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Food Safety For Those Over 60

KATE GUSTMAN RDN, CD, Ridgewood Care Center Dietician

Everyone needs to practice food safety and sanitation. However, for the very young and old the consequences of not doing so are much more detrimental. It is best to follow these guidelines:

  • Practice frequent hand-washing — Wash hands before, during and after cooking, as well as before you eat. Use warm water and soap for 20 seconds, then dry with a clean towel.
  • Keep raw meat and eggs separate — Raw items should not touch anything that may introduce bacteria into your mouth. This includes cutting boards, knifes and countertops; sanitize before re-using.
  • Practice keeping foods properly cooled — Set refrigerator temperature lower than 40 degrees. Put cold items in refrigerator right away after shopping. Refrigerate leftovers within two hours, putting large quantities into smaller, shallow containers to cool more quickly. Use leftovers within seven days. Use foods by expiration date.
  • Cook foods to proper temperatures — This can be checked using a calibrated meat thermometer. Most food packages have the minimum temperature listed on them.

Also note these foods that are not safe for older adults: undercooked meat and fish (sushi), refrigerated smoked seafood, unpasteurized dairy, some fresh soft cheeses, raw/undercooked egg, raw sprouts, deli salads, unpasteurized fruit and vegetable juices.

Wisconsin Dairy Hit With Raw Milk Penalty

The owners of a Pepin County dairy, Roland and Diana Reed of Arkansaw, have agreed to penalties stemming from a foodborne illness outbreak that sickened 32 Durand High School students and coaches in September 2014, said food safety officials today. The Wisconsin Department of Agriculture, Trade and Consumer Protection’s (DATCP) announcement comes after a thorough review of the investigation report written by the Wisconsin Department of Health Services (DHS).

“After reviewing the circumstances described in the final DHS epidemiological and laboratory report, we have determined that the farm violated current statutes and rules by distributing unpasteurized milk in an unauthorized manner, so we are taking appropriate action,” said Dr. Steve Ingham, administrator of the Division of Food Safety for DATCP.

The Reeds have agreed to a DATCP plan that includes suspending the farm’s Grade A permit for 30 days.  If the farm violates the conditions of the agreement within three years, the Grade A permit will be suspended again for 150 days for the current violation and their Grade A permit will be revoked for no less than six months for the additional violation. After revocation, the Reeds must reapply to be considered again for Grade A status.

“Our goal is to prevent a reoccurrence by changing the practices that led to this outbreak,” Ingham says. “We take our responsibility to protect public health seriously and uniformly enforce the law.”

Arizona, Missouri and New Mexico Hardest Hit in Listeria Apple Outbreak

Arizona – 5
California – 3
Colorado – 1
Minnesota – 4
Missouri – 5
Nevada – 1
New Mexico – 6
North Carolina – 1
Texas – 4
Utah – 1
Washington – 1
Wisconsin – 1

The Centers for Disease Control and Prevention (CDC) reports a total of 35 people infected with the outbreak strains of Listeria monocytogenes were reported from 12 states.  Of these, 34 people were hospitalized. Listeriosis contributed to at least three of the seven deaths reported.  Eleven illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant), with one illness resulting in a fetal loss.  Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.  Twenty-eight (90%) of the 31 ill people interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill.  The Public Health Agency of Canada (PHAC) identified one case of listeriosis in Canada that is genetically related to the U.S. outbreak.

On January 6, 2015, Bidart Bros. of Bakersfield, California voluntarily recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility.  On January 18, 2015, FDA laboratory analyses using whole genome sequencing (WGS) showed that these Listeria isolates were highly related to the outbreak strains.  Happy Apples, California Snack Foods, and Merb’s Candies each announced a voluntary recall of commercially produced, prepackaged caramel apples.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria 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 Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as caramel apples, cantaloupe, cheese, celery and milk.

Bidart Listeria Apple Outbreak Over After 37 Sickened

CDC collaborated with public health officials in several states and with the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections (listeriosis). Joint investigation efforts indicated that commercially produced, prepackaged caramel apples made from Bidart Bros. apples were the likely source of this outbreak.

Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA “fingerprinting” is performed on Listeria bacteria isolated from ill people using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS).

