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Raw Milk Cause of Durand High School Campylobacter Outbreak

The Wisconsin Department of Health Services (DHS), the Wisconsin State Lab of Hygiene (WSLH), the Department of Agriculture, Trade and Consumer Protection (DATCP) and the Pepin County Health Department have been working on an investigation into an outbreak of illnesses that affected some members of the football team and coaching staff at the Durand Jr/Sr High School who attended a team dinner on September 18th, 2014. Testing performed at the Wisconsin State Lab of Hygiene and area labs and clinics confirmed that the outbreak was caused by Campylobactor jejuni bacteria.

As part of the investigation, DHS interviewed all of the football team members (ill and well) and coaching staff to assess illnesses and ask questions about things they may have been exposed to (activities, foods, water sources, etc.) in the days before becoming ill. In a comparison of the interview responses from ill and well team members, consumption of raw milk was the only food item associated with illness.

At the request of DHS, DATCP staff collected cow manure specimens. Wisconsin State Lab of Hygiene test results (genetic fingerprinting) show that the bacteria that caused diarrheal illness among individuals who drank the unpasteurized (raw) milk at the potluck was the same bacteria strain found on the farm that supplied the raw milk.

Campylobacter jejuni bacteria can cause diarrhea, which can be bloody, abdominal cramping, fever, nausea and vomiting. Campylobacter can be transmitted by consuming food contaminated directly or indirectly by animal feces or handled by someone with the infection who has not adequately washed hands after using the bathroom.

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

Did Ebola Outbreak Begin With Food?

Last week as the news surrounding the hospitalization of an Ebola victim in Dallas, I passed through the Dallas/Fort Worth airport on my way to Austin to give a series of food safety speeches.  By the time I got home came the report of the first death in the United States.  This morning came the report of a infected health care worker at the Dallas Hospital where the original victim died last week.

The outbreak, which to date has primarily impacted West Africa – Total Cases: 8399, Laboratory-Confirmed Cases: 4655, Total Deaths: 4033 – has now clearly hit our shores.

The World Health Organization reports that it is “thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.”

It does make you think.

Botulism Risk Recall: Pumpkin Seed Pesto

California Department of Public Health (CDPH) Director and State Health Officer Dr. Ron Chapman warned consumers today not to eat Williams-Sonoma Pumpkin Seed Pesto sauce because it may have been improperly produced, making it susceptible to contamination with Clostridium botulinum.

Ingestion of botulism toxin from improperly processed jarred and canned foods may lead to serious illness and death.

The manufacturer of the product, California Olive and Vine, LLC, of Sutter, California, initiated the voluntary recall after CDPH determined that the product had been improperly processed. The product was packaged in eight ounce glass jars with screw-on metal lids. The recalled product can be identified by the following stock keeping unit (SKU) numbers: 6404305 and 6389043. Photographs of the affected product package are located on the Recalled Product Photo Page. The Williams-Sonoma Pumpkin Seed Pesto has been sold nationwide at Williams-Sonoma retail stores since September 2014.

Zov’s Shigella Outbreak Update

Zov’s restaurant in Irvine was forced to shut down briefly Wednesday in the wake of a foodborne illness probe tied to four sick customers, health department officials said Thursday.

The sickened guests ate at Zov’s on Portola on three different dates between Sept. 16-22, said Deanne Thompson, a spokeswoman for the county’s Health Care Agency. All four people tested positive for shigella, an intestinal disease that triggers severe diarrhea.

Health investigators cleared Zov’s to reopen the same day after the restaurant’s owners took quick action to sanitize the restaurant and discard all ready-to-eat foods including fresh produce.

Employees, who cannot return to work until they are medically cleared by the health agency, were also given training on proper hand-washing, Thompson said.

Here is a little online history:

REASON FOR PERMIT SUSPENSION/CLOSURE ONGOING FOODBORNE ILLNESS INVESTIGATION 10/01/2014

HEALTH PERMIT REINSTATEMENT 10/01/2014

ROUTINE INSPECTION 09/30/2014

Eating/Drinking/Smoking in Food Storage/Prep Areas

Lack of/Improper Handwashing

Unsanitary Equipment/Utensil/Linen/Plumbing

Lack of/Unsanitary/Condition Walls/Floors/Ceilings

Improper Food Storage/Receiving

Water Temp (100F-119F)/Wash Temp <100F/Cross Con

Inoperable/Lack of Food Thermometer

Lack of/Improper Handwashing/Handwashing Sup.

ROUTINE INSPECTION 04/29/2014

Water Temp (100F-119F)/Wash Temp <100F/Cross Con

Unsanitary Equipment/Utensil/Linen/Plumbing

Inappropriate Sanitizer Level/ Lack of Test Strips

Lack of/Unsanitary/Condition Walls/Floors/Ceilings

Improper Food Storage/Receiving

ROUTINE INSPECTION 10/21/2013

Improper Holding Temp of PHF (60F-120F), (50F-59F)

Improper Food Storage/Receiving

Improper Thawing

Change Room Improper Use/Lack of Inadequate Hygiene (Hair/Clothing/Eating/Drinking)

Lack of/Improper Handwashing/Handwashing Sup.

Inappropriate Sanitizer Level/ Lack of Test Strips

Unapproved Pesticides/Chemicals/Labeling

Unsanitary Equipment/Utensil/Linen/Plumbing

Water Temp (100F-119F)/Wash Temp <100F/Cross Con

ROUTINE INSPECTION 04/22/2013

Improper Holding Temp of PHF (60F-120F), (50F-59F)

Improper Food Storage/Receiving

Inappropriate Sanitizer Level/ Lack of Test Strips

Lack of/Unsanitary/Condition Walls/Floors/Ceilings

ROUTINE INSPECTION 12/21/2012

Improper Warewashing/Inoperable Dishmachine

Unapproved Pesticides/Chemicals/Labeling

Water Temp (100F-119F)/Wash Temp <100F/Cross Con

Unsanitary Equipment/Utensil/Linen/PlumbingChange Room Improper Use/Lack of Lack of/Unsanitary/Condition Walls/Floors/Ceilings

Lack of/Improper Handwashing/Handwashing Sup.

Improper Food Storage/Receiving

Lack of Food Protection Manager Certificate

Major Violations pose the highest risk of causing food poisoning (or foodborne illness. Major violations are sometimes resolved during the inspection or a reinspection may be scheduled to verify compliance.

Minor Violations pose less risk of causing food poisoning (or foodborne illness), and do not warrant immediate verification of compliance.

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

Durand High School May be Facing a Campylobacter Outbreak

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

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

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

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

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

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

All About Shigella

Shigella

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

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

Symptoms of Shigella Food Poisoning

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

Common Shigella Food Poisoning Symptoms

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

Complications from Shigella

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

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

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

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

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

Diagnosis of Shigella

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

Shigella Food Poisoning Treatment

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

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

Preventing a Shigella Infection

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

Steps for Preventing the Spread of Shigella Infection

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

Additional Resources for Shigella

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

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

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

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

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

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

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

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

Norovirus Prompts Oyster Recall

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

Salmonella Illnesses Prompt Peanut Butter Recall

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

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

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

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and those with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

Time to Ban Petting Zoos – with E. coli?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

- Educate visitors about disease risk and prevention procedures.

- Properly care for and manage animals.

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

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

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

Or is it simply time to ban petting zoos?

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