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Whole Foods Recalls Pesto Pasta Salad with Arugula

Green Cuisine is initiating a voluntary recall of “Pesto Pasta Salad with Arugula” 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.

Green Cuisine is issuing this voluntary recall after being notified by their supplier, National Frozen Foods, that the frozen green peas used in the product are being recalled because they have the potential to be contaminated with Listeria monocytogenes.

The recalled products was sold in Southern California, Nevada and Arizona Whole Foods Market locations between 06/15/16 and 06/16/16.

There have been no reported illnesses attributed to the recalled items to date.

The recalled product was sold in 7.4 oz clear plastic containers with the name “Whole Foods Pesto Pasta Salad w/Arugula,” UPC code 857898004333 and “best by” date of 6/20/16.

Pho 75 tied to E. coli O157:H7 Outbreak

c2d777927cd87b17b2838a1c2dd73c0eColorado press reports that the Colorado Department of Public Health and Environment are investigating an outbreak of E. coli O157:H7 in Aurora. The outbreak was reported at Pho 75, an Aurora restaurant located at 2050 South Havana Street.

So far, four ill people have been identified, but as with any outbreak, it is possible that there are more sick than reported, as some might not go to the doctor. One of the four ill was hospitalized.

The Tri-County Health Department is working with the restaurant during the investigation. Pho 75 voluntarily closed yesterday. According to the state, typically when a restaurant closes in this kind of situation, a list of requirements must be met before they are allowed to reopen.

The Thompson Family speaks out: http://kdvr.com/2016/06/11/e-coli-linked-to-restaurant-pho-75-adds-to-history-of-violations/#ooid=BrM3EzNDE6yR-qN8tXn0aa8W9UqsX_mY

Here is a history of inspections:

Inspection Details
03/31/2016 Inspection, Education
No Violations Observed
03/24/2016 Inspection, Routine
01b – Critical
Food Source: Wholesome, free of spoilage
Inspector Comments: A dented can of coconut juice was stored with wholesome cans in the dry storage cabinet. Corrected on-site. Complied on: 03/24/2016
01c – Critical, Food Borne Illness Risk
Food Source: Cross-contamination
Inspector Comments: A bag of raw sausage was stored above ready-to-eat lettuce and ready-to-eat cucumbers in the preparation area, double-door, reach-in refrigerator. Corrected on-site. Complied on: 03/24/2016
02c – Critical, Food Borne Illness Risk
Personnel: Hands washed as needed
Inspector Comments: An employee in the ware washing area was observed touching dirty dishes and proceeded to touch clean dishes without washing their hands in between. An employee on the cook line repeatedly failed to wash her hands before donning new pairs of gloves. Complied on: 03/31/2016
02d – Critical, Food Borne Illness Risk
Personnel: Hygienic practices
Inspector Comments: An employee on the cook line failed to use their single-use gloves appropriately, as they repeatedly wore them for multiple tasks. An employee was observed touching his face with gloved hands and proceeded to touch ready-to-eat lettuce on the cook line. Complied on: 03/31/2016
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Cut lettuce was 48°F in a plastic container on top of the cook line, chest freezer. Cooked beef balls were 56°F in the basin of the preparation sink. Complied on: 03/31/2016
04a – Critical
Sanitation: Manual
Inspector Comments: A cutting board was manually washed in the basin of the preparation sink with soap and water only. Complied on: 03/31/2016
08b – Critical
Poisonous Or Toxic Items: Properly labeled
Inspector Comments: A chemical spray bottle was unlabeled as to its contents below the wait station sink. Corrected on-site. Complied on: 03/24/2016
09b – Non-Critical
Food Labeling, Food Protection: Food protected from contamination
Inspector Comments: Frozen, cooked chicken and frozen beef were thawing using an unapproved method on top of the wait station, chest, reach-in freezer. Cooked soup was observed cooling in a deep, large, plastic container in the walk-in refrigerator.
10a – Non-Critical
Equipment Design, Construction: Food-contact surfaces
Inspector Comments: The interiors of all the establishment’s chest freezers had an excessive amount of ice build-up. The interiors of the establishment’s chest freezers were cracked and in disrepair. The cook line cutting board was deeply grooved. The edges of the cuttings boards in the ware washing area were cracked.
10b – Non-Critical
Equipment Design, Construction: Nonfood-contact surfaces
Inspector Comments: The preparation sink was not firmly attached to the wall. A door gasket was torn in the cook line, cold-top refrigerator. A door gasket was torn in the storage area reach-in freezer. A door gasket was torn in the preparation area’s two-door, reach-in refrigerator.
12a – Non-Critical
Cleaning Of Equipment & Utensils: Food-contact surfaces
Inspector Comments: The interiors of the establishment’s chest freezers were heavily soiled with food debris. The interior of the storage area, reach-in freezer was heavily soiled with food debris. The interior of the ice machine was soiled with grime.
12b – Non-Critical
Cleaning Of Equipment & Utensils: Nonfood-contact surfaces
Inspector Comments: The storage shelf above the preparation sink was heavily soiled. The shelves of the walk-in refrigerator were soiled with food debris. The storage shelves throughout food preparation areas in the establishment were heavily soiled with food debris. The exterior of the preparation area chest freezer was soiled.
12d – Non-Critical
Cleaning Of Equipment & Utensils: Wiping cloths
Inspector Comments: Damp wiping cloths were stored out of contact with sanitizer in the ware washing area.
13a – Non-Critical
Utensils, Single-Service Articles: Utensils provided, used, stored
Inspector Comments: Clean forks at the wait station were not stored protected with their handles presented. Knives intended for use on the cook line were stored in between the cold-top refrigerator cutting board and the soiled storage shelf.
13b – Non-Critical
Utensils, Single-Service Articles: Single service articles stored, used
Inspector Comments: Single-use, plastic forks and spoons were not stored protected with their handles presented at the wait station.
13c – Non-Critical
Utensils, Single-Service Articles: No reuse of single-service articles
Inspector Comments: A single-use container of beef was reused to store water on the cook line. A single-use container of soy sauce was reused in the walk-in refrigerator to store soup.
14a – Non-Critical
Physical Facilities: Plumbing: installed, maintained
