Header graphic for print
Food Poison Journal Food Poisoning Outbreaks and Litigation: Surveillance and Analysis

Food Poisoning Information

Subscribe to the Food Poisoning Information Section RSS Feed

Amended Complaint Filed in Hawaii Hepatitis A Lawsuit

Oahu resident Brant Mauk is suing Genki Sushi Restaurant Koha Foods and now Sea Port Bay Scallops, who sold and imported scallops now believed to have triggered the Hepatitis A outbreak that has sickened 206 people and hospitalized 53 since June 2016. Michael F. O’Connor of Ogawa, Lau, Nakamura & Jew, and food safety advocate William D. Marler, managing attorney at Marler Clark LLP, the Food Safety Law Firm, based in Seattle, are representing the victim.Marler is returning to Oahu Tuesday evening, August 16, having previously visited in July to act as a consultant for victims and their families. Marler,  an advocate for the requirement of Hepatitis A vaccination in food service workers, will be in Hawaii until the morning of Friday, August 19. “The reach and extent of this outbreak is unfortunate, but unsurprising when vaccines aren’t required for food workers,” said Marler. “If policies on vaccination don’t change, this won’t be the last major outbreak we see.” Hepatitis A presents higher than usual risk in the food industry, since the pathogen can survive for months in salt and fresh water, as well as in frozen products.

Brant Mauk found himself among the outbreak’s victims in late June of 2016, when, some time after eating at Genki Sushi, he developed the flu-like symptoms that typify a Hepatitis A infection. A visit to the hospital and tests confirmed that he had Hepatitis A. He received a vaccine and was sent home on July 7th, but was hospitalized again that same day as the vaccine combated his worsening symptoms. In total, Mr. Mauk spent 7 days in the hospital, and he continues his recovery today.

Tracking the source of the outbreak proved difficult as the victim count increased, but the Hawaii Department of Health (HDOH) has at last succeeded in identifying the culprit. Genki Sushi Restaurants on Oahu and Kauai are now closed, as the HDOH has identified raw scallops sold at the restaurant and imported by Koha Foods and Sea Port Bay Scallops as the likely culprits of the outbreak. Commented Marler, “The Hawaii Department of Health should be congratulated for taking decisive action. Sources for Hepatitis A outbreaks are hard to trace, but thanks to their efforts, justice can be done for those who suffered illness and continue to suffer today.”

The acute, flu-like symptoms of hepatitis A tend to kick in suddenly about a month after the virus is contracted. The illness usually lasts a few weeks, but recovery can take up to a year. Most affected individuals show complete recovery within three to six months of the onset of illness. Relapse is possible, although it is more common in children than adults.

The best protection against a hepatitis A infection is to get vaccinated. An estimated 80,000 cases of HAV occur each year, although much higher estimates have been proposed. Hepatitis A is a virus that primarily infects the liver, and an estimated 100 people die each year as a result of acute liver failure in the U.S. due to hepatitis A. However, the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Because HAV is so readily transmitted, Marler encourages restaurants and food handlers to adhere to strict sanitary protocols. He warns, “The virus is almost exclusively transmitted through fecal-oral contact. I can’t stress how important it is that all employees thoroughly wash their hands after using the restroom.” For more information about hepatitis A, please visit www.about-hepatitis.com.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A 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 Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food. The law firm has represented thousands of individuals in class action lawsuits related to HAV, and have brought Hepatitis A lawsuits against such companies as Costco, Subway, Red Robin, Chi-Chi’s, McDonald’s, Chipotle, Quizno’s and Carl’s Jr.

Scallops Test Positive For Hepatitis A

web1_20160818_sea_port_scallopsAccording to press reports, federal laboratory tests confirmed the presence of hepatitis A virus in scallops from the Philippines that the state Health Department had identified as the likely source of the disease outbreak in Hawaii, officials announced this afternoon.

The Hawaii Health Department blocked the sale and distribution of Sea Port Bay Scallops (Wild Harvest, Raw Frozen) in the state early this week, immediately after concluding they were the probable cause of the outbreak, which has sickened 206 people.

The U.S. Food and Drug Administration tested the product and results came back positive today.

The scallops are produced by De Oro Resources Inc., in Suba Basbas, Philippines, and imported by Sea Port Products Corp. in Washington state. Health authorities closed Genki Sushi restaurants on Oahu and Kauai late Monday because the scallops had been served there.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A 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 Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Costco, Subway, McDonald’s, Red Robin, Chipotle, Quiznos and Carl’s Jr.  We proudly represented the family of Donald Rockwell, who died after consuming hepatitis A tainted food and Richard Miller, wo required a liver transplant after eating food at a Chi-Chi’s restaurant.

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

Oahu Hawaii Mystery Hepatitis A Outbreak Hits 135

hepatitisa11As of August 3, 2016, the Hawaii Department of Health has identified 42 new cases of hepatitis A.  All cases have been in adults, 39 have required hospitalization.  The total is now 135 with onset of illness ranging between 6/12/16 – 7/24/16.

Findings of the investigation suggest that the source of the outbreak is focused on Oahu.  Seven (7) individuals now live on the islands of Hawaii, Kauai, and Maui, and one visitor has returned to the mainland.

The following locations are NOT the source of the outbreak, but ill persons have work there and have expose other people:

  • Baskin-Robbins Oahu Waikele Center – exposure risk: June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3, 2016
  • Chili’s Oahu Kapolei (590 Farrington Highway) – exposure risk: July 10, 12, 14, 15, 17, 18, 20, 21, 22, 23, 25, 26, and 27, 2016
  • Costco Bakery Oahu Hawaii Kai – exposure risk: June 16-20, 2016
  • Hawaiian Airlines Flight – exposure risk: July 1-26, 2016
  • Sushi Shiono Hawaii Waikoloa Beach Resort, Queen’s MarketPlace (69-201 Waikoloa Beach Drive) – exposure risk: July 5-8, 11-15, and 18-21, 2016
  • Taco Bell Oahu Waipio (94-790 Ukee Street) – exposure risk: June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11, 2016

Hepatitis A:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A 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 Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Costco, Subway, McDonald’s, Red Robin, Chipotle, Quiznos and Carl’s Jr.  We proudly represented the family of Donald Rockwell, who died after consuming hepatitis A tainted food and Richard Miller, wo required a liver transplant after eating food at a Chi-Chi’s restaurant.

