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

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What is Listeria?

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

Approximately 2,500 cases of listeriosis are estimated to occur in the U.S. each year. About 200 in every 1000 cases result in death. Certain groups of individuals are at greater risk for listeriosis, including pregnant women (and their unborn children) and immunocompromised persons. Among infants, listeriosis occurs when the infection is transmitted from the mother, either through the placenta or during the birthing process. These host factors, along with the amount of bacteria ingested and the virulence of the strain, determine the risk of disease. Human cases of listeriosis are, for the most part, sporadic and treatable. Nonetheless, Listeria remains an important threat to public health, especially among those most susceptible to this disease.

Listeria is often isolated in cattle, sheep, and fowl, and is also found in dairy products, fruits, and vegetables.

What are the Symptoms of Listeria Infection?

It is thought that ingestion of as few as 1,000 cells of Listeria bacteria can result in illness. After ingestion of food contaminated with Listeria, incubation periods (from time of exposure to onset of illness) are in the range of one to eight weeks, averaging about 31 days. Five days to three weeks after ingestion, Listeria has access to all body areas and may involve the central nervous system, heart, eyes, or other locations.

A person with listeriosis usually has fever, muscle aches, and gastrointestinal symptoms such as nausea or diarrhea. If infection spreads to the nervous system, symptoms such as headache, stiff neck, loss of balance, confusion, obtundation (decreased consciousness) or convulsions can occur. With brain involvement, listeriosis may mimic a stroke. Infected pregnant women will ordinarily experience only a mild, flu-like illness; however, infection during pregnancy can lead to miscarriage, infection of the newborn or even stillbirth. Pregnant women are about 20 times more likely than other healthy adults to get listeriosis; about one-third of listeriosis cases happen during pregnancy. The incidence of listeriosis in the newborn is 8.6 cases per 100,000 live births. The perinatal and neonatal mortality rate (stillbirths and early infant deaths) from listeriosis is 80%.

How to Diagnosis and Treat a Listeria Infection?

If you have symptoms of listeriosis, a health care provider can have a blood or spinal fluid test done to detect the infection. During pregnancy, a blood test is the most reliable way to find out if your symptoms are due to listeriosis. If you are in a high-risk group, have eaten the contaminated product, and within 2 months become ill with fever or signs of serious illness, you should contact your health care provider and inform him or her about this exposure. 

There are several antibiotics with which Listeria may be treated. When infection occurs during pregnancy, antibiotics given promptly to the pregnant woman can often prevent infection of the fetus. Babies with listeriosis receive the same antibiotics as adults, although a combination of antibiotics is often used until physicians are certain of the diagnosis.

How to Prevent a Listeria Infection?

General recommendations include: thoroughly cook raw food from animal sources; keep uncooked meats separate from vegetables and from cooked and ready-to-eat foods; avoid unpasteurized (raw) milk or foods made from unpasteurized milk; wash hands, knives, and cutting boards after handling uncooked foods; wash raw vegetables thoroughly before eating; and consume perishable and ready-to-eat foods as soon as possible.

Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above, include: do not eat hot dogs, luncheon or deli meats, unless they are reheated until steaming hot, and wash hands after handling those products; do not eat soft cheeses (such as feta, Brie, Camembert, blue-veined, or Mexican-style cheese), unless they have labels that clearly state they are made from pasteurized milk; and do not eat meat spreads or smoked seafood from the refrigerated or deli section of the store (canned or shelf-stable products may be eaten).

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 cantaloupe, cheese, celery and milk.

Yet Another Organic Pastures Raw Milk Recall

20100220-IMG_2765This time a new bug – Salmonella

Raw milk and cream produced by Organic Pastures Dairy of Fresno County with a code date of MAY 18 is the subject of a statewide recall and quarantine order announced by California State Veterinarian Dr. Annette Jones.  The quarantine order followed the confirmed detection of Salmonella bacteria in raw cream.  No illnesses have been reported at this time

Under the recall, Organic Pastures Dairy brand raw milk, raw skim milk and raw cream labeled with a code date of MAY 18 is to be pulled immediately from retail shelves, and consumers are strongly urged to dispose of any product remaining in their refrigerators.

CDFA inspectors found the bacteria as a result of product testing conducted as part of routine inspection and sample collection at the facility.

According to the California Department of Public Health, symptoms of Salmonella infection include fever, abdominal cramps and diarrhea which may be bloody. Most persons infected with Salmonella develop symptoms 12 to 72 hours after exposure. While most individuals recover in four to seven days without medical intervention, some may develop complications that require hospitalization. Infants, the elderly and people with weakened immune systems are at highest risk for more severe illness.


In January 2016 the California Department of Public Health (CDPH) learned of a cluster of four children diagnosed with E. coli O157 who reported consuming Organic Pastures Dairy Company (OPDC) brand raw cow milk before they became sick. Molecular strain typing of patient isolates showed these four patients were infected with an indistinguishable strain of E. coli O157 identified as PulseNet pattern combination “EXHX01.6177/EXHA26.0628.” Genetic testing by Multiple-Locus Variable Number Tandem Repeat Analysis (MLVA) confirmed PFGE findings.

By late February 2016 ten outbreak associated case-patients residing in seven northern and central California counties had been identified. Nine case-patients had E. coli O157 with the predominant PFGE pattern combination EXHX01.6177/EXHA26.0628. One case-patient had a closely related PFGE pattern combination EXHX01.6275/EXHA26.0628. Both pattern combinations were given the Centers for Disease Control and Prevention (CDC) cluster code 1602CAEXH-1. The patients were primarily children, with a median age of 8 years (range 1 to 26 years). Onset dates of illness ranged from January 14 to January 28, 2016. Four were hospitalized including two children with hemolytic uremic syndrome (HUS). Of the ten case-patients, nine were interviewed.  One patient was lost to follow-up and never interviewed. Of the nine that were interviewed, six (67%) reported consuming OPDC bran raw milk prior to illness onset. Three denied known raw milk exposure.