Inspector Comments: A leak was observed from the pipe underneath the wait station sink. The caulking at the cook line handsink was in disrepair.
14c – Non-Critical
Physical Facilities: Floors, walls, and ceilings
Inspector Comments: Several floor tiles were cracked on the cook line. Several floor tiles were cracked in the walk-in refrigerator. The ceiling tiles above the cook line were dusty. The walls underneath the three-compartment sink and preparation sink were heavily soiled.
14d – Non-Critical
Physical Facilities: Lighting
Inspector Comments: A light was not operational above the storage area.
10/08/2015 Inspection, Follow-Up
01c – Critical, Food Borne Illness Risk
Food Source: Cross-contamination
Inspector Comments: Raw shell eggs were stored above ready-to-eat limes in the walk-in refrigerator. Corrected on-site. Complied on: 10/08/2015
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Shredded lettuce was 50°F in an ice bath on top of the preparation area reach-in freezer. Cooked noodles were 70-72°F out of temperature control on the preparation sink drainboard. Corrected on-site. Complied on: 10/08/2015
09/30/2015 Inspection, Critical Item
01b – Critical
Food Source: Wholesome, free of spoilage
Inspector Comments: A dented can of bean sauce was stored with wholesome cans in the back storage room. Complied on: 10/08/2015
01c – Critical, Food Borne Illness Risk
Food Source: Cross-contamination
Inspector Comments: Raw shell eggs were stored above ready-to-eat tomatoes and lettuce in the walk-in refrigerator. Raw egg and shrimp were stored above cooked beef, tofu, and pork in the cook line reach-in refrigerator. Complied on: 10/08/2015
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: The following items in the cook line cold-top refrigerator were above 41°F: raw sausage (48°F) and sliced beef (51°F). Bean sprouts (51-61°F) and raw beef/pork (53-61°F) were stored out of temperature control in the cook line preparation area. The following were above 41°F in the double-door standing refrigerator: raw beef (46°F), raw pork (49°F), cooked shrimp (59°F), raw shrimp (62°F), raw chicken with sauce (47°F), raw beef (45°F) and wonton filling (44-45°F). Raw beef with cut lettuce was 44°F in the walk-in refrigerator. Complied on: 10/08/2015
08a – Critical
Poisonous Or Toxic Items: Properly stored
Inspector Comments: A bottle of employee medicine was stored next to single-service straws and above the boba station. Complied on: 10/08/2015
08/05/2015 Inspection, Follow-Up
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Bean sprouts were 47°F in a plastic container on top of the cook line chest freezer. Corrected on-site. Complied on: 08/05/2015
07/27/2015 Inspection, Critical Item
02e – Critical
Personnel: Smoking, eating, drinking
Inspector Comments: An unapproved, twist-top employee beverage was observed on the serving counter next to the water glasses. Corrected on-site. Complied on: 07/27/2015
03a – Critical, Food Borne Illness Risk
Food Temperature Control: Rapidly cool foods to 41°f or less
Inspector Comments: A container of cooked noddles was 46-47°F after being cooked the previous day and stored in the walk-in refrigerator for more than 6 hours. Complied on: 08/05/2015
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Whipping cream (51°F) and milk (50°F) were stored above 41°F in the preparation line cold-top refrigerator. Bean sprouts were 57°F in a plastic container on top of the cook line chest freezer. Crab rangoons were 47°F in the walk-in refrigerator. Complied on: 08/05/2015
03f – Critical
Food Temperature Control: Food thermometer (probe type)
Inspector Comments: A probe food thermometer capable of measuring internal food temperatures from 0-220°F was not available in the establishment. Complied on: 08/05/2015
06c – Critical, Food Borne Illness Risk
Hand Washing: Soap and drying devices
Inspector Comments: Paper towels were not readily available at the preparation area handsink. Corrected on-site. Complied on: 07/27/2015
08a – Critical
Poisonous Or Toxic Items: Properly stored
Inspector Comments: A bottle of non-food grade oil was stored on top of the dish machine. A bottle of non-food grade oil was stored above customer food on the storage shelf adjacent to the walk-in refrigerator. Complied on: 08/05/2015
02/06/2015 Inspection, Follow-Up
No Violations Observed
02/02/2015 Inspection, Follow-Up
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Bean sprouts (52°F) were stored with ice on top of the cook area reach-in freezer. Cooked beef (44-46°F) was stored in the walk-in refrigerator for less than 4 hours. Complied on: 02/06/2015
01/08/2015 Inspection, Routine
02e – Critical
Personnel: Smoking, eating, drinking
Inspector Comments: An employee on the cook line was observed drinking from an unapproved, pop-top drink container. Two containers of employee food (beans) were stored in the reach-in refrigerator, adjacent to the back exit, above and next to customer food items. Complied on: 02/02/2015