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

What you need to know about Hepatitis A

An Introduction to Hepatitis A

Exposure to the hepatitis A virus can cause an acute infection of the liver that is typically mild and resolves on its own. [11, 17] The symptoms and duration of illness vary a great deal, with many persons showing no symptoms at all. [11] Fever and jaundice are two of the symptoms most commonly associated with a hepatitis A infection. [17]It has been written that the “earliest accounts of contagious jaundice are found in ancient China.” [11] According to the CDC:

The first descriptions of hepatitis (epidemic jaundice) are generally attributed to Hippocrates. Outbreaks of jaundice, probably hepatitis A, were reported in the 17th and 18th centuries, particularly in association with military campaigns. Hepatitis A (formerly called infectious hepatitis) was first differentiated epidemiologically from hepatitis B, which has a long incubation period, in the 1940s. Development of serologic tests allowed definitive diagnosis of hepatitis B. In the 1970s, identification of the virus, and development of serologic tests helped differentiate hepatitis A from other types of non-B hepatitis.Until 2004, hepatitis A was the most frequently reported type of hepatitis in the United States. In the pre-vaccine era, the primary methods used for preventing hepatitis A were hygienic measures and passive protection with immune globulin (IG). Hepatitis A vaccines were licensed in 1995 and 1996. These vaccines provide long-term protection against hepatitis A virus (HAV) infection. [7]Consequently, hepatitis A is the only common vaccine-preventable foodborne disease in the United States. [7, 12]  This virus is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. [11] Unlike hepatitis B and C, hepatitis A does not develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions, [7, 11, 17] Nonetheless, infection with the hepatitis A virus (HAV) can lead to acute liver failure and death. [12, 17]The Incidence of Hepatitis AInfectionsHepatitis A is much more common in countries with underdeveloped sanitation systems and, thus, is a risk in most of the world. [11, 16] An increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe. [9] Nevertheless, infections continue to occur in the United States, where approximately one-third of the population has been previously infected with HAV. [6, 12]Each year, approximately 30,000 to 50,000 cases of hepatitis A occur in the United States. [5, 7] Historically, acute hepatitis A rates have varied cyclically, with nationwide increases every 10 to 15 years. [13] The national rate of HAV infections has declined steadily since the last peak in 1995. [5, 6] Although the national incidence—1.0 cases per 100,000 population—of hepatitis A was the lowest ever recorded in 2007, it is estimated that asymptomatic infections and underreporting kept the documented incidence-rate lower than it actually is. In fact, it is estimated that there were 25,000 new infections in 2007. [6, 22]Although the rates of HAV infection have declined over the years, rates are twice as high among American Indians and Alaskan Natives. [1] Hispanics are also twice as likely to be infected compared to non-Hispanic Whites in the United States. [19]. Rates among American Indians and Alaskan Natives have decreased dramatically, largely as a result of increased vaccination of children in both urban and rural communities. [1]In 2007, the CDC reported a total of 2,979 acute symptomatic cases of hepatitis A. [6] Of these, information about food and water exposure was known for 1,047 cases, leading to an estimate that 6.5% of all infections were caused by exposure to contaminated water or food. [6] In 2,500 of the cases, no known risk factor was identified. [6]Estimates of the annual costs (direct and indirect) of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars. [5] In one study conducted in Spokane, Washington, the combined direct and indirect costs for each case of hepatitis A from all sources ranged from $2892 to $3837. [2, 13] In a 2007 Ohio study, each case of HAV infection attributable to contaminated food was estimated to cost at least $10,000, including medical and other non-economic costs. [21] Nationwide, adults who become ill miss an average of 27 workdays per illness, and 11-to-22 percent of those infected are hospitalized. [6, 7] All of these costs are entirely preventable given the effectiveness of a vaccination in providing immunity from infection. [7, 13] How is Hepatitis A Transmitted?

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person. [11] Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water. [11, 16] Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler. [6, 7, 12]  The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins. [12]

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A. [12, 25] In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states. [15] Six years later, in 2003, fresh green onions were identified as the source of a hepatitis A outbreak traced to consumption of food at a Pennsylvania restaurant. [25] Other produce, such as blueberries and lettuce, has been associated with hepatitis A outbreaks in the U.S. as well as other developed countries. [3, 4]

HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces. [11, 17] The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of sodium hypochlorite (household bleach) in tap water. [8, 13, 24]  It must be noted, however, that HAV can still be spread from cooked food if it is contaminated after cooking. [12]

Although ingestion of contaminated food is a common means of spread for hepatitis A, it may also be spread by household contact among families or roommates, sexual contact, or by direct inoculation from persons sharing illicit drugs. [12, 17] Children are often asymptomatic, or have unrecognized infections, and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children. [11, 18, 22]

Symptoms of a Hepatitis A Infection

Hepatitis A may cause no symptoms at all when it is contracted, especially in children. [12] Asymptomatic individuals will only know they were infected (and have become immune, given that you can only get hepatitis A once) by getting a blood test later in life. [17] Approximately 10 to 12 days after exposure, HAV is present in blood and is excreted via the biliary system into the feces. [7, 11]  Although the virus is present in the blood, its concentration is much higher in feces. [11] HAV excretion begins to decline at the onset of clinical illness, and decreases significantly by 7 to 10 days after onset of symptoms. [11] Most infected persons no longer excrete virus in the feces by the third week of illness; children may excrete HAV longer than adults. [11, 20]

Seventy percent of hepatitis A infections in children younger than six years of age are asymptomatic; in older children and adults, infection tends to be symptomatic with more than 70% of those infected developing jaundice. [7] Symptoms typically begin about 28 days after contracting HAV, but can begin as early as 15 days or as late as 50 days after exposure. [7, 11, 12] The symptoms include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise. [[7, 11, 17]

After a few days of typical symptoms, jaundice (also termed “icterus”) sets in. [11, 17] Jaundice is a yellowing of the skin, eyes and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood. [17] The urine will also turn dark with bile and the stool light or clay-colored from lack of bile. [7, 11, 17] When jaundice sets in, initial symptoms such as fever and headache begin to subside. [17]

In general, symptoms usually last less than 2 months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months. [13, 14] It is not unusual, however, for blood tests to remain abnormal for six months or more. [11] The jaundice so commonly associated with hepatitis A can also linger for a prolonged period in some infected persons—sometimes as long as eight months or more. [11, 17] Additionally, pruritus, or severe “itchiness” of the skin, can persist for several months after the onset of symptoms. These conditions are frequently accompanied by diarrhea, anorexia, and fatigue. [7, 17]

Relapse is possible with hepatitis A, typically within three months of the initial onset of symptoms. [14] Although relapse is more common in children, it does occur with some regularity in adults. [11, 14] The vast majority of persons who are infected with hepatitis A fully recover, and do not develop chronic hepatitis. [17] Persons do not carry hepatitis A long-term as with hepatitis B and C. [5, 7]