The 35 ill people included in this outbreak investigation were reported from 12 states: Arizona (5), California (3), Colorado (1), Minnesota (4), Missouri (5), Nevada (1), New Mexico (6), North Carolina (1), Texas (4), Utah (1), Washington (1), and Wisconsin (3). Illness onset dates ranged from October 17, 2014, to January 6, 2015. Eleven illnesses were associated with a pregnancy (occurred in a pregnant woman or her newborn infant). One fetal loss was reported. Among people whose illnesses were not associated with a pregnancy, ages ranged from 7 to 92 years, with a median age of 62 years, and 33% were female. Three invasive illnesses (meningitis) occurred among otherwise healthy children aged 5–15 years. Thirty-four people were hospitalized, and listeriosis contributed to at least three of the seven deaths reported.

The Public Health Agency of Canada (PHAC) identified two cases of listeriosis in Canada with the same PFGE patterns as those seen in the U.S. outbreak. More detailed testing using WGS showed that the isolate from only one of the two cases was genetically related to the U.S. outbreak. That person reported eating a caramel apple.

On January 6, 2015, Bidart Bros. of Bakersfield, California, voluntarily recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility. The recall included all Granny Smith and Gala apples shipped from its Shafter, California, packing facility in 2014. On January 8, 2015, FDA laboratory analyses using PFGE showed that environmental Listeria isolates from the Bidart Bros. facility were indistinguishable from the outbreak strains. On January 18, 2015, WGS found that these isolates were highly related to the outbreak strains. In addition, WGS showed that Listeria isolates from whole apples produced by Bidart Bros., collected along the distribution chain, also were highly related to the outbreak strains.

Three firms that produce caramel apples issued voluntary recalls after receiving notice from Bidart Bros. that there may be a connection between Bidart Bros. apples and this listeriosis outbreak. On December 24, 2014, Happy Apple Company of Washington, Missouri, voluntarily recalled Happy Apples brand caramel apples with a best use by date between August 25 and November 23, 2014. On December 31, 2014, Happy Apple Company expanded the recall to include Kroger brand caramel apples produced by Happy Apple Company with a best use by date between September 15 and November 18, 2014. On December 27, 2014, California Snack Foods voluntarily recalled Karm’l Dapple brand caramel apples with a best use by date between August 15 and November 28, 2014. On December 29, 2014, Merb’s Candies of St. Louis, Missouri issued a voluntary recall of Merb’s Candies Bionic Apples and Double Dipped Apples that would have been available from September 8 through November 25, 2014.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Listeria outbreaks. The Listeria lawyers of Marler Clark have represented thousands of victims of Listeria 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 Listeria lawyers have litigated Listeria cases stemming from outbreaks traced to a variety of foods, such as caramel apples, cantaloupe, cheese, celery and milk.

New Jersey School Cafeteria Worker With Hepatitis A

The Passaic New Jersey Superintendent of Schools sent letters to parents and staff members alerting them that a high school employee had been diagnosed with Hepatitis A by their personal doctor.

Anyone who bought food from the Passaic High School teachers cafeteria between Jan. 15th and Jan. 30th was urged to be on the lookout for symptoms.

Symptoms include fatigue, fever and vomiting.

In the letter, superintendent Pablo Munoz said: “The school district immediately notified local health officials about the diagnosis and is currently following every recommendation of these health care professionals. This morning I met with all the school principals, school leaders and staff to discuss this diagnosis of an employee. The school district is sending letters home about the diagnosis of Hepatitis A and providing details about where they can get additional information. While local health officials believe that the chance of students becoming ill is small, we will continue to take every precaution recommended by them.”

Munoz told parents that local and state officials believe the chances of children becoming ill is small, but that they should be aware of several facts:

Hepatitis A is an illness of the liver caused by infection with the Hepatitis A virus.

The virus is shed in the stool of the infected person.

People become infected with Hepatitis A by swallowing the virus. This can occur when an individual eats or drinks food or water contaminated with Hepatitis A virus, or has direct contact with an infected person who has poor personal hygiene.

An individual infected with Hepatitis A, may display a range of symptoms including:

  • Fever
  • Fatigue
  • Poor appetite
  • Vomiting or abdominal discomfort
  • Dark colored urine
  • Clay-colored (pale) stool
  • Yellow discoloration of skin and whites of the eye (a condition known as jaundice)

Young children with Hepatitis A usually do not display symptoms, yet may be a source of infection to close household contacts by sharing food and/or eating or drinking utensils.

No specific medications, including antibiotics, are indicated for the treatment of Hepatitis A. Most individuals fully recover, without treatment, within a few weeks.