03c – Critical, Food Borne Illness Risk
Food Temperature Control: Hot hold at 135°f or greater
Inspector Comments: Cooked noodles (91°F) were stored in the cook line microwave for less than 4 hours. Complied on: 02/02/2015
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Cooked shrimp (51°F), shredded cabbage (55°F), and wonton filling (51°F) were stored out of temperature control on top of the cook line reach-in freezer. Raw bean sprouts (48°F) were stored on ice on top of the reach-in freezer across from the kitchen handsink. Cut cabbage (60°F) was stored for more than 4 hours in a container on a prep shelf across from the kitchen handsink. Complied on: 02/06/2015
04c – Critical
Sanitation: In-place
Inspector Comments: Knives stored in the warewashing area were not washed, rinsed, and sanitized as required-at least every 4 hours. Complied on: 02/02/2015
08a – Critical
Poisonous Or Toxic Items: Properly stored
Inspector Comments: Employee medicine was stored on top of a dish rack on the cook line-above clean dishes. Complied on: 02/02/2015
08b – Critical
Poisonous Or Toxic Items: Properly labeled
Inspector Comments: Four unlabeled spray bottles (degreaser and metal cleaner) were stored on top of the dish machine. Complied on: 02/02/2015
09b – Non-Critical
Food Labeling, Food Protection: Food protected from contamination
Inspector Comments: A head of cabbage was stored unprotected in a box of pots, pans, and plastic bags on the lowest shelf of the kitchen prep table. Plastic containers of miscellaneous food items were stored on the floor of the walk-in refrigerator.
10a – Non-Critical
Equipment Design, Construction: Food-contact surfaces
Inspector Comments: An excessive amount of ice build-up was observed in the reach-in freezer adjacent to the walk-in refrigerator entrance.
10b – Non-Critical
Equipment Design, Construction: Nonfood-contact surfaces
Inspector Comments: A door gasket was torn on the cook line reach-in refrigerator. Aluminum foil was used to line shelves in the walk-in refrigerator.
11a – Non-Critical
Testing Devices: Refrigeration units provided with accurate, conspicuous thermometer
Inspector Comments: The exterior thermometer for the walk-in refrigerator was not recording air temperatures within +/-3°F.
12b – Non-Critical
Cleaning Of Equipment & Utensils: Nonfood-contact surfaces
Inspector Comments: The kitchen handsink was excessively soiled with grime. The ventilation hood above the grill had a significant build-up of grease and dust. The fan guards in the walk-in refrigerator were dusty. The handle of the walk-in refrigerator was soiled with food debris. The reach-in freezers in the dry storage room were significantly soiled with food debris. The storage racks above and adjacent to the 3-compartment sink were grimy with miscellaneous debris.
13a – Non-Critical
Utensils, Single-Service Articles: Utensils provided, used, stored
Inspector Comments: A scoop without a handle was observed in the a container of fried onions.
14c – Non-Critical
Physical Facilities: Floors, walls, and ceilings
Inspector Comments: The ceiling tiles throughout food preparation areas were soiled and stained.
14f – Non-Critical
Physical Facilities: Locker rooms
Inspector Comments: An employee’s retainer and cell phone were not stored appropriately in the kitchen adjacent to the 3-compartment sink.
08/13/2014 Inspection, Follow-Up
No Violations Observed
07/22/2014 Inspection, Critical Item
01c – Critical, Food Borne Illness Risk
Food Source: Cross-contamination
Inspector Comments: Whole raw eggs were stored above ready-to-eat customer food. Complied on: 08/13/2014
02d – Critical, Food Borne Illness Risk
Personnel: Hygienic practices
Inspector Comments: An employee was observed rinsing gloved hands in the preparation sink. Complied on: 08/13/2014
03a – Critical, Food Borne Illness Risk
Food Temperature Control: Rapidly cool foods to 41°f or less
Inspector Comments: A whole chicken was stored next to the preparation sink at 83°F and not undergoing preparation. Complied on: 08/13/2014
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Raw chicken was stored in a bowl under the preparation sink 68°F. Complied on: 08/13/2014
04b – Critical
Sanitation: Mechanical
Inspector Comments: The final sanitization rinse of the dish machine was less than 50 ppm chlorine residual. Complied on: 08/13/2014
08b – Critical
Poisonous Or Toxic Items: Properly labeled
Inspector Comments: Several chemical spray bottles stored on top of the dish machine were not labeled as to its contents. Complied on: 08/13/2014
02/24/2014 Inspection, Follow-Up
No Violations Observed
02/20/2014 Inspection, Follow-Up
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: In containers on the chest freezer in the kitchen, cut lettuce was 51°F. On the bottom shelf of the two-door standing refrigerator, raw beef was 46°F. Complied on: 02/24/2014