Fulminant Hepatitis A

Fulminant hepatitis A is a rare but devastating complication of HAV infection. [10] As many as 50% of individuals with acute liver failure may die or require emergency liver transplantation. [23] Elderly patients and patients with chronic liver disease are at higher risk for fulminant hepatitis A. [11, 23] In parallel with a declining incidence of acute HAV infection in the general population, however, the incidence of fulminant HAV appears to be decreasing. [23]

HAV infects the liver’s parenchymal cells (internal liver cells). [10, 11] Once a cell has been penetrated by the viral particles, the hepatitis A virus releases its own toxins that cause, in essence, a hostile takeover of the host’s cellular system. [11, 22] The cell then produces new viral components that are released into the bile capillaries or tubes that run between the liver’s parenchymal cells. [11] This process results in the death of liver cells, called hepatic necrosis. [11, 23]

The fulminant form of hepatitis occurs when this necrotic process kills so many liver cells—upwards of three-quarters of the liver’s total cell count—that the liver can no longer perform its job. [10, 23] Aside from the loss of liver function, fulminant hepatic failure can lead to encephalopathy and cerebral edema. [10] Encephalopathy is a brain disorder that causes central nervous system depression and abnormal neuromuscular function. [10, 11] Cerebral edema is a swelling of the brain that can result in dangerous intracranial pressure. [10] Intracranial hypertensions leading to brain stem death and sepsis with multiple organ failure are the leading causes of death in individuals with fulminant hepatic failure. [10, 23]

How is a Hepatitis A Infection Diagnosed

The various human hepatitis viruses cause very similar illnesses. [11] Therefore, neither the individual nor the healthcare provider can tell by symptoms or signs if a given individual is suffering from hepatitis A unless laboratory tests are performed. [7, 17]

Fortunately, blood tests are widely available to accurately diagnose hepatitis A, including tests for antibodies, or the affected person’s immune response to hepatitis A proteins. [7] This immune response is conclusively demonstrated by the presence of Immunoglobulin M (IgM) antibodies, indicating acute disease, and immunoglobulin G (IgG), indicating a past infection. [11, 13] The IgG antibodies are present for life, indicating immunity. [13] Following is some guidance for the interpretation of the test results:

  • IgM negative / IgG negative: Most persons with these results have never contracted hepatitis A. Antibodies of the IgM variety develop five to ten days prior to the onset of symptoms.
  • IgM positive / IgG negative: This result indicates acute hepatitis A.
  • IgM positive / IgG positive: This result indicates that acute hepatitis A occurred within the last six months. By six months, the IgM reverts to negative.
  • IgM negative / IgG positive: Persons with this result are immune to hepatitis A. They have either been infected with the virus months or years in the past (with or without symptoms), or they have been vaccinated for hepatitis A. However, if they are currently ill, it is not likely to be due to hepatitis A.

Treatment for Acute Hepatitis A Infections

Once a clinical infection is established, there is no specific treatment for hepatitis A.  Affected individuals generally suffer from loss of appetite, so the main concern is ensuring a patient receives adequate nutrition and avoids permanent liver damage. [7, 17] An individual’s perception of the severity of fatigue or malaise is the best determinant of the need for rest. [17]

Treatment of those suffering from fulminant hepatic failure depends largely on the affected person’s status.  [23, 26] Those who have not become encephalopathic generally undergo an intense course of supportive treatment.  [10, 23] But for those whose liver failure is so complete that it has lead to encephalopathy or cerebral edema, timely liver transplantation is often the only option. [10, 14] Unfortunately, many individuals with irreversible liver failure do not receive a transplant because of contraindications or the unavailability of donor livers. [11, 23]

Real Life Impacts

The number of acute hepatitis A infections in the U.S. drastically fell in the first part of the 21stCentury, largely in part because hepatitis A vaccination was recommended for persons in groups shown to be at high risk for infection and children living in communities with high rates of disease beginning in 1996.   By 2006, hepatitis A vaccine had been incorporated into the Advisory Committee on Immunization Practices’ recommended childhood vaccination schedule. [27]

Despite a decrease in the number of hepatitis A cases reported annually, anyone who has not been vaccinated is at increased risk for contracting hepatitis A infection.  Persons over the age of 50, those with chronic liver disease, and immunocompromised individuals who have not been vaccinated against hepatitis A remain most at risk for developing fulminant hepatitis, a rare but devastating complication of a hepatitis A infection that can lead to the need for a liver transplant, or death.

How to Prevent Hepatitis A

Hepatitis A is totally and completely preventable. [12] Although outbreaks continue to occur in the United States, no one should ever get infected if preventive measures are taken. [7, 12] For example, food handlers must always wash their hands with soap and water after using the bathroom, changing a diaper, and certainly before preparing food. [12, 24] Food handlers should always wear gloves when handling or preparing ready-to-eat foods, although gloves are not a substitute for good hand washing. Ill food-handlers should be excluded from work. [14, 24]

After exposure, immune globulin (IG) is 80% to 90% effective in preventing clinical hepatitis A when administered within 2 weeks of last exposure. [9] Although efficacy is greatest when IG is administered early in the incubation period, when administered later, IG is still likely to make the symptoms less severe. [9, 11] Given the lack of appropriately designed studies comparing the postexposure efficacy of vaccine with that of IG, the Advisory Committee on Immunization Practices (ACIP) recommends IG exclusively for post-exposure. [9] Hepatitis A vaccine, if recommended for other reasons, could be given at the same time. [9, 13]

In 2006, the ACIP recommended routine hepatitis A vaccination for all children ages 12-23 months, that hepatitis A vaccination be integrated into the routine childhood vaccination schedule, and that children not vaccinated by two years of age be vaccinated subsequently. [9, 13] The vaccine is recommended for the following persons:

  • Travelers to areas with increased rates of hepatitis A
  • Men who have sex with men
  • Injecting and non-injecting drug users
  • Persons with clotting factor disorders (e.g. hemophilia)
  • Persons with chronic liver disease
  • Persons with occupational risk of infection (e.g. those who work with hepatitis A-infected primates or with hepatitis A virus in a laboratory setting)
  • Children living in regions of the U.S. with increased rates of hepatitis A
  • Household members and other close personal contacts (such as regular babysitters) of adopted children newly arriving from countries with high or intermediate rates of hepatitis A. [9]

The vaccine may also help protect household contacts of those persons infected with hepatitis A. [9, 20] Although generally not a legal requirement at this time, vaccination of food handlers would be expected to substantially diminish the incidence of hepatitis A outbreaks. [12] Persons traveling to a high-risk area less than four weeks after receiving the initial dose of hepatitis A vaccine, or travelers who choose not to be vaccinated against hepatitis A should receive a single dose of Immune Globulin, which provides protection against hepatitis A infection for up to three months. [9, 11, 18]

For more information visit www.about-hepatitis.com.

