization. A severe infection with high fever may be associated with seizures in children less than 2 years old.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Shigella outbreaks. The Shigella lawyers of Marler Clark have represented thousands of victims of Shigella and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Shigella lawyers have litigated Shigella cases stemming from outbreaks traced to a variety of sources, such as tomatoes, airplane and restaurant food.