02/12/2014 Inspection, Routine
01b – Critical
Food Source: Wholesome, free of spoilage
Inspector Comments: A severely dented can was stored next to wholesome cans in the dry storage room by the back door. Complied on: 02/20/2014
01c – Critical, Food Borne Illness Risk
Food Source: Cross-contamination
Inspector Comments: Raw beef was stored above cooked rice in the standing two door refrigerator in the side kitchen room. Complied on: 02/20/2014
02c – Critical, Food Borne Illness Risk
Personnel: Hands washed as needed
Inspector Comments: An employee was observed washing their hands with out first removing their gloves. Complied on: 02/20/2014
02d – Critical, Food Borne Illness Risk
Personnel: Hygienic practices
Inspector Comments: An employee was observed using a towel with a concentration less than 50 ppm chlorine to wipe food contact surfaces and hands. Complied on: 02/20/2014
02f – Critical
Personnel: Demonstration of knowledge
Inspector Comments: A lack of food safety knowledge was demonstrated by the 9 other critical violations that were observed during routine inspection. Complied on: 02/20/2014
03c – Critical, Food Borne Illness Risk
Food Temperature Control: Hot hold at 135°f or greater
Inspector Comments: Tapioca balls were 106°F on the boba tea cart in the kitchen. Complied on: 02/20/2014
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: In the containers on top of the freezer chest in the middle of the kitchen, sprouts were 47°F, cut lettuce mix was 51°F, and cut lettuce was 52°F. Raw beef on the bottom shelf of the 2 door standing refrigerator was 44°F. Condensed milk in cups on a ice tray in the kitchen was 62°F. Complied on: 02/24/2014
03f – Critical
Food Temperature Control: Food thermometer (probe type)
Inspector Comments: The facility did not have a probe-type thermometer measure at least 0-220°F.Complied on: 02/20/2014
04a – Critical
Sanitation: Manual
Inspector Comments: An employee was observed washing a pan and a cutting board without sanitizing in the manual ware-washing procedure. Complied on: 02/20/2014
08b – Critical
Poisonous Or Toxic Items: Properly labeled
Inspector Comments: Two unlabeled chemical spray bottles were observed on top of the ware-washing machine. Complied on: 02/20/2014
09b – Non-Critical
Food Labeling, Food Protection: Food protected from contamination
Inspector Comments: Beef was thawing using an unapproved method in packages sitting out on the preparation sink drain board and on the dirty dish drainboard. Chicken was thawing with in time and temperature controls nut using an unapproved method in a strainer on the preparation table next to the cold top refrigerator. Sprouts were stored in a container that was not NSF approved for food contact.
10b – Non-Critical
Equipment Design, Construction: Nonfood-contact surfaces
Inspector Comments: The kitchen hand sink was not sealed to the wall. Foil was used to cover the dish storage shelves in the kitchen. The lid to the chest freezer was split and broken.
10c – Non-Critical
Equipment Design, Construction: Dishwashing facilities
Inspector Comments: The three-compartment sink was not sealed to the wall.
11c – Non-Critical
Testing Devices: Chemical test kits provided and accessible
Inspector Comments: The facility did not have chemical test strips to verify the concentration of chlorine in the sanitizer solution.
12a – Non-Critical
Cleaning Of Equipment & Utensils: Food-contact surfaces
Inspector Comments: The interior of the standing freezer in the dry storage room, the 2-door standing refrigerator and of the cold-top refrigerator was soiled with food debris.
12b – Non-Critical
Cleaning Of Equipment & Utensils: Nonfood-contact surfaces
Inspector Comments: The drying shelf above the three-compartment sink was heavily soiled with grime. The fan guard in the walk-in refrigerator was soiled with dust. The door gaskets on the boba cold-top refrigerator and on the pho cold-top refrigerator were soiled with food debris. The interior of the chest freezer contained excessive ice build up.
13a – Non-Critical
Utensils, Single-Service Articles: Utensils provided, used, stored
Inspector Comments: The spoon used to scoop boba tapioca balls was store in still luke warm soiled water.
14c – Non-Critical
Physical Facilities: Floors, walls, and ceilings
Inspector Comments: Floor tiles and coving were loose, missing and cracked. The walls in the kitchen were all soiled with grime and grease. The floor under the standing refrigerators and freezers outside of the walk-in cooler were heavily soiled with grime, food debris, and trash. The floor of the walk-in cooler was soiled with food debris.
10/29/2013 Inspection, Follow-Up
No Violations Observed
10/23/2013 Inspection, Routine
01b – Critical
Food Source: Wholesome, free of spoilage
Inspector Comments: Raw meat was stored over ready to eat cut cucumbers in the standing refrigerator.Complied on: 10/30/2013