References
1.         Bialek, Stephanie, et al., “Hepatitis A Incidence and Hepatitis A Vaccination among American Indians and Alaska Natives, 1990–2001,” American Journal of Public Health.Vol. 94, No. 6, pp. 996-1001 (2004). Full text of article is available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448379/pdf/0940996.pdf.
2.         Bownds, Lynne, et al., “Economic Impact of a Hepatitis A Epidemic in a Mid-Sized Urban Community: The Case of Spokane, Washington,” Journal of Community Health, Vol. 28, No. 4, pp. 233-246 (2003). Abstract available online at http://www.ncbi.nlm.nih.gov/pubmed/12856793
3.         Butot S, et al., “Effects of Sanitation, Freezing and Frozen Storage on Enteric Viruses in Berries and Herbs,” International Journal of Food Microbiology, Vol. 126, pp. 30-35 (2008). Full text of article is available at http://www.prograd.uff.br/virologia/sites/default/files/bulot_et_al_2008_inactivation.pdf
4.         Calder, L, et al., “An Outbreak of Hepatitis A Associated with Consumption of Raw Blueberries,” Epidemiology and Infection, Vol. 131, No. 1, 745-751 (2003) at  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870016/pdf/12948375.pdf
5.         CDC Summary, “Disease Burden from Viral Hepatitis A, B, and C in the United States, 2004-2009, at http://www.cdc.gov/hepatitis/pdfs/disease_burden.pdf
6.         CDC, “Surveillance for Acute Viral Hepatitis — United States, 2007, Morbidity and Mortality Weekly Report, Surveillance Summaries, Vol. 58, No. SS03 (May 22, 2009) at http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5803a1.htm
7.         CDC, “Hepatitis A,” in EPIDEMIOLOGY AND PREVENTION OF VACCINE-PREVENTABLE DISEASES (also known as “The Pink Book”), Atkinson W, Wolfe S, Hamborsky J, McIntyre L, editors, 12th edition. Chapter available online at http://www.cdc.gov/vaccines/pubs/pinkbook/hepa.html
8.         CDC, “Updated recommendations from Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees,” Morbidity and Mortality Weekly Report, Vol. 58, No. 36, (Sept. 18, 2009), http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5836a4.htm
9.         CDC, “Update: Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers, Updated ACIP Recommendations,” Morbidity and Mortality Weekly Report, Vol. 56, No. 41, pp. 1080-84 (Oct. 19, 2007), online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5641a3.htm.
10.       Detry, Oliver, et al., “Brain Edema and Intracranial Hypertension in Fulminant Hepatic Failure:  Pathophysiology and Management,” World Journal of Gastroenterology, Vol. 12, No. 46, pp. 7405-7412 (Dec. 14, 2006). Full article is available online at http://www.wjgnet.com/1007-9327/12/7405.pdf
11.       Feinstone, Stephen and Gust, Ian, “Hepatitis A Virus,” in Mandell, Douglas, & Bennett’s PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES, Fifth Edition, Chap. 161, pp. 1920-40 (2000).
12.       Fiore, Anthony, Division of Viral Hepatitis, CDC, “Hepatitis A Transmitted by Food,” Clinical Infectious Diseases, Vol. 38, 705-715 (March 1, 2004). Full text online at http://www.cdc.gov/hepatitis/PDFs/fiore_ha_transmitted_by_food.pdf
13.       Fiore, Anthony, et al., Advisory Committee on Immunization Practices (ACIP), Prevention of Hepatitis-A Through Active or Passive Immunization: Recommendations, Morbidity & Mortality Weekly Review, Vol. 55, Report 407, (May 19, 2006) at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm
14.       Gilkson Miryam, et al., “Relapsing Hepatitis A. Review of 14 cases and literature survey,”  Medicine, Vol. 71, No. 1, 14-23 ( Jan. 1992). Abstract of article online at http://www.ncbi.nlm.nih.gov/pubmed/1312659
15.       Hutin YJF, et al., “A Multistate, Foodborne Outbreak of Hepatitis A,” New England Journal of Medincine, Vol. 340, pp. 595–602 (1999). Full text of article is online at http://www.nejm.org/doi/full/10.1056/NEJM199902253400802
16.       Jaykus Lee Ann, “Epidemiology and Detection as Options for Control of Viral and Parasitic Foodborne Disease,” Emerging Infectious Diseases, Vol. 3, No. 4, pp. 529-39 (October-December 1997). Full text of the article is available online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2640072/pdf/9366607.pdf
17.       Mayo Clinic Staff, “Hepatitis A,” (last updated Sept. 1, 2011). Articles available online at http://www.mayoclinic.com/health/hepatitis-a/DS00397 .
18.       Piazza, M, et al., “Safety and Immunogenicity of Hepatitis A Vaccine in Infants: A Candidate for Inclusion in Childhood Vaccination Program,” Vaccine. Vol. 17, pp. 585-588 (1999). Abstract at http://www.ncbi.nlm.nih.gov/pubmed/10075165
19.       Rawls, R.A. and Vega, K.J., “Viral Hepatitis in Minority America,” Journal of Clinical Gastroenterology, Vol. 39, No. 2, pp. 144–151 (Feb. 2005). Abstract is at  http://www.ncbi.nlm.nih.gov/pubmed/15681912
20.       Sagliocca, Luciano, et al., “Efficacy of Hepatitis A Vaccine in Prevention of Secondary Hepatitis A Infection: A Randomized Trial,” Lancet, Vol. 353, 1136-39 (1999). Abstract at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)08139-2/abstract
21.       Scharff, RL, et al., “Economic Cost of Foodborne Illness in Ohio,” Journal of Food Protection, Vol. 72, No. 1, pp. 128-136 (2009). Abstract available online at http://www.ingentaconnect.com/content/iafp/jfp/2009/00000072/00000001/art00018
22.       Schiff, E.R., “Atypical Manifestations of hepatitis-A,” Vaccine, Vol. 10, Suppl. 1, pp. 18-20 (1992). Abstract at http://www.ncbi.nlm.nih.gov/pubmed/1475999
23.       Taylor, Ryan, et al., “Fulminant Hepatitis A Virus Infection in the United States: Incidence, Prognosis, and Outcomes,” Hepatology, Vol. 44, 1589-1597 (2006). Full text http://deepblue.lib.umich.edu/bitstream/2027.42/55879/1/21439_ftp.pdf
24.       Todd, Ewan C. D., et al., “Outbreaks Where Food Workers Have Been Implicated in the Spread of Foodborne Disease. Part 6. Transmission and Survival of Pathogens in the Food Processing and Preparation-environment,” Journal of Food Protection, Vol. 72, 202-219 (2009). Full text of the article is available online at http://courses.washington.edu/eh451/articles/Todd_2009_food%20processing.pdf
25.       Wheeler, C, et al., “An Outbreak of Hepatitis A Associated with Green Onions,” New England Journal of Medicine, Vol. 353, 890-897 (2005). Full text of article available at http://www.nejm.org/doi/full/10.1056/NEJMoa050855
26.       Willner, IR, et al., “Serious Hepatitis A: An Analysis of Patients Hospitalized During an Urban Epidemic in the United States,” Annals of Internal Medicine, Vol. 128, No. 2, pp. 111-114 (Jan. 15, 1998). Full text of the article is available at http://www.annals.org/content/128/2/111.full.pdf+html
27.       CDC. “Prevention of Hepatitis A through Active or Passive Immunization:  Recommendations of the Advisory Committee on Immunization Practices (ACIP),”  Morbidity and Mortality Weekly Report, Vol. 55, (RR07), pp. 1-23 (May 29, 2006) online at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5507a1.htm.