In response to the initial reports of illness, OPDC initiated a recall on February 5, 2016 of two lot codes of raw milk. This recall affected over 100 retail locations in northern and central California. Samples obtained from a patient in Fresno and from multiple retail locations throughout northern California were tested. E. coli O157 was not detected in any of these samples of raw milk.

During discussions with OPDC management, CDPH investigators learned that E. coli O157:H7 had been detected in a bulk milk tank sample in early January 2016. Although this milk was not distributed to the public, this finding resulted in further testing of the milk herd. One of the cows, Cow 149, was identified as having milk that was positive for E. coli O157.  CDPH Food and Drug Laboratory Branch (FDLB) conducted PFGE testing on four isolates cultured from samples collected from Cow 149. PFGE analysis determined the four isolates were PulseNet strain EXHX01.6177/EXHA26.0628 and were indistinguishable from the main outbreak pattern seen in clinical isolates.

On February 8, 2016 CDPH Food and Drug Branch (FDB) investigators conducted an on-site investigation at OPDC. FDB investigators collected a total of 97 environmental and product samples including 20 product samples (raw milk and cream), 56 cow feces, 18 soil, and 3 water. E. coli O157 was not detected in any of the product samples collected at OPDC. However, multiple environmental samples tested positive for E. coli O157:H7, including feces, soil, and water. These environmental samples were determined by FDLB to have 3 strains of E. coli O157 including the two strains isolated in case-patients (EXHX01.6177/EXHA26.0628 and EXHX01.6275/EXHA26.0628).

The evidence collected indicated that cattle in the OPDC milking herd were shedding E. coli O157 that matched PFGE patterns associated with ten illnesses in January 2016. Cow 149 produced milk contaminated with E. coli O157 and it is likely that milk from Cow 149 was bottled and shipped to consumers.


October 2015 – Organic Pastures Raw Milk Linked to Campylobacter Test:

Raw milk produced by Organic Pastures Dairy of Fresno County with a code date of OCT 24 is the subject of a statewide recall and quarantine order announced by California State Veterinarian Dr. Annette Jones.[1] The quarantine order followed the confirmed detection of campylobacter bacteria in raw whole milk. No illnesses have been reported at this time. Under the recall, Organic Pastures Dairy brand Grade-A raw milk labeled with a code date of OCT 24 is to be pulled immediately from retail shelves, and consumers are strongly urged to dispose of any product remaining in their refrigerators.

CDFA inspectors found the bacteria as a result of product testing conducted as part of routine inspection and sample collection at the facility.

September 2012 – Organic Pastures Raw Milk Linked to Campylobacter Test:

Raw milk, raw skim milk (non-fat) and raw cream produced by Organic Pastures Dairy of Fresno County and with a code date of SEP 13 are the subjects of a statewide recall and quarantine order announced by California State Veterinarian Dr. Annette Jones.[2] The quarantine order followed the confirmed detection of campylobacter bacteria in raw cream. No illnesses have been reported at this time.

Under the recall, Organic Pastures Dairy brand Grade A raw cream, Grade A raw milk and Grade A raw skim milk, all with a labeled code date of SEP 13, are to be pulled immediately from retail shelves, and consumers are strongly urged to dispose of any product remaining in their refrigerators.

CDFA inspectors found the bacteria as a result of product testing conducted as part of routine inspection and sample collection at the facility.

May 2012 – Organic Pastures Raw Milk Linked to Campylobacter Illnesses:

Raw milk, raw skim milk (non-fat), raw cream and raw butter produced by Organic Pastures Dairy of Fresno County is the subject of a statewide recall and quarantine order announced by California State Veterinarian Dr. Annette Whiteford.[3] The quarantine order came following the confirmed detection of campylobacter bacteria in raw cream.

Consumers are strongly urged to dispose of any Organic Pastures products of these types remaining in their refrigerators, and retailers are to pull those products immediately from their shelves.

From January through April 30, 2012, the California Department of Public Health (CDPH) reports that at least 10 people with campylobacter infection were identified throughout California and reported consuming Organic Pastures raw milk prior to illness onset. Their median age is 11.5 years, with six under 18. The age range is nine months to 38 years. They are residents of Fresno, Los Angeles, San Diego, San Luis Obispo and Santa Clara counties. None of the patients have been hospitalized, and there have been no deaths.

According to CDPH, symptoms of campylobacteriosis include diarrhea, abdominal cramps, and fever. Most people with campylobacteriosis recover completely. Illness usually occurs 2 to 5 days after exposure to campylobacter and lasts about a week. The illness is usually mild and some people with campylobacteriosis have no symptoms at all. However, in some persons with compromised immune systems, it can cause a serious, life-threatening infection. A small percentage of people may have joint pain and swelling after infection. In addition, a rare disease called Guillain-Barré syndrome that causes weakness and paralysis can occur several weeks after the initial illness.

2011 Organic Pastures E. coli Outbreak:

In November 2011, a cluster of five young children with Escherichia coli (E. coli) O157:H7 infection with matching pulse-field gel electrophoresis (PFGE) patterns was identified. Illness onsets were from August 25 to October 25, 2011. All five children reported drinking commercially available raw (unpasteurized) milk from a single dairy (Organic Pastures) and had no other common exposures. Statistical analysis of case­ patients’ exposures with a comparison group of E. coli O157:H7 patients with non­-cluster PFGE patterns indicated a strong association with raw milk. The epidemiological findings led to a quarantine and recall of all Organic Pastures products except cheese aged more than 60 days, and investigations by the California Department of Public Health (CDPH) Food and Drug Branch (FOB) and the California Department of Food and Agriculture (CDFA). Environmental samples collected at Organic Pastures yielded E. coli O157:H7 isolates that had PFGE patterns indistinguishable from the patient isolates. Organic Pastures raw milk consumed by the case-patients was likely contaminated with this strain of E. coli O157:H7, resulting in their illnesses. See Final Report.[4]