Whole Foods Recalls Salmonella Macadamia Nuts

Whole Foods Market is recalling packaged raw macadamia nuts due to possible Salmonella contamination. 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 (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.

The product was labeled as “Whole Foods Market Raw Macadamia Nuts” and was packaged in 5.6 oz. plastic tubs. The recalled products have sell-by dates of 4/22/15, 5/4/15 and 5/6/15 and a UPC code of 7-23055-21415-3. The recalled product was distributed to Whole Foods Market, Greenlife Grocery, and Harry’s Farmers Market stores in AL, GA, MS, NC, SC and TN.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella 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 Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

2013 Salmonella Outbreak Linked to Raw Meat

In January 2013 local, state and federal officials announced an outbreak of Salmonella Typhimurium linked to consumption of ground beef produced by Jouni Meats, Inc. and Gab Halal Foods.  Public health investigators used DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify patients considered to be part of the outbreak. Collaborative investigative efforts indicated that ground beef produced by Jouni Meats, Inc. and Gab Halal Foods were the likely source of the outbreak.

A total of 22 persons infected with the outbreak strain were reported from six states:  Arizona, Illinois, Iowa, Michigan, Pennsylvania, and Wisconsin. Among persons for whom information was available, illness onset dates ranged from December 9, 2012 to February 20, 2013.  Ill persons ranged in age from 2 years to 87 years. Among 14 persons with available information, 7 ill persons were hospitalized.  No deaths were reported.

Initial investigations focused on 7 ill persons in Michigan (6) and Arizona (1) who reported eating at the same restaurant before their illness began.  All seven of these ill persons reported eating raw ground beef kibbeh (a dish typically made of finely ground red meat, usually lamb, minced onions, and bulgur wheat) at this restaurant before becoming ill.  An additional 9 ill persons were interviewed and answered questions about foods consumed and other exposures during the week before becoming ill.  Although several of these ill persons reported eating beef prior to becoming ill, a likely source was not identified that linked these illnesses with the illnesses at the restaurant.

On January 24, 2013 Jouni Meats, Inc. recalled approximately 500 pounds of ground beef products.[1]  In the FSIS recall news release announcing this recall, FSIS stated that the investigation identified that raw ground beef was consumed at a restaurant. The products subject to recall are various size packages of ground beef. These products were produced between December 4, 2012 and December 9, 2012, and distributed to a restaurant in Macomb County, Michigan, and sold directly to consumers at Jouni Meats, Inc.  On January 25, 2013 Gab Halal Foods recalled approximately 550 pounds of ground beef products.[2]  The products subject to recall are various size packages of ground beef wrapped in clear plastic. These products were produced between December 4, 2012, and December 10, 2012, and distributed to a restaurant in Macomb County, Michigan, and sold directly to consumers at Gab Halal Foods.

On March 15, 2013 the CDC issued a final notice declaring the outbreak to be over.[3]

A Report on the 2012 multistate foodborne illness outbreak associated with Salmonella typhimurium including Michigan and an evaluation of traceback records.

Background information

In March 2013, the Centers for Disease Control reported on a multistate outbreak of foodborne illness related to Salmonella typhimurium in 6 states.  A total of 22 confirmed cases were listed in the report, which were indistinguishable by pulsed field gel electrophoresis (PFGE) and included 9 cases in the State of Michigan and 1 case in the State of Arizona.  The Arizona case consumed the suspect meal in Michigan during the same time period as the other Michigan cases.  Because of this outbreak two meat-processing establishments issued voluntary recalls because of the link of illnesses to their processing facilities.  Seven (7) of the Michigan cases and the 1 Arizona case consumed “Kibbeh” (a product made with raw ground beef and not further cooked), at the same restaurant “Ike’s” in Sterling Heights, Michigan.  All of the products were purchased on the same date, November 8, 2012 although one of the cases consumed the product as a leftover on the following day.  The other 6 cases consumed the product at the restaurant.  Further, 3 additional cases were epidemiologically linked to eating kibbeh at Ike’s Restaurant.

During the same time period, the United States Department of Agriculture, Agricultural Marketing Service (USDA/AMS) routinely sampled ground beef destined for their food commodity-purchasing program.  This sample, from a slaughter/processing plant in Minnesota, also matched the outbreak strain by PFGE.