01c – Critical, Food Borne Illness Risk
Food Source: Cross-contamination
Inspector Comments: Raw beef was stored in contact with cooked chicken in the standing refrigerator.Complied on: 10/30/2013
01f – Critical
Food Source: Consumer advisory (7/1/13)
Inspector Comments: A consumer advisory was not provided for undercooked eggs served at the facility.Complied on: 02/20/2014
02c – Critical, Food Borne Illness Risk
Personnel: Hands washed as needed
Inspector Comments: An employee was observed changing gloves without washing their hands. Complied on: 10/30/2013
03c – Critical, Food Borne Illness Risk
Food Temperature Control: Hot hold at 135°f or greater
Inspector Comments: Noodles were stored inside the microwave at 106°F. Complied on: 10/30/2013
03e – Critical, Food Borne Illness Risk
Food Temperature Control: Cold hold at 41°f or less
Inspector Comments: Onion, garlic, chili paste and oil were found at 68°F. Cut lettuce on top of the chest freezer was found at 58°. Tapioca balls were found at 74°F. Complied on: 10/30/2013
06c – Critical, Food Borne Illness Risk
Hand Washing: Soap and drying devices
Inspector Comments: No hand soap was provided at the kitchen hand sink. Complied on: 10/30/2013
08b – Critical
Poisonous Or Toxic Items: Properly labeled
Inspector Comments: Two chemical spray bottles stored to the left of the 3 compartment sink were not labeled. Complied on: 10/30/2013
09b – Non-Critical
Food Labeling, Food Protection: Food protected from contamination
Inspector Comments: Raw chicken was stored uncovered and on the floor of the walk-in refrigerator. Cups containing ice and lemon were stored uncovered next to the microwave behind the cold top refrigerator. Cut jalapenos, bean sprouts, and basil were stored uncovered on top of the chest freezer.
10a – Non-Critical
Equipment Design, Construction: Food-contact surfaces
Inspector Comments: The cutting boards on the preparation table and on the bubble tea station were deeply grooved. A residential crock-pot was being used to hot hold peanut sauce.
10b – Non-Critical
Equipment Design, Construction: Nonfood-contact surfaces
Inspector Comments: The lid gaskets on the chest freezer were torn. The gaskets of the reach-in refrigerator on the cook line were torn.
10c – Non-Critical
Equipment Design, Construction: Dishwashing facilities
Inspector Comments: The three compartment sink was not sealed to the wall.
12a – Non-Critical
Cleaning Of Equipment & Utensils: Food-contact surfaces
Inspector Comments: The following equipment were soiled with food debris: the shelves of the reach in refrigerators on the cook line, the shelves of the standing freezers in the back room, the inside surfaces of the chest freezer, and the shelves of the standing refrigerator in the back room, and the shelves and walls of the walk-in refrigerator. The inside surface of the microwave was soiled with food debris.
12b – Non-Critical
Cleaning Of Equipment & Utensils: Nonfood-contact surfaces
Inspector Comments: The fans in the walk-in refrigerator were soiled with dust. The drying rack above the three compartment sink was soiled with food debris. The ventilation hoods over the fryer were soiled with grease.
12c – Non-Critical
Cleaning Of Equipment & Utensils: Dishwashing operations
Inspector Comments: Clean dishes on the drying rack were stacked while still wet.
13a – Non-Critical
Utensils, Single-Service Articles: Utensils provided, used, stored
Inspector Comments: The clean silverware was stored handle-down at the wait station.
14c – Non-Critical
Physical Facilities: Floors, walls, and ceilings
Inspector Comments: The ceiling vents in the kitchen were soiled with dirt and dust.

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.

What to Know in a Campylobacter Outbreak

What is Campylobacter bacteria?

Campylobacter (camp-UH-low-back-ter) is a genus of bacteria that is among the most common causes of bacterial infections in humans worldwide. [1, 5, 6] The name means “curved rod,” deriving from the Greek campylos (curved) and baktron (rod). [5, 22] It has been noted that there “is wide diversity in the genus. The species are metabolically and genetically different to the extent that one can question whether one genus is adequate to house all of the species.” [22]

Of its many species, Campylobacter jejuni (juh-JUNE-eye) is considered one of the most important from both a microbiological and public health perspective. The history of this species of bacteria has been summarized as follows:

Awareness of the public health implications of Campylobacter infections has evolved over more than a century. In 1886, Escherich observed organisms resembling campylobacters in stool samples of children with diarrhea. In 1913, McFaydean and Stockman identified campylobacters (called related Vibrio) in fetal tissues of aborted sheep. In 1957, King described the isolation of related Vibrio from