Organic Pastures has been involved in recalls and outbreaks in the past:

Organic Pastures products were recalled for pathogens in 2006, 2007 and 2008. It was tied to a 2007 outbreak of Campylobacter. Most notably, it was quarantined in 2006 after six children became ill with E. coli infections – two with hemolytic uremic syndrome. See Final Report.[5]

2006: 3 strains of E. coli O157:H7 cultured from OPDC heifer feces. See Press Release.[6]

2007: 50 strains of Campylobacter jejuni plus Campylobacter coli, Campylobacter fetus, Campylobacter hyointetinalis, and Campylobacter lari cultured from OPDC dairy cow feces after eight people were sickened. See State Report.[7]

2007: Listeria monocytogenes cultured from Organic Pastures Grade A raw cream. See Press Release.[8]

2008: Campylobacter cultured from Organic Pastures Grade A raw cream. See Press Release.[9]


[1]           https://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=15-050

[2]           https://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=12-033

[3]           https://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=12-018

[4]           https://www.cdfa.ca.gov/egov/press_releases/Press_Release.asp?PRnum=11-064

[5]           http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a2.htm

[6]           http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a2.htm

[7]           https://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=15-050

[8]           http://www.fda.gov/Safety/Recalls/ArchiveRecalls/2005/ucm112271.htm

[9]           https://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=08-061

What you need to know about hepatitis A

What is hepatitis A?

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) 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. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most virus is present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults.

Symptoms of hepatitis A Infection

Hepatitis A infection may cause no symptoms at all when it is contracted, especially in children. Such individuals will only know they were infected (and have become immune ñ you can only get hepatitis A once) by getting a blood test later in life. The incubation period (from exposure to onset of symptoms) is 15-50 days, with an average of 30 days. Many children and most adults will experience the sudden onset of flu-like symptoms. After a day or two of muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever and malaise, jaundice (also termed icterus) sets in. Jaundice is a yellowing of the skin, eyes and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood. The urine will turn dark with bile and the stool will be light or clay-colored from lack of bile. When jaundice sets in, the initial symptoms begin to subside.

In general, the period of acute illness lasts from 10 days to three weeks, at which time affected individuals tend to recapture some sense of wellness. It is not unusual for blood tests to remain abnormal for six months (or more), prolonging recovery for up to a year. Most affected individuals show complete recovery within three to six months of the onset of illness. Relapse is possible, and although more common in children, it does occur with some regularity in adults.

Diagnosis and treatment of hepatitis A

There are blood tests widely available to accurately diagnose hepatitis A; blood samples are tested for hepatitis antibodies, which are present when the immune system responds to the hepatitis virus. Antibodies of the immune globulin (Ig) M variety, which indicate acute disease, and IgG antibodies, which stay positive for life, should both be measured.

Hepatitis A infection is an acute self-limiting disease. There is no specific treatment; treatment and management is merely supportive. The liver function tests generally improve as the affected individual begins to feel better. It is therefore well accepted that the need for rest is best determined by the person’s own perception of the severity of fatigue or malaise.

Preventing hepatitis A Infection

Hepatitis A infection is totally preventable. Ill food-handlers should be excluded from work. Commercial food workers and other individuals who prepare food for others must always wash their hands with soap and water after using the bathroom, changing a diaper, and before preparing food. Cooking food to a temperature of 185∞F or higher will inactivate hepatitis A.

After a known exposure to hepatitis A, administration of a shot of immune globulin should be considered. If administered within two weeks of the exposure, it will usually be effective in preventing or at least ameliorating the disease.

Hepatitis A vaccine is the best protection from hepatitis A infection. The vaccine is recommended for persons traveling to areas with increased rates of hepatitis A, men who have sex with men, injecting and non-injecting drug users, persons with blood clotting factor disorders (such as hemophilia), persons with chronic liver disease, and children living in regions of the U.S. with increased rates of hepatitis A. The vaccine may also help protect household contacts of those with hepatitis A infection. Vaccination of food handlers would likely substantially diminish the incidence of hepatitis A outbreaks. The vaccine is licensed for individuals aged two and older, but there is good evidence that the vaccine is safe and effective at one year of age.


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Bialek SR, Thoroughman DA, Hu D, Simard EP, Chattin J, Cheek J, Bell BP. (2004). Hepatitis A Incidence and Hepatitis A Vaccination Among American Indians and Alaska Natives, 1990–2001. Am J Public Health. 94(6):996-1001.

Bownds L, Lindekugel R, Stepak P. (2003). Economic impact of a hepatitis A epidemic in a mid-sized urban community: the case of Spokane, Washington. J Community Health. 28(4):233-246.

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Calder L, Simmons G, Thornley C, Taylor P, Pritchard K, Greening G, Bishop J. (2003). An outbreak of hepatitis A associated with consumption of raw blueberries. Epidemiol Infect. 131(1):745-751.

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Feldman, M, Friedman, LS, Sleisenger, MH. (2002). Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th ed. [2-volume set]. St. Louis, MO: Saunders. 80: 1571.

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Hutin YJF, Pool V, Cramer EH, et al. (1999). A multistate, foodborne outbreak of hepatitis A. N Engl J Med. 340:595–602.

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Scharff RL, McDowell J, Medeiros L. (2009). Economic Cost of Foodborne Illness in Ohio. J Food Prot. 72(1):128-136.

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CDC: We Need Bacterial Cultures to Catch Foodborne Outbreaks

p0414-foodborne-illness-test-400pxChanges in the tests that diagnose foodborne illness are helping identify infections faster but could soon pose challenges to finding outbreaks and monitoring progress toward preventing foodborne disease, according to a report published today in CDC’s Morbidity and Mortality Week Report.