The Traceback

Ike’s Restaurant purchases ground beef from two suppliers: Gab Halal Foods also called Bob Berry & Sons and from Jouni Halal Meats.  The product is ground beef made from boneless peeled beef knuckles, which is from the primal cut sirloin.  Ike’s predominantly purchases from Gab Halal Foods and did purchase kibbeh meat on 12/06/2012- 10 pounds and on 12/08/2012-35 pounds.  However, on 12/07/2012 Gab Halal Foods was not able to provide meat for kibbeh and Ike’s purchased 25 pounds from Jouni Halal Meats.

The owner of Ike’s Restaurant stated that he does carry over kibbeh from one day to the next.  Nevertheless, since the last date of delivery from Gab Halal Foods was a 10-pound order on 12/06/2012 it is unlikely that this product would have been served on 12/08/2012 the date of consumption.  Gab Halal Foods and Jouni Halal Meats have the same wholesale supplier called Saad Wholesale Meats in Detroit, Michigan.

Saad Wholesale Meats receives beef products from American Foods Group (AFG), headquartered in Alexandria, Minnesota.  AFG has 10 beef slaughter plants in the United States and 2 of them are located in Minnesota: Dakota Premium in South St. Paul and Long Prairie Packing in Long Prairie.  As stated previously, USDA/AMS obtained a PFGE match for the outbreak strain during routine sampling of ground beef products.  The USDA/AMS does not provide detailed information on the location of the plant only that it is a plant located in Minnesota.  Additional handwritten notes received from the State of Michigan Department of Agriculture and Rural Development (MDARD) listed that USDA was in the process of conducting an EA (environmental assessment), or in-depth verification review in USDA terminology at Dakota Premium, USDA establishment 357.  Since the MDARD was in discussions with USDA, Food Safety Inspection Service (FSIS) on the impending recall by Jouni Halal Meats and Gab Halal Foods, this information was most likely provided by USDA/FSIS during a telephone conversation with an MDARD representative.

Ike’s Restaurant purchased 10 pounds of kibbeh meat on 12/06/2012 and 35 pounds on 12/08/2012 from Gab Halal Foods.  Gab Halal Foods purchased 2-70 pound boxes of beef knuckles from Saad Wholesale Meats on 12/04/2012.  Saad Wholesale Meats purchased 14,721 pounds of beef knuckles from AFG delivery date of 11/28/2012 and 15,834 pounds of beef knuckles from AFG with a delivery date of 12/05/2012.

On 12/07/2012 Ike’s purchased 25 pounds of kibbeh meat from Jouni Halal Meats.  Jouni Halal Meats purchased 69 pounds of beef knuckles from Saad Wholesale Meats on 12/04/2012 and 158 pounds of beef knuckles on 12/07/2012.  Saad Wholesale Meats purchased 14,721 pounds of beef knuckles from AFG delivery date of 11/28/2012 and 15,834 pounds of beef knuckles from AFG with a delivery date of 12/05/2012.

In case 4330502377 ground beef was purchased (date unknown) for household consumption from Rababeh Meat Mkt. in Dearborn Heights, Michigan.  On 12/04/2012 Rababeh Meat Mkt. purchased 250 pounds of beef knuckles from Saad Wholesale Meats and on 12/07/2012 purchased 208 pounds of beef knuckles.  Saad Wholesale Meats purchased 14,721 pounds of beef knuckles from AFG delivery date 11/28/2012 and 15,834 pounds of beef knuckles from AFG with a delivery date of 12/05/2012.

Conclusion

In this investigation the most probable cause of the majority of the illness cases is the kibbeh meat from Ike’s Restaurant purchased on 12/08/2012.  The kibbeh meat came from two sources:  On 12/07/2012 Jouni Halal Meats and on 12/08/2012 Gab Halal Foods.  Either of these deliveries could have been served on 12/08/2012 as the owner of Ike’s Restaurant stated that product from previous day’s deliveries is used.

Both Gab Halal Foods and Jouni Halal Meats have the same source of beef knuckles used for grinding kibbeh meat and that is Saad Wholesale Meats.