Chili’s and Hawaiian Airlines now linked to Hepatitis A Mystery

They Join Baskin-Robbins, Chilli’s, Costco and Sushi Shiono.

The Hawaii State Department of Health (DOH) is continuing its investigation of a hepatitis A outbreak on the island of Oahu and has confirmed two new cases in a food service employee at Chili’s restaurant located at 590 Farrington Highway in Kapolei, and a Hawaiian Airlines flight attendant.

As of July 26, the current number of hepatitis A cases linked to the outbreak is 93. This number is updated weekly on Wednesday and posted at http://health.hawaii.gov/docd/hepatitis-a-outbreak-2016/.

Business Island Location Dates of Service
Baskin-Robbins Oahu Waikele Center June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3, 2016
Chili’s Oahu Kapolei (590 Farrington Highway) July 10, 12, 14, 15, 17, 18, 20, 21, 22, 23, 25, 26, and 27, 2016
Costco Bakery Oahu Hawaii Kai June 16-20, 2016
Hawaiian Airlines Flight list (click here) July 1-26, 2016
Sushi Shiono Hawaii Waikoloa Beach Resort, Queen’s MarketPlace (69-201 Waikoloa Beach Drive) July 5-8, 11-15, and 18-21, 2016
Taco Bell Oahu Waipio (94-790 Ukee Street) June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11, 2016

 

Hepatitis A:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A 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 Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Costco, Subway, McDonald’s, Red Robin, Chipotle, Quiznos and Carl’s Jr.  We proudly represented the family of Donald Rockwell, who died after consuming hepatitis A tainted food and Richard Miller, wo required a liver transplant after eating food at a Chi-Chi’s restaurant.

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

What to know About Salmonella during an Outbreak

WHAT IS SALMONELLA?

It has long been said that, in 1885, pioneering American veterinary scientist, Daniel E. Salmon, discovered the first strain of Salmonella. Actually, Theobald Smith, research-assistant to Dr. Salmon, discovered the first strain of SalmonellaSalmonella cholerae suis. But, being the one in charge, Dr. Salmon got all the credit. In any case, today the number of known strains of the bacteria totals over two thousand. In recent years, concerns have been raised, as particular strains of the bacteria have become resistant to traditional antibiotics, in both animals and humans.

The term Salmonella refers to a group or family of bacteria that variously cause illness in humans. The taxonomy and nomenclature of Salmonella have changed over the years and are still evolving. Currently, the Centers for Disease Control and Prevention (CDC) recognizes two species which are divided into seven subspecies. These subspecies are divided into over 50 serogroups based on somatic (O) antigens present. The most common Salmonella serogroups are A, B, C, D, E, F, and G. Serogroups are further divided into over 2,500 serotypes. Salmonella serotypes are typically identified through a series of tests of antigenic formulas listed in a document called the Kauffmann-White Scheme published by the World Health Organization Collaborating Centre for Reference and Research on Salmonella.[1]

Three serotypes – Enteriditis, Typhimurium, and Newport – have persisted as the serotypes most often isolated in patients and reported to the CDC over the last decade. In 2009, these three serotypes accounted for 42% of all reported cases of Salmonella.[2] Salmonella Schwarzengrund is relatively rare. In 2009 S. Montevideo accounted for less than 1% of all salmonellosis reported, causing 348 infections.

Where Does Salmonella Come From?

Salmonella is an enteric bacterium, which means that it lives in the intestinal tracts of humans and other animals, including birds. Salmonella bacteria are usually transmitted to humans by eating foods contaminated with animal feces or foods that have been handled by infected food service workers who have practiced poor personal hygiene. Contaminated foods usually look and smell normal. Contaminated foods are often of animal origin, such as beef, poultry, milk, or eggs, but all foods, including vegetables, may become contaminated. Many raw foods of animal origin are frequently contaminated, but thorough cooking kills Salmonella. The food handler who neglects to thoroughly wash his or her hands with soap and warm water after using the bathroom may contaminate foods that have otherwise been properly prepared.

What are the Symptoms of Salmonellosis?

Once in the lumen of the small intestine, the bacteria penetrate the epithelium, multiply, and enter the blood within 24 to 72 hours. Variables such as the health and age of the host and virulence differences among the serotypes affect the nature of the diagnosis. Infants, the elderly, individuals hospitalized, and the immune-suppressed are the populations that are the most susceptible to disease and suffer the most severe symptoms.

“The majority of persons infected with Salmonella have diarrhea, fever, and abdominal cramps 12-72 hours after exposure. The illness usually lasts 4-7 days, and the majority of persons recover without treatment.” MMWR Weekly, supra at 684. However, much longer incubation periods of 120 hours to 31 days have been documented in previous Salmonella outbreaks.[3]

The acute symptoms of Salmonella gastroenteritis include the sudden onset of nausea, abdominal cramping, and bloody diarrhea with mucous. As already noted, there is no real cure for a Salmonella infection; treatment, therefore, tends to be palliative – although prescription of antibiotics is common, even if usually contraindicated.

Medical treatment is acutely important if the patient becomes severely dehydrated or if the infection spreads from the intestines. Persons with severe diarrhea often require re-hydration, usually with intravenous fluids. Antibiotics are not necessary or indicated unless the infection spreads from the intestines, and then it can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Unfortunately, some Salmonella bacteria have become resistant to antibiotics, largely as a result of the use of antibiotics to promote the growth of feed animals.

MEDICAL COMPLICATIONS

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.[4] The resulting joint pain and inflammation can resolve completely over time or permanent joint damage can occur.[5]

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). Id. This triad of symptoms is called Reiter’s Syndrome.[6] 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 SalmonellaCampylobacterYersinia, 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.[7]

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.