Culture-independent diagnostic tests (CIDTs) help doctors diagnose infections quickly because they provide results in hours instead of the days needed for traditional culture methods, which require growing bacteria to determine the cause of illness. But without a bacterial culture, public health officials cannot get the detailed information about the bacteria needed to help find outbreaks, check for antibiotic resistance, and track foodborne disease trends.

In 2015, the percentage of foodborne infections diagnosed only by CIDT was about double compared with the percentage in 2012-2014.

“Foodborne infections continue to be an important public health problem in the United States,” said Robert Tauxe, M.D., M.P.H, director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “We are working with partners to make sure we still get important information about harmful bacteria despite the increasing use of diagnostic tests that don’t require a culture.”

The increased use of CIDT could affect public health officials’ ability to monitor trends and detect outbreaks. In the short term, clinical laboratories should work with their public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection. For a long-term solution, CDC is working with partners to develop advanced testing methods that, without culture, will give health care providers information to diagnose illness and also give the detailed information that public health officials need to detect and investigate outbreaks.

Limited progress in reducing foodborne illness

The report included the most recent data from CDC’s Foodborne Diseases Active Surveillance Network, or FoodNet. It summarizes preliminary 2015 data on nine germs spread commonly through food. Overall, progress in reducing rates of foodborne illnesses has been limited since 2012, according to the report. The most frequent causes of infection in 2015 were Salmonella and Campylobacter, which is consistent with previous years.

Other key findings from the FoodNet report include:

  • The incidence of Salmonella Typhimurium infection, often linked to poultry and beef, decreased 15 percent from 2012-2014 levels.
    • This decline may be due in part to tighter regulatory standards and vaccination of chicken flocks against Salmonella.
  • The incidence of some infections increased:
    • Reported Cryptosporidium infections increased 57 percent since 2012-2014, likely due to increased testing for this pathogen.
    • Reported non-O157 Shiga toxin-producing Escherichia coli (STEC) infections increased 40 percent since 2012-2014. Quicker and easier testing likely accounted for some or all of this increase.

FoodNet has been monitoring illness trends since 1996. FoodNet provides a foundation for food safety policy and prevention efforts because surveillance data can tell us where prevention efforts are needed to reduce foodborne illnesses.

CDC is working with federal, state, and local partners, and the food industry to improve food safety. New regulations and continuing industry efforts are focusing on challenging areas. USDA has made improvements in its poultry inspection and testing models and has tightened standards for both Salmonellaand Campylobacter in poultry.

“In 2013, we launched a series of targeted efforts to address Salmonella in meat and poultry products, known as the Salmonella Action Plan, and recent data show that since then the incidence of Salmonella Typhimurium infection has dropped by 15 percent,” said USDA Deputy Undersecretary for Food Safety, Al Almanza. “However our work is not done. The newly published performance standards for poultry parts will lead to further Salmonellareductions and fewer foodborne illnesses.”

In 2015, FDA published new rules to improve the safety of the food supply including produce, processed foods, and imported foods.

Dr. Kathleen Gensheimer, MD, MPH, director of the FDA’s Coordinated Outbreak Response and Evaluation team and Chief Medical Officer, Foods and Veterinary Medicine Program, said, “We want to respond quickly to foodborne illness, but our true goal is to move forward with preventive measures that will be implemented from farm to table. In addition to collaboration with other government agencies at the local, state and federal level, the rules we are implementing under the FDA Food Safety Modernization Act will help the food industry minimize the risk of contamination to our food supply.”

Herring with Listeria Recalled

ucm496278OLMA-XXI, Inc. of Brooklyn, NY, is recalling NORVEN herring in oil, Lot 530611, because it has the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women.

NORVEN herring in oil was distributed to distributors and retail stores in NY, NJ, CT, IL, PA, MA, MD, VA, FL, and CA.

The affected NORVEN herring in oil is packaged in plastic containers (tubs):

Net Wt. 17.6 oz. (500g), UPC barcode 856687004196; Lot # 530611, Best before: 10/27/16 (stamped on bottom label);
Net Wt. 10.6 oz. (300g), UPC barcode 856687004189; Lot # 530611, Best before: 10/27/16 (stamped on bottom label).

No illnesses have been reported to date.

The recall is the result of sampling and testing by the U.S. Food and Drug Administration (FDA) which revealed the presence of Listeria monocytogenes in the 17.6 oz. (500g) packages of NORVEN Herring in oil, Lot # 530611. The distribution of the product has been suspended while FDA and the company continue to investigate the source of the problem.

Fresh from Tennessee: Raw Milk Can be Hazardous to Your Health

Milk, whether it comes from seemingly healthy cows, goats or any other animal, can cause serious health problems, including death, if it has not been pasteurized to kill harmful bacteria. This reminder from the Tennessee Department of Health comes following the Centers for Disease Control and Prevention’s announcement regarding hospitalizations and a death from Listeria infections linked to people drinking raw milk from a Pennsylvania dairy.

Tennessee Department of Health Commissioner John Dreyzehner, MD, MPH, suggests those who perceive raw milk as having significant health benefits compared to pasteurized milk should understand the risks.

“Consuming raw milk believing it’s healthier than pasteurized milk is a perilous risk that shakes off the possibility of a range of serious and occasionally fatal illnesses for the individuals and anyone they share it with,” said TDH Commissioner John Dreyzehner, MD, MPH. “Our best choice for healthy, nutritious milk is the pasteurized kind. Even if one believes there are health benefits, an upside, is it worth taking a chance on the downside risk of a serious illness, especially in a child?”

In the last three years, Tennessee has experienced outbreaks associated with drinking raw milk that was not pasteurized. Notably, in 2013, nine residents under the age of nine years were sickened with E.coli O157 bacteria. Five required hospitalization for life-threatening kidney failure. Fortunately, none of the children died.