Saad Wholesale Meats has one supplier for Halal beef knuckles and that is American Foods Group based in Alexandria, Minnesota.  Coincidently, USDA/AMS had PFGE match to the outbreak strain in a routine sample that was very likely obtained from Dakota Premium Meats, an AFG plant.  Based on this information more likely than not the meat that caused the foodborne illness outbreak was the kibbeh meat served at Ike’s Restaurant and received from Gab Halal Foods and Jouni Halal Meats.  Additionally one case was from ground beef purchased from Rababeh Meat Mkt.  All three establishments, Gab Halal Foods, Jouni Halal Meats and Rababeh Meat Mkt. received beef knuckles from Saad Wholesale Meats who purchases beef knuckles from American Foods Group, Alexandria, Minnesota.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella 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 Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

“Good on Ya” Foster Farms – 5% Salmonella is better than 15.4%

I was reading Foster Farms Press Release following FSIS’s release of its “Salmonella Action Plan.”  I’m impressed with Foster Farm’s commitment to lowering the percentage of tainted chicken heading out of its plant.  But it does beg the question – If you can take it from 15.4% to 5%, why not 0%?  Here is the Press Release:

In conjunction with today’s announcement by the United States Department of Agriculture Food Safety Inspection Service USDA-FSIS regarding a proposed 15.4 percent standard for Salmonella prevalence in raw poultry parts, California poultry producer Foster Farms has reaffirmed its commitment to maintaining Salmonella prevalence levels below 5 percent. Foster Farms has maintained an average Salmonella prevalence level of two percent for the last nine consecutive months. This performance record is the result of a $75 million food safety program launched in 2013.

“We support the USDA in taking this critical step to advance food safety across the poultry industry,” said Foster Farms President and CEO Ron Foster. “Foster Farms has made a tremendous investment to ensure that our practices represent the very best in the industry. We stand by our commitment to lead the industry with Salmonella prevalence levels of less than 5 percent. We remain dedicated to continuous food safety advances.”

Prior to today’s FSIS announcement, there was no established regulatory standard for raw poultry parts, though the most recent 2011-2012 reported industry average was 25 percent. Foster Farms has worked closely with the USDA, CDC, poultry industry and retailers to share its learnings in controlling Salmonella in the interest of creating a safer food supply system nationwide. The company continues to draw on the best food safety advice in and outside of the poultry industry through its Food Safety Advisory Board.

In 2013, Foster Farms implemented a $75 million food safety program that effectively reduced Salmonella system-wide from the breeder level, to the farms where the birds are raised and to the plants where the chicken is processed and packaged. This included improvements to equipment and processes, the implementation of a continuous testing program and food safety education.

Foster Farms’ multi-hurdle program has been credited by the CDC and the USDA for its consistent control of Salmonella in raw chicken. The company has also been recognized for its leadership in controlling Salmonella by U.S. Senator Dianne Feinstein, a champion of improved food safety. Based on the program’s success, Foster Farms is actively sharing data and insights with other poultry and meat producers. As part of this collaboration, Dr. Robert O’Connor, Foster Farms’ Senior Vice President for Technical Services, leads a National Chicken Council committee on Salmonella reduction at the parts level and has informed retailers in their development of vendor protocols.

Salmonella Tuna Scrape Sickened 425 in 2012

Local, state, the CDC and the U.S. Food and Drug Administration (FDA) collaborated in an investigation of a multistate outbreak of Salmonella Bareilly and Salmonella Nchanga infections which was ultimately shown to be associated with consumption of an imported frozen raw yellow fin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. Nakaochi Scrape is tuna backmeat that is scraped from the bones of tuna and may be used in sushi, sashimi, ceviche, and similar dishes.

Salmonella Bareilly and Salmonella Nchanga are unusual serotypes of Salmonella in the United States. Public health investigators used DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that were counted as outbreak associated cases.  They used data from 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.

A total of 425 individuals infected with the outbreak strains of Salmonella Bareilly or Salmonella Nchanga. Four hundred and ten persons infected with the outbreak strain of Salmonella Bareilly were reported from 28 states and the District of Columbia. The number of ill persons infected with the outbreak strain of Salmonella Bareilly identified in each state was as follows: Alabama (5), Arkansas (1), California (8), Colorado (1), Connecticut (11), District of Columbia (3), Florida (1), Georgia (20), Illinois (30) Indiana (1), Kansas (1), Louisiana (6), Massachusetts (36), Maryland (39), Missouri (4), Mississippi (2), Nebraska (2), New Hampshire (2), New Jersey (39), New York (62), North Carolina (12), Pennsylvania (37), Rhode Island (6), South Carolina (5), Tennessee (4), Texas (14), Virginia (33), Vermont (1), and Wisconsin (24).