Salmonella has been the most frequently studied bacteria associated with reactive arthritis. Overall, studies have found rates of Salmonella-associated reactive arthritis to vary between 6 and 30%.[8] The frequency of postinfectious Reiter’s syndrome, however, has not been well described. In a Washington State study, while 29% developed arthritis, only 3% developed the triad of symptoms associated with Reiter’s syndrome.[9] In addition, individuals of Caucasian descent may be more likely those of Asian descent to develop reactive arthritis,[10] and children may be less susceptible than adults to reactive arthritis following infection with Salmonella.[11]

A clear association has been made between reactive arthritis and a genetic factor called the human leukocyte antigen (HLA) B27 genotype. HLA is the major histocompatibility complex in humans; these are proteins present on the surface of all body cells that contain a nucleus, and are in especially high concentrations in white blood cells (leukocytes). It is thought that HLA-B27 may affect the elimination of the infecting bacteria or an individual’s immune response.[12] HLA-B27 has been shown to be a predisposing factor in one-half to over two-thirds of individuals with reactive arthritis.[13] While HLA-B27 does not appear to predispose to the initial infection itself, it increases the risk of developing arthritis that is more likely to be severe and prolonged. This risk may be slightly greater for Salmonella and Yersinia-associated arthritis than with Campylobacter, but more research is required to clarify this.[14]

Irritable Bowel Syndrome

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.[15] 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.[16]

In terms of its own data, the “study confirm[ed] a strong and significant relationship between acute enteric infection and subsequent IBS symptoms.”[17] 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.[18]

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.[19] 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.[20] IBS sufferers typically experienced symptoms for an average of 8.1 days per month.[21]

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.[22] And even when able to work, a significant majority (67%), felt less productive at work because of their symptoms.[23] 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.[24] 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.[25]

THE SIGNIFICANCE OF AGE IN INFECTION

The occurrence of bacterial infection is a function of several major variables: (1) the virulence of the bacterial pathogen, that is, its ability to cause severe disease; (2) how the pathogen is transmitted to the “host”—for example, whether it is airborne, foodborne, blood borne, etc.; and (3) host susceptibility—i.e. how well the host can defend itself against the bacterial pathogen. Increased susceptibility, in turn, may result from two different processes: a bigger infectious dose in a given case of disease may cause a more severe infection, and physical characteristics particular to an individual host may render him or her less able to limit the spread of infectious microorganisms from the intestinal tract to the bloodstream.[26]

Morbidity and mortality in the elderly from infectious disease is far greater than in other populations. For instance, death rates for infectious diarrheal disease alone are five times higher in people over 74 years of age than in the next highest group, children under four years of age, and fifteen times higher than the rates seen in younger adults.[27] Published studies attribute the elderly’s heightened risks, both of infection and mortality due to enteric infectious disease, to several factors: (1) aging of the gastrointestinal tract (reduced gastric acidity/reduced gastric mobility); (2) higher prevalence of underlying medical disorders (co-morbidity factors); and (3) malnutrition and a decline in the immune response that leaves the host less able to defend itself against infectious agents.[28]

Aging of the Gastrointestinal Tract – An Invitation to Infection

Inflammation and shrinkage of the gastric mucosa increase with age, leading to low gastric acidity. In patients with gastric ulcer disease, the drugs used to treat the condition further block gastric acid production. Because stomach acids play an important role in limiting the number of bacteria that enter the small intestine, low gastric acidity increases the likelihood of infection upon ingesting contaminated food or water.[29]

Peristalsis, which is the mechanism that propels the stomach contents through the intestinal tract, decreases with age. Peristalsis is also the mechanical means for removing ingested, life-threatening pathogens. Because the risk of infection by potentially invasive pathogens corresponds with the duration of contact between the pathogen and the intestinal mucosa, a decrease in peristalsis delays the clearance of the pathogen from the intestinal tract and contributes substantially to the increased prevalence and severity of infection in the elderly.[30] If the pathogen is Salmonella, decreased peristalsis allows more of the bacteria to be absorbed in the gastrointestinal tract, thus increasing the risk of suffering one of the complications described above.

A Higher Prevalence of Underlying Medical Conditions – Co-Morbidity Factors

Underlying medical conditions or disease (co-morbid factors) also contribute to the morbidity and mortality of infection in the elderly. Among hospitalized patients, those older than 65 develop pneumonia twice as often as younger patients due to poor nutrition, neuromuscular disease (poor cough reflex and aspiration), pharyngeal colonization, depressed level of alertness, endotracheal intubation, intensive care unit admission, nasogastric tube use, and antacid use.[31] Pneumonia is the leading infectious cause of death in the elderly.[32]

Atherosclerosis, another common co-morbid disease, compromises circulation and blood flow to the peripheral tissues and the skin, particularly in elderly individuals who are hospitalized and bedridden with an infectious illness. Unfortunately, it is the skin and the previously discussed mucous membranes that serve as the body’s first line of defense against invasion by infectious microorganisms. Loss of the integrity of the skin may result in the development of pressure ulcers, which are warm, moist mediums for infectious microorganisms to rapidly multiply and are associated with a number of infectious complications.

When an infectious microorganism, regardless of source, gains access to the bloodstream, the patient may develop systemic sepsis, also known as bacteremia.[33] Bacteremia is most common in people who are already affected by, or are being treated for, some other medical problem (co-morbid disease); conversely, people in good health with strong immune systems rarely develop bacteremia. The main sources of bacteremia in elderly patients are the urinary tract, gastrointestinal tract, respiratory tract, and the skin. Other potential sources include surgical wounds, invasive tubes and catheters, intravenous lines—virtually any site where an invasive medical procedure has occurred. Bacterial organisms most likely to cause bacteremia include members of the Staphylococcus, Streptococcus, Salmonella and Escherichia coli genera. Because bacteremia is far more prevalent in those with co-morbid conditions, which group is substantially populated by the elderly, the presence of co-morbid conditions is clearly a determinant of the mortality associated with infectious disease.

___________

[1]           Grimont, PAD, Weill, F. Antigenic formulae of the Salmonella serovars, 2007, 9th Edition. WHO Collaborating Centre for Reference and Research on Salmonella. Paris: Pasteur Institute. http://www.pasteur.fr/ip/portal/action/WebdriveActionEvent/oid/01S-000036-089.

[2]           http://www.cdc.gov/ncezid/dfwed/PDFs/SalmonellaAnnualSummaryTables2009.pdf, Table 1.

[3]           O’ Mahony, et al. An outbreak of Salmonella Heidelberg infection associated with a long incubation period. J. Public Health (1990) 12 (1): 19-21; Abe, et al. Prolonged Incubation Period of Salmonellosis Associated with Low Bacterial Doses. J. Food Protection (2004) Vol. 67, No. 12; 2735-2740.