“The most common arguments we hear about raw milk are ‘pasteurization kills the good parts of milk’ and ‘people have been drinking milk for years without harm,’” said State Epidemiologist Tim Jones, MD.  “In reality, the process of pasteurization is a simple heating process that destroys bacteria without causing significant change to the nutritional benefits of milk. No one really knows how many people may have been harmed by drinking raw milk because the effects can mimic other health issues, and illnesses and deaths in the past may not have been properly linked to the contaminated milk they consumed.”

According the CDC, the most common causes of milk contamination include getting animal feces directly in the milk. Pasteurization effectively kills these bad bacteria. Without this important step, raw milk from even the cleanest, most well-run dairy operations can contain harmful bacteria, viruses and parasites capable of causing serious illness.  These germs do not affect the color, smell or taste of milk, but can cause days of diarrhea, stomach cramping and vomiting.  In some cases, drinking contaminated milk can lead to kidney failure and death.

“The Tennessee Department of Agriculture inspects licensed farms, trucks and plants where raw milk for pasteurization is collected, handled and processed to make certain that safety standards are met and regulations are followed,” said Tennessee Department of Agriculture Dairy Administrator Bill Thompson. “Pasteurization equipment is tested every three months to verify proper operation, and oversight even extends to the manufacture of packaging containers. Periodic testing of raw milk for pasteurization and finished milk and dairy products also helps ensure what you buy at the store is safe and wholesome for you and your family.”

“If you think about where milk comes out of a cow or goat, you know it’s not far where manure comes out,” said John Dunn, DVM, who directs zoonotic disease outbreaks with TDH.  “Even very conscientious cleaning of the udder and care while milking can’t prevent all risks of contamination during the milking process. Pasteurization kills bad bacteria that inadvertently contaminate milk and makes it safe to drink.”

While even the healthiest people can become ill from drinking contaminated raw milk, those at greatest risk for harm are the elderly, young children and people who have weak immune systems including those undergoing treatment for cancer, who have had an organ transplant or who have HIV/AIDS. Young children, who may be fed raw milk by well-intentioned family members, actually have the highest risk for harm and little ability to make a decision about the risk.

The mission of the Tennessee Department of Health is to protect, promote and improve the health and prosperity of people in Tennessee. TDH has facilities in all 95 counties and provides direct services for more than one in five Tennesseans annually as well as indirect services for everyone in the state, including emergency response to health threats, licensure of health professionals, regulation of health care facilities and inspection of food service establishments. Learn more about TDH services and programs at www.tn.gov/health.

Oak Leaf Dairy E. coli Outbreak – 41 ill with 3 with HUS

The State Department of Public Health (DPH) today issued the following update on the E. coli outbreak linked to the Oak Leaf Dairy in Lebanon, CT.

DPH is investigating 41 confirmed cases of E. coli O157 infection linked to the farm.  The patients range in age from 9 months to 45 years, with a median age of five years.  The patients include seven adults and 34 children 18 years old and under; 22 of the children are age five years or under.  In total, 10 patients have been hospitalized with one still in the hospital.  Three of the hospitalized patients were diagnosed with hemolytic uremic syndrome (HUS), a rare but serious illness that affects the kidneys and blood clotting system.  Two of the three children with HUS have recovered and were discharged from the hospital.

The investigation by DPH, Department of Agriculture, and the Centers for Disease Control and Prevention (CDC) is continuing and expected to last several weeks.  DPH, in collaboration with CDC, is planning additional studies to better understand the scope of the outbreak and specific risk factors for illness among persons who visited the farm.

Based on interviews of visitors to the farm conducted by DPH so far, there is no evidence that the milk, cheeses, caramels, lip balms, soaps, and salves sold by the Oak Leaf Dairy were the cause of this E. coli outbreak.  The milk and cheese products were pasteurized.

The outbreak was first identified on Thursday, March 24th when six of seven individuals sickened with E. coliwere confirmed by DPH to have recently visited Oak Leaf Dairy and come into contact with goats on the farm.  DPH has been able to determine that the exposures happened between March 6th and March 20th, with onset of symptoms occurring between March 7th and March 24th.

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.

Pizza Ranch E. coli Outbreak Update

The CDC reports that 13 people have been sickened by E. coli O157:H7 in Illinois, Iowa, Kansas, Minnesota, North Carolina, Nebraska, New Jersey, South Dakota and Wisconsin. Nine of the people recently had eaten at Pizza Ranch restaurants.  Two children, in Kansas and Nebraska, suffered kidney failure (hemolytic uremic syndrome – HUS) and are still hospitalized.The investigation has focused on a dry dough mix that may have been contaminated by E. coli.If you or a family member became ill with an E. coli infection or HUS after eating at a Pizza Ranch you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

Marler: Speech at Long Beach Department of Health



An accomplished attorney and national expert in food safety, William (Bill) Marler has become the most prominent foodborne illness lawyer in America and a major force in food policy in the U.S. and around the world .  Marler Clark, The Food Safety Law Firm, has represented thousands of individuals in claims against food companies whose contaminated products have caused life altering injury and even death.

He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the historic Jack in the Box E. coli O157:H7 outbreak, in her landmark $15.6 million settlement with the company.  The 2011 book, Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat, by best-selling author Jeff Benedict, chronicles the Jack in the Box outbreak and the rise of Bill Marler as a food safety attorney.

For the last 20 years, he has represented victims of nearly every large foodborne illness outbreak in the United States.  He has filed lawsuits against such companies as Chili’s, Chi-Chi’s, Cargill, ConAgra, Dole, Excel, Golden Corral, KFC, McDonald’s, Odwalla, Peanut Corporation of America, Sheetz, Sizzler, Supervalu, Taco Bell and Wendy’s, securing over $600,000,000 for victims of E. coli, Salmonella, and other foodborne illnesses.