Fifteen persons infected with the outbreak strain of Salmonella Nchanga were reported from 7 states. The number of ill persons infected with the outbreak strain of Salmonella Nchanga identified in each state was as follows: Georgia (2), Maryland (1), New Jersey (3), New York (6), Texas (1), Virginia (1), and Wisconsin (1).

Illness onset dates ranged from January 1 to July 7, 2012.  Ill persons ranged in age from less than 1 year to 86 years, with a median age of 30 years; 60% of patients were female. Among 326 persons with available information, 55 (17%) reported being hospitalized. No deaths were reported.

Interviews of ill persons conducted by states in March and April, 2012 suggested consumption of sushi made with raw tuna as a source of these infections. By April 11, 2012, 43 (81%) of 53 ill persons interviewed with a detailed questionnaire reported eating sushi. This proportion was significantly higher when compared with results from a survey of healthy persons in which 5% reported eating “sushi, sashimi, or ceviche made with raw fish or shellfish” in the 7 days before they were interviewed. Of the 43 ill persons reporting eating sushi, 39 (91%) reported eating a sushi item containing tuna and 36 (84%) reported eating a sushi item containing “spicy tuna.”

Several methods were used to evaluate the association between tuna and illness in this outbreak. On March 29, 2012, a study was launched to estimate the frequency of consumption of tuna and “spicy tuna” among all sushi eaters. Investigators assembled a comparison group from 1) diners who ate at one of the cluster restaurants or grocery stores or 2) a restaurant where a single ill person, who was judged to have a reliable memory, recalled consuming sushi only once in the week before illness. Records were collected on sushi orders that were placed at the same time of day (lunch or dinner) and as close to the date when the ill person ate at the restaurant.

On April 9, 2012, preliminary results of the comparison study using information available from 4 illness clusters at restaurants or grocery stores showed that the proportion of sushi orders that contained tuna as an ingredient averaged 61% (ranging from 43% to 71%). The proportion of sushi orders that contained “spicy tuna” as an ingredient averaged 37% (ranging from 29% to 53%). These data suggested there was an association between illness and consumption of sushi made with tuna, and specifically “spicy tuna.”

State and local public health and regulatory officials worked with the U.S. Food and Drug Administration (FDA) to conduct a traceback investigation of tuna. Investigators visited restaurants and grocery stores associated with ill persons and collected information about the ingredients used in “spicy tuna” recipes. Raw tuna was found to be a common ingredient used to make “spicy tuna” among all 5 restaurant or grocery store clusters for which ingredient information was available. FDA selected 4 of the clusters, which were located in Connecticut, Rhode Island, Texas, and Wisconsin, as the focus of the initial traceback investigation. All 4 establishments received the same imported frozen raw Nakaochi Scrape tuna product from a single tuna processing facility in India, Moon Fishery Pvt Ltd.

On April 13, 2012, Moon Marine USA Corporation (also known as MMI) of Cupertino, California voluntarily recalled 58,828 pounds of a frozen raw yellow fin tuna product, labeled as Nakaochi Scrape AA or AAA. A Seafood HACCP (Hazard Analysis and Critical Control Point) inspection was conducted by FDA April 19–24, 2012 at the Moon Fishery Pvt Ltd. processing facility in Aroor, India. Based on the initial tour of the facility, inspectors identified several seafood HACCP deficiencies, such as lack of controls for histamine at receipt of product, lack of controls for Clostridium botulinum at storage, and several significant sanitation observations of concern. A copy of the inspection observations document is available.[1]

During the investigation, samples of the implicated product were collected for laboratory testing. On April 24, 2012, the Wisconsin Department of Health Services announced that the Department of Agriculture Trade and Consumer Protection laboratory had found Salmonella Bareilly contamination in recalled yellow fin tuna and in a spicy tuna roll made with the recalled tuna.

On April 26, 2012, FDA announced finding the outbreak strain of Salmonella Bareilly from two samples taken from unopened packages of recalled Nakaochi Scrape tuna from Moon Marine USA Corporation. One of the samples also yielded another type of Salmonella with a PFGE pattern indistinguishable from a cluster of Salmonella Nchanga infections. Based on an epidemiological link and results of laboratory testing, CDC combined the Salmonella Bareilly investigation with an ongoing Salmonella Nchanga investigation, and the 2 associated PFGE patterns were grouped together as the “outbreak strains.”

By May 17, 2012, laboratory testing conducted by state public health laboratories in Connecticut, Maryland, Massachusetts, Pennsylvania, South Carolina, and Wisconsin isolated Salmonella from 53 (96%) of 55 samples taken from intact packages of frozen yellow fin tuna scrape from Moon Marine USA Corporation or from sushi prepared with the implicated scrape tuna product. Of the 41 Salmonella isolates for which PFGE results are available, 36 samples yielded the outbreak strain of Salmonella Bareilly, and 12 samples yielded the outbreak strain of Salmonella Nchanga. Seven samples yielded the outbreak strains of both Salmonella Bareilly and Salmonella Nchanga.

On May 10, 2012, Moon Fishery (India) Pvt. Ltd., the manufacturer of the frozen yellow fin tuna Nakaochi Scrape, expanded the voluntary to include its 22-pound boxes of “Tuna Strips”, Product of India, marked as “AA” or “AAA Grade” because the product has the potential to be contaminated with Salmonella. The recall was announced after FDA laboratories isolated the outbreak strain of Salmonella Bareilly from a sample of tuna strips from Moon Fishery (India) Pvt Ltd collected as part of increased surveillance efforts. The shipment in question did not enter into U.S. commerce and no human illnesses were associated with this product.[2]

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella 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 Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.


[1]           http://www.fda.gov/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/CFSANFOIAElectronicReadingRoom/ucm303435.htm

[2]           See CDC Final Update dated July 26, 2012, http://www.cdc.gov/salmonella/bareilly-04-12/index.html

2008 E. coli O157:H7 Outbreak at a Washington Ixtapa Restaurant

Snohomish County Health District (SCHD) Communicable Disease (CD) program received the first report of a confirmed E. coli O157:H7 illness, in what would soon become a cluster of such illnesses, on October 14, 2008. The next report of illness came the following day, October 15.  It was subsequently determined that both ill individuals had dined at Ixtapa in Lake Stevens in the days before onset of their illnesses.

The third and fourth reports of illness came in on October 16, and when these people reported that they, too, had eaten at Ixtapa, SCHD knew that an outbreak was underway.  Many more reports of illness followed.  Accordingly, SCHD issued a press release on October 21, 2008, stating that the health authorities investigating the cluster of E. coli O157:H7 illnesses had “narrowed down the likely source of E. coli illness . . . [to] Ixtapa restaurant, 303-91st Ave. NE. #B201.”  Ixtapa voluntarily closed for business the same day so that it could be sanitized.

Ultimately, the collaborative investigation between SCHD and the Washington State Department of Health (WDOH) concluded that 68 people were likely infected by E. coli O157:H7 in the outbreak. The investigation also determined that there was a “strong association” between consuming guacamole at Ixtapa and becoming ill, but SCHD/WSDOH was unable to definitively conclude that guacamole was the specific food vehicle for transmission of E. coli bacteria to all restaurant patrons.

More likely, it was a combination of contaminated guacamole and other modes of transmission within the Ixtapa facility that made so many people ill.  Notably, WSDOH’s lead investigator wrote in an October 20, 2008 email:

We learned that they don’t wear gloves all the time (just as Chris suspected).  Primarily the cooks have bhc [bare-hand contact] at night when there is less chance someone will catch them without gloves.  Also, The wait staff use bare hands on tortillas both before and after they are warmed in the steamer.  They use a scoop to put chips in a basket but bare hands to assist in this process.

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They do not regularly use sanitizer and they don’t know how to check the concentration of the sanitizer.  We found buckets without sanitizer and many wiping cloths without sanitizer too.  This indicates a lack of ability to properly clean and sanitize work areas.

The cutting boards and wiping cloths are all stained and or very dirty.  Their outer clothing and dry towels are frequently used for hand cleaning as they too are very dirty with food debris.  The stains are from both raw meat and other foods indicating a lack of cross contamination control.

In other words, conditions at Ixtapa were ripe for exactly the kind of unfortunate scenario that played out at the restaurant in October 2008.  The E. coli O157:H7 bacteria clearly came into the restaurant on one item (if not from an infected foodworker), and there it found an environment where it was allowed to flourish, sickening people for almost two straight weeks by multiple different vectors and food-handling errors.

In any case, the SCHD and WSDOH findings leave little doubt whether Ixtapa the source of this significant outbreak; and they eliminate any argument that any other person or entity—e.g. upstream suppliers—are at fault.  As a result, unless Ixtapa challenges the epidemiological relatedness of any particular client to the outbreak, these are damages-only cases.

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