[4]           See J. Lindsey. “Chronic Sequellae of Foodborne Disease,” Emerging Infectious Diseases, Vol. 3, No. 4, Oct-Dec, 1997.

[5]           Id.

[6]           IdSee also, Dworkin, et al. “Reactive Arthritis and Reiter’s Syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis,” Clin. Infect. Dis., 2001 Oct. 1;33(7): 1010-4; Barth, W. and Segal, K. “Reactive Arthritis (Reiter’s Syndrome),” American Family Physician, Aug. 1999, online at www.aafp.org/afp/990800ap/499.html.

[7]           Hill Gaston JS, Lillicrap MS. (2003). Arthritis associated with enteric infection. Best Practices & Research Clinical Rheumatology. 17(2):219-239.

[8]           Id.

[9]           Dworkin MS, Shoemaker PC, Goldoft MJ, Kobayashi JM. “Reactive arthritis and Reiter’s syndrome following an outbreak of gastroenteritis caused by Salmonella enteritidis.” Clin. Infect. Dis. 33(7):1010-1014.

[10]          McColl GJ, Diviney MB, Holdsworth RF, McNair PD, Carnie J, Hart W, McCluskey J. “HLA-B27 expression and reactive arthritis susceptibility in two patient cohorts infected with Salmonella Typhimurium,” Australian and New Zealand Journal of Medicine. 30(1):28-32 (2001).

[11]          Rudwaleit M, Richter S, Braun J, Sieper J. “Low incidence of reactive arthritis in children following a Salmonella outbreak,” Annals of the Rheumatic Diseases, 60(11):1055-1057 (2001).

[12]          Hill Gaston and Lillicrap, supra Note 7.

[13]          Id.; Barth WF, Segal K., “Reactive arthritis (Reiter’s syndrome).” American Family Physician, 60(2):499-503, 507 (1999).

[14]          Hill Gaston and Lillicrap, supra Note 7.

[15]          J. Marshall, et al. Incidence and Epidemiology of Irritable Bowel Syndrome After a Large Waterborne Outbreak of Bacterial Dysentery, Gastro., 2006; 131;445-50 (hereinafter “Walkerton Health Study” or “WHS”). The WHS followed one of the largest E. coli O157:H7 outbreaks in the history of North America. Contaminated drinking water caused over 2,300 people to be infected with E. coli O157:H7, resulting in 27 recognized cases of HUS, and 7 deaths. Id. at 445. The WHS followed 2,069 eligible study participants. Id. For Salmonella specific references, see Smith, J.L., Bayles, D.O., Post-Infectious Irritable Bowel Syndrome: A Long Term Consequence of Bacterial Gastroenteritis. Journal of Food Protection, 2007:70(7);1762-1769.

[16]          Id. at 445 (citing multiple sources).

[17]          WHS, supra note 34, at 449.

[18]          Id. at 447.

[19]          A.P.S. Hungin, et al. Irritable Bowel Syndrome in the United States: Prevalence, Symptom Patterns and Impact, Aliment Pharmacol. Ther., 2005:21 (11); 1365-75.

[20]          Id. at 1367.

[21]          Id.

[22]          Id. at 1368.

[23]          Id.

[24]          Id.

[25]          Amy Foxx-Orenstein, DO, FACG, FACP. IBS—Review and What’s New. General Medicine, 2006:8(3) (Medscape 2006) (collecting and citing studies). Indeed, PI-IBS has been found to be characterized by more diarrhea but less psychiatric illness with regard to its pathogenesis. See Nicholas J. Talley, MD, PhD. Irritable Bowel Syndrome: From Epidemiology to Treatment, from American College of Gastroenterology 68th Annual Scientific Meeting and Postgraduate Course (Medscape 2003).

[26]          Morris, JG, Morris P. Emergence of New Pathogens as a Function of Changes in Host Susceptibility. Emerging Infectious Diseases 1997;3(4):435-440.

[27]          Lew, JF, et al. Diarrheal deaths in the United States, 1979 through 1987. A special problem for the elderly. JAMA 1991;265:3280-3284.

[28]          Smith, JL. Foodborne Illness in the Elderly. J Food Prot. 1998;61(9):1229-1239.

[29]          Berkow, R. (Ed.) 1992. The Merck manual of diagnosis and therapy, 16th ed. Merck & Co., Inc.

[30]          Sprinz, H. Pathogenesis of intestinal infections. Arch. Pathol. 1969; 87:556-562.

[31]          Hanson, LC, et al. Risk factors for nosocomial pneumonia in the elderly. Am. J. Med. 1992;92:161-166.

[32]          Pinner, RW, Teutsch, SM, Simonsen, L, et al. Trends in infectious diseases mortality in the United States. JAMA 1996;275:189-193.

[33]          Bryan, CS, Dew, CE, Reynolds, KL. Bacteremia associated with decubitus ulcers. Arch. Intern. Med. 1987;82:602-606.

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.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

Texas Finalizes Penalty Agreement With Blue Bell

Texas health officials today finalized with Blue Bell Creameries a penalty and agreement that the company will continue to test and monitor its ice cream following last year’s outbreak of Listeria monocytogenes linked to Blue Bell products made in Brenham.

The total penalty amount is $850,000. Of that, $175,000 must be paid within 30 days. The remaining balance will not have to be paid if the company follows the terms outlined in the agreement for 18 months. The penalty was issued against the company because it allowed adulterated product to enter the marketplace and cause illness.

The enforcement agreement between Blue Bell and the Texas Department of State Health Services extends several requirements from a previous agreement for the next 18 months. Blue Bell must continue to notify DSHS of any presumptive positive test results for Listeria monocytogenes in ice cream, ingredients, food surfaces, machinery and other equipment in its Brenham plant. The company must maintain its “test and hold” procedures for all finished product, meaning ice cream must be found to be free of pathogens before it can be sold to the public. As a licensed frozen dessert manufacturer, the company also must continue to provide state inspectors with full access to the plant to take samples.

Last year the company temporarily shut down its Brenham operation following the discovery of Listeria monocytogenes in certain ice cream products that were linked to several cases of Listeriosis. At the time, Texas health officials outlined requirements and milestones the company had to reach before releasing ice cream into the marketplace. State health inspectors periodically were on site at the Brenham plant to evaluate test results and records, review cleaning procedures and assess training activities.

The company is currently producing, testing and selling ice cream made at the plant.

The enforcement agreement is posted here

Two in Massachusetts part of New Hampshire E. coli Cluster

Ground_Beef_Patties_Raw_Burgers_20160722195147751_5503196_ver1.0_640_360Two Massachusetts residents have fallen ill with E. coli after eating tainted beef from a New Hampshire farm.