Among the most notable cases he has litigated, Bill counts those of nineteen-year-old dancer Stephanie Smith, who was sickened by an E. coli-contaminated hamburger that left her brain damaged and paralyzed, and Linda Rivera, a fifty-seven-year-old mother of six from Nevada, who was hospitalized for over 2 years after she was stricken with what her doctor described as “the most severe multi-organ [bowel, kidney, brain, lung, gall bladder, and pancreas] case of E. coli mediated HUS I have seen in my extensive experience.”

New York Times reporter Michael Moss won a Pulitzer Prize for his coverage of Smith’s case, which was settled by Cargill in 2010 for an amount “to care for her throughout her life.” Linda’s story hit the front page of the Washington Post and became Senate Majority Leader Harry Reid’s touchstone for successfully moving forward the Food Safety Modernization Act in 2010.


Bill Marler’s advocacy for a safer food supply includes petitioning the United States Department of Agriculture to better regulate pathogenic E. coli, working with nonprofit food safety and foodborne illness victims’ organizations, and helping spur the passage of the 2010-2011 FDA Food Safety Modernization Act.  His work has led to invitations to address local, national, and international gatherings on food safety, including testimony before the U.S. House of Representatives Committee on Energy and Commerce.

At little or no cost to event organizers, Bill travels widely and frequently to speak to food industry groups, fair associations, and public health groups about the litigation of claims resulting from outbreaks of pathogenic bacteria and viruses and the issues surrounding it.  He gives frequent donations to industry groups for the promotion of improved food safety, and has established numerous collegiate science scholarships across the nation.

He is a frequent writer on topics related to foodborne illness.  Bill’s articles include “Separating the Chaff from the Wheat: How to Determine the Strength of a Foodborne Illness Claim”, “Food Claims and Litigation”, “How to Keep Your Focus on Food Safety”, and “How to Document a Food Poisoning Case” (co-authored with David Babcock.)  He is the publisher of the online news site, Food Safety News and his award winning blog, www.marlerblog.com is avidly read by the food safety and legal communities. He is frequent media guest on food safety issues and has been profiled in numerous publications.

In 2010 Bill was awarded the NSF Food Safety Leadership Award for Education and in 2008 earned the Outstanding Lawyer Award by the King County Bar Association.  He has also received the Public Justice Award from the Washington State Trial Lawyers Association.

Bill graduated from the Seattle University School of Law in 1987, and in 1998 was the Law School’s “Lawyer in Residence.”  In 2011 he was given Seattle University’s Professional Achievement Award.  He is a former board member of the Washington State Trial Lawyers, a member of the board of directors of Bainbridge Youth Services, former President of the Governor-appointed Board of Regents at Washington State University, and a member of the Children’s Hospital Circle of Care.

Bill is married to Julie Marler and has three daughters, Morgan, Olivia, and Sydney.


1987 –  J.D. Seattle University School of Law

1982 –  B.A.s Political Science, Economics, English, Washington State University


2013 – Seattle University Distinguished Law Graduate Award

2011- Seattle University Professional Achievement Award

2011 to Present – ABA Journal “Blawg 100” Best Legal Blogs

2010 – NSF Food Safety Leadership Award: Innovation in Education

2009 to Present –  Best Lawyers in America

2002 to Present –  Bar Register of Preeminent Attorneys

2008 –  Public Justice Award, Washington State Trial Lawyer’s Association

2008 – Outstanding Lawyer Award, Seattle/King County Bar Association

1998 to Present –  “Super Lawyer”, Washington State Attorneys

1998 – 2004 Governor Appointee, Washington State University Board of Regents Chairman

1997 –  Distinguished Achievement Award, WSU College of Liberal Arts


2011 – Separating the Chaff From the Wheat: The Reality of Proving a Foodborne Illness Case. White Paper

2010 – Laywers, Microbiologists, and Safe Food

Microbiologist Magazine, Vol 11, No 2

2009 – Legal Issues for Food Safety:  What Every Food Professional Should Know

Food Safety and Quality Magazine, Volume 5, Issue 3

2009 – Serving Up Trouble

American Association of Justice Trial Magazine, Vol 45, No 2

2007 –  Food Safety and the CEO:(PDF) Keys to Bottom Line Success

Food Safety Magazine

2005 –  Food Claims and Litigation (PDF)

Food Safety In-sight Newsletter by Environ Health Associates, Inc

2005 –  Separating the Chaff from the Wheat: How to Determine the Strength of a Foodborne Illness Claim (PDF)

Paper presented at Defense Research Institute meeting on Food Liability

2005 –  How to Keep Your Focus on Food Safety

Food Safety Magazine

2004 –  How to Document a Food Poisoning Case

(co-authored with David Babcock) Trial Magazine


2015 – Profile in Obsession: Bill Marler, By Naomi Tomky

2015 – The New Yorker – A Bug in the System

The New Yorker, Wil S. Hylton

2014 – Q&A: Food Safety Lawyer Bill Marler on What Not to Eat

The National Law Journal, Interview with Jenna Greene

2012 – Bill Marler, Attorney, Blogger, and Food Safety Advocate, Talks Turkey (Or Spinach, Rather)

Miami New Times, Interview with Ily Goyanes

2012 – Bill Marler Interview, Part Two: His Most Difficult Cases and Lobbying Congress

Miami New Times, Interview with Ily Goyanes

2012 – Profiles in Public Health Law: Interview with William “Bill” Marler CDC Public Health Law News

2012 – Food Safety Lawyer Bill Marler On Sprouts, Raw Milk, and Why “Local” Isn’t Always Safer Blisstree.com, Hanna Brooks Olsen

2011 – Listeria outbreak draws Seattle lawyer to battle

Associated Press, Shannon Dininny

2011 – Food-Borne Illness Attorney: Top Foods to Avoid

ABC News, Neal Karlinsky

2011 – How to Keep Food Free of Salmonella: Lawsuits

The Atlantic, Barry Estabrook

2011 – More Stomach-Churning Facts about the E. Coli Outbreak

New York Times, Mark Bittman

2011 – Bill Marler: A Personal Injury Attorney and More

The Xemplar, Nicole Black

2011 – Good Food Hero: Bill Marler, Food Safety Attorney

Good Food World, Gail Nickel-Kailing

2011- Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat.

Inspire Books, Jeff Benedict

2011 – New Book Chronicles Islander Marler’s Work.

Bainbride Island Review, Connie Mears

2010 – Food Safety Lawyer Puts His Money Where Your Mouth Is

AOL News, Andrew Schneider

2009 – Food Safety Lawyer’s Wish: Put Me Out of Business

Seattle Times, Maureen O’Hagan

2009 – WSU Discourse on Food Safety, Courtesy Seattle Lawyer

Kitsap Sun, Tristan Baurick

2009 – When Food Sickens, He Heads for Courthouse

Minneapolis Star-Tribune, Matt McKinney

2009 –  Bill Marler, The Food-Safety Litigator

Culinate, Miriam Wolf

2009 – Food Fight:Bill Marler’s Beef (PDF)

Washington Law & Politics, David Volk

2009 – Candidate for Top FSIS Job talks E. coli Testing, Irradiation, Education

The Meating Place, Ann Bagel Storck

2009 – Five Minutes with Bill Marler, Well Known Lawyer, Food Safety Activist

CattleNetwork, Chuck Jolley

2009 – Heath Surveillance the Key to Fresh Produce

The Packer, Tom Karst

2008 – Seattle Food Contamination Expert in China as Tainted Milk Sickens Thousands of Kids

Seattle Health Examiner

2008 –  E. Coli Lawyer Is Busier Than Ever

Associated Press

2007 –  Legally Speaking: The Food Poisoning Lawyer

The Southeast Texas Record, John G. Browning

2007 –  The Nation’s Leading Food-borne Illness Attorney Tells All

Washington State Magazine, Hannelore Sudermann

2007 –  Back to Court: Burst of E. coli Cases Returns Jack in the Box Litigator to the Scene

Meat and Poultry News, Steve Bjerklie

2007 – Food Fight

Portland Oregonian, Alex Pulaski

2007 –  Mr. Food Illness Esquire

QSR Magazine, Fred Minnick

2006 –  Seattle Attorney Dominates Food-Borne Illness Litigation


2006 –  How a Tiny Law Firm Made Hay Out of Tainted Spinach

The Wall Street Journal, Heather Won Tesoriero and Peter Lattman

2005 – Bill Marler – Education Holds Key in Tainted Food Fight

King County Bar Association Bar Bulletin, Ross Anderson

2001 –  THE INSIDE STORY: How 11 Schoolkids Got $4.75 Million in E. coli Lawsuit

MeatingPlace.com, Bryan Salvage

2001 –  Hammer Time: Preparation Pays When Disputes Escalate to Lawsuits

Meat & Poultry Magazine, David Hendee

2001 –  For Seattle Attorney, A Bacterium Brings Riches—and Enemies

The Wall Street Journal, Rachel Zimmerman

2001 –  The Bug That Ate The Burger

Los Angeles Times, Emily Green

1999 –  Courting Publicity, Attorney Makes Safe Food His Business

Seattle Post, Maggie Leung

CDC, Listeria and the Deli

Laura G. Brown, PhD1; E. Rickamer Hoover, PhD1; Danny Ripley2; Bailey Matis, MPH3; David Nicholas, MPH4; Nicole Hedeen, MS5; Brenda Faw6 (View author affiliations)

Listeria monocytogenes (Listeria) causes the third highest number of foodborne illness deaths (an estimated 255) in the United States annually, after nontyphoidal Salmonella species and Toxoplasma gondii (1). Deli meats are a major source of listeriosis illnesses (2,3), and meats sliced and packaged at retail delis are the major source of listeriosis illnesses attributed to deli meat (4). Mechanical slicers pose cross-contamination risks in delis and are an important source of Listeria cross-contamination (5,6). Reducing Listeria contamination of sliced meats in delis will likely reduce Listeria illnesses and outbreaks (6). Good slicer cleaning practices can reduce this foodborne illness risk (7). CDC’s Environmental Health Specialists Network (EHS-Net) studied how often retail deli slicers were fully cleaned (disassembled, cleaned, and sanitized) at the Food and Drug Administration (FDA) Food Code–specified minimum frequency of every 4 hours and examined deli and staff characteristics related to slicer cleaning frequency (8). Interviews with staff members in 298 randomly-selected delis in six EHS-Net sites showed that approximately half of delis fully cleaned their slicers less often than FDA’s specified minimum frequency. Chain-owned delis and delis with more customers, more slicers, required manager food safety training, food safety–knowledgeable workers, written slicer-cleaning policies, and food safety–certified managers fully cleaned their slicers more frequently than did other types of delis, according to deli managers or workers. States and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their establishments. Because independent and smaller delis had lower frequencies of slicer cleaning, prevention efforts should focus on these types of delis.

The FDA Food Code is a model food code offered for adoption by state and local governmental jurisdictions that regulate retail food safety (i.e., states and localities). It contains science-based guidance to improve food safety in retail food service establishments. Although not all states and localities have adopted the latest version of the Food Code (2013), FDA and CDC strongly encourage its adoption at all levels of government.* The FDA Food Code states that food contact surfaces, including slicers, should be cleaned and sanitized at least every 4 hours (4–602.11[C]) (8), and that food contact surfaces should be disassembled before cleaning and sanitizing (4–202.11[A][5]) (8). U.S. Department of Agriculture (USDA) guidance also recommends slicer disassembly before cleaning and sanitizing (6). Knowledge about retail delis’ cleaning practices is critical to developing effective interventions. EHS-Net, a collaborative program of CDC, FDA, USDA, and six EHS-Net–funded state and local health departments,† assessed how often deli slicers were fully cleaned (disassembled, cleaned, and sanitized) at the FDA–specified minimum frequency of every 4 hours. EHS-Net also assessed deli and staff characteristics related to slicer cleaning frequency.