The two cases are part of a cluster of 14 patients who have become sick.

The tainted products were shipped to retail locations and for institutional use in Maine, Massachusetts, New Hampshire, and Vermont. The Massachusetts Department of Public Health said that Massachusetts retail locations have been notified of the recall.

Items being recalled include ground beef, ground beef patties and other sub-primal cuts and were produced between June 6 and June 16, 2016. The products subject to recall bear the establishment number “8868” inside the USDA mark of inspection on the product label, and would have one of the following names on the label:

  • PT Farm (North Haverhill, NH)
  • Robie Farm (Piermont, NH)
  • Chestnut Farms (Hardwick, MA)
  • Miles Smith Farm (Loudon, NH)
  • Meadowview Farm (Gilmanton, NH)
  • Farmer’s Brand (North Haverhill, NH)
  • Webster Ridge Farm (Webster, NH)

Consumers who have purchased these products and still have them, fresh or frozen, should discard them or return them to the place of purchase.

Hawaii Should Mandate Hepatitis A Vaccines for Food Service Workers

My bet is Baskins-Robbins, Sushi Shiono and Taco Bell would agree.

According to the Hawaii Department of Health, an employee of each of the following food service businesses has been diagnosed with hepatitis A.  These restaurants are not the source of the 93 people sickened – the three employees are part of the 93 sickened.  Persons who have consumed food or drink products from these businesses during the identified dates of service should contact their healthcare provider for advice and possible preventive care.

Baskin-Robbins, Oahu, Waikele Center – Exposure Risk Dates:  June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3, 2016

Sushi Shiono, Hawaii, Waikoloa Beach Resort, Queen’s MarketPlace – Exposure Risk Dates:  July 5-8, 11-15, and 18-21, 2016

Taco Bell, Oahu, Waipio – Exposure Risk Dates:  June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11, 2016

Hardly a month passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak. Absent vaccinations of food handlers, combined with an effective and rigorous hand-washing policy, there will continue to be more hepatitis A outbreaks.

It is time for health departments across the country to require vaccinations of food-service workers, especially those who serve the very young and the elderly.

Hepatitis A is a communicable disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Hepatitis A is the only foodborne illness that is vaccine-preventable. According to the U.S. Centers for Disease Control and Prevention (CDC), since the inception of the vaccine, rates of infection have declined 92 percent.

CDC estimate that 83,000 cases of hepatitis A occur in the United States every year, and that many of these cases are related to food-borne transmission. In 1999, more than 10,000 people were hospitalized due to hepatitis A infections, and 83 people died. In 2003, 650 people became sickened, four died, and nearly 10,000 people got IG (immunoglobulin) shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but also businesses lose customers or some simply go out of business.

Although CDC has not yet called for mandatory vaccination of food-service workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of foodborne illness in the U.S.

Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S., despite FDA approval of hepatitis A vaccine in 1995. Widespread vaccination of appropriate susceptible populations would substantially lower disease incidence and potentially eliminate indigenous transmission of hepatitis A infections. Vaccinations cost about $50. The major economic reason that these preventive shots have not been used is because of the high turnover rate of food-service employees. Eating out becomes a whole lot less of a gamble if all food-service workers faced the same requirement.

According to CDC, the costs associated with hepatitis A are substantial. Between 11 percent and 22 percent of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs in providing post-exposure prophylaxis to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $433 to $1,492 per case for children younger than 18. In 1989, the estimated annual direct and indirect costs of hepatitis A in the U.S. were more than $200 million, equivalent to more than $300 million in 1997 dollars.  A new CDC report shows that, in 2010, slightly more than 10 percent of people between the ages of 19 and 49 got a hepatitis A shot.

Vaccinating employees make sense – especially in a state so dependent on tourism.

It is moral to protect customers from an illness that can cause serious illness and death. Vaccines also protect the business from the multi-million-dollar fallout that can come if people become ill or if thousands are forced to stand in line to be vaccinated to prevent a more serious problem.

Hepatitis A:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A 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 Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Subway, McDonald’s, Chipotle, Quiznos and Carl’s Jr.

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

A Baker’s Dozen of E. coli Cases in New Hampshire

No announcement of where illnesses are located or what the source of the E. coli infections are as of today.

AP reports the as the investigation of an outbreak of E. coli bacteria associated with ground beef continues in New Hampshire, the Health Department says a 13th person has gotten sick since June.

Investigations started last week to determine the source of the ground beef. The safety of ground beef in the United States is regulated by the United States Department of Agriculture, which is assisting the state with the investigation.

The people who became ill ate ground beef at a number of different locations in the state.

New Hampshire E. coli Outbreak Linked to Ground Beef Sickens 12

UnknowneThe New Hampshire Department of Health and Human Services (DHHS), Division of Public Health Services (DPHS) is investigating an outbreak of Escherichia coli O157:H7 (E. coli) associated with ground beef. Since June, 12 people have been infected with the same strain of E. coli after eating ground beef. Investigations are underway to determine the source of the ground beef. The safety of ground beef in the United States is regulated by the United States Department of Agriculture (USDA), which is assisting DPHS with the investigation.

“The Division of Public Health Services is working with our federal partners to investigate the source of the ground beef that is causing people in New Hampshire to become ill,” said Marcella Bobinsky, Acting Director of DPHS. “Ground beef is a known source of E. coli and it is important for people to avoid eating under-cooked ground beef whether at home or at a restaurant. Young children and the elderly are especially vulnerable to severe illness with this infection.”

The people who became ill ate ground beef at a number of different locations. DPHS and USDA are actively working to identify the specific source of the ground beef and will provide updates as they become available. This outbreak does not present a risk to New Hampshire residents as long as they strictly follow food safety best practices. Ground beef should be cooked to a temperature of at least 160°F or 70˚C. It is best to use a thermometer, since color is not a very reliable indicator of ‘doneness.’ People should also prevent cross contamination in food preparation areas by thoroughly washing hands, counters, cutting boards, and utensils after they touch raw meat.

Escherichia coli O157:H7 is bacteria that causes severe stomach cramps, diarrhea (often bloody), and vomiting. If there is fever, it usually is not very high. Most people get better within 5–7 days. Some infections are very mild, but others are severe or even life-threatening. Very young children and the elderly are more likely to develop a potentially life-threatening complication known as hemolytic uremic syndrome (HUS). Antibiotics should not be used to treat this infection because they may increase the risk of HUS.

For further information visit the CDC website at http://www.cdc.gov/ecoli/general/index.html, or to report a suspected case contact the DPHS Bureau of Infectious Disease Control at 603-271-4496.

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.

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