Within each EHS-Net site, data collectors chose a convenient geographic area, based on reasonable travel distance, in which to survey delis by telephone to determine study eligibility and request study participation. A software program was then used to select a random sample of delis within in each of the site geographic areas. Delis eligible for the study had at least one slicer, prepared or served ready-to-eat foods (with a delay between purchase and consumption), and had staff members who could be interviewed in English. Data collectors assessed approximately 50 delis in each site. Data were collected during January–September 2012.

Data collectors interviewed deli managers about their characteristics, their deli’s characteristics; and how often slicers were fully cleaned (“On average, how many times are food slicers fully cleaned [disassembled, cleaned, and sanitized] during a shift?”). Deli managers also completed a written, eight-item food safety knowledge survey. Data collectors interviewed food workers, away from the manager, about their characteristics and food safety knowledge, and how often each slicer was fully cleaned (“How often do you break down, clean, then sanitize this slicer?”). Simple and multiple logistic regression models were used to examine associations between deli, manager, and worker characteristics and slicer-cleaning frequencies. The cut-off for variable inclusion in the multiple regression models was p≤0.10.

Among 691 managers of eligible delis who were contacted, 298 (43%) agreed to be interviewed. In 294 (98.7%) participating delis, data collectors were also able to interview a worker. The majority of delis were chains (55.0%) and had 1–2 slicers (56.8%) (Table 1).

Half of managers (49.5%) said that slicers were fully cleaned at least every 4 hours (Table 1). The remaining managers said that slicers were fully cleaned less frequently. Workers reported that 63.0% (393 of 624) of slicers were fully cleaned at least every 4 hours. Deli-level aggregation of these worker-reported data indicated that in 45.8% of delis, all slicers were fully cleaned at least every 4 hours (Table 1). In the remaining delis, at least one slicer was fully cleaned less frequently. Managers and workers agreed on cleaning frequency in 79.0% of delis (215 of 279, r = 0.587, p<0.001).

Simple regression models showed that the characteristics of deli chain ownership, a higher average number of workers per shift, more shifts per day, more customers served on the busiest day, more slicers, more chubs (plastic tubes of meat) sold daily, deli-required manager food safety training, a written policy on slicer cleaning, manager certification (current or ever), and manager and worker food safety knowledge were significantly associated with both managers and workers indicating that their slicers were fully cleaned at least every 4 hours (Table 2). Worker rating of deli slicers as easy to clean was significantly associated with managers indicating that slicers were fully cleaned at least every 4 hours. Deli-required manager food safety certification and more worker experience in the deli were significantly associated with workers indicating that slicers were fully cleaned at least every 4 hours.

A multiple regression model showed that deli chain ownership, more customers served on the busiest day, and worker food safety knowledge were significantly associated with managers indicating that slicers were fully cleaned at least every 4 hours. A second multiple regression model showed that deli chain ownership, more customers served on the busiest day, more slicers, more chubs sold daily, deli-required manager food safety training, and more worker experience in the deli were significantly associated with workers indicating that slicers were fully cleaned at least every 4 hours. (Table 3).

These analyses indicate that many delis have insufficient slicer-cleaning frequency, which could lead to cross-contamination of deli meats with Listeria and other pathogens. In at least half of delis studied, managers and workers reported that slicers were not fully cleaned at the FDA–specified minimum frequency of every 4 hours.

Multiple regression findings indicate that chain delis reported more frequent slicer cleaning than did independent delis, and delis with more slicers, serving more customers, and selling more chubs daily reported more frequent slicer cleaning than did delis with fewer slicers, serving fewer customers, or selling fewer chubs daily. These characteristics are likely indicators of deli size, and these data are consistent with other findings suggesting that both chain and larger establishments’ food safety practices tend to be better than those of independent and smaller establishments (9,10). Compared with both independent and smaller delis, chain and larger delis might have more resources, more or better trained staff, or more standardized cleaning procedures.

The association of required manager food safety training and certification with more frequent reported slicer-cleaning is consistent with other findings indicating that training and certification are important in retail food safety (9,10), and highlights the important role that management can play in food safety. The finding that delis with workers with more food safety knowledge and experience had more frequent reported slicer cleaning suggests that workers also play an important role in food safety.

Simple logistic regression findings suggest other characteristics that might improve cleaning frequencies. Written slicer-cleaning policies and worker ratings of slicers as being easy to clean were both associated with more frequent reported cleaning, suggesting that workplace policies and slicer design can affect cleaning frequency. Finally, delis with a food safety–certified manager had better reported cleaning frequencies, again pointing to the importance of training and certification.

Because slicer-cleaning frequency and disassembly guidance are presented separately from each other in the FDA Food Code, some deli managers might be unaware that cleaning should include disassembly, and might clean and sanitize slicers without disassembling them. It is also possible that some slicers included in this study, especially newer ones, do not need to be disassembled to be fully cleaned.

The findings in this study are subject to at least three limitations. First, the interview data might be affected by social desirability bias, which might have resulted in overreporting of cleaning frequency. Second, because interviewed workers were selected by managers, and not at random, worker data might not represent all workers. Finally, because the data were collected from English-speaking staff members only, they might not reflect practices in delis with no English-speaking staff. It is also important to note that the data from this study do not allow causal inferences about relationships between characteristics and cleaning frequency nor do they link slicer cleaning frequency with foodborne illness.

States and localities should require deli manager training and certification, as specified in the FDA Food Code. They should also consider providing education on the topics of slicer-cleaning frequency and the importance of slicer disassembly, and encouraging or requiring delis to have written slicer-cleaning policies. Retail food industry leaders can also implement these prevention efforts to reduce risk in their food establishments. Because frequencies of slicer cleaning were lower at independent and smaller delis, prevention efforts should focus on these types of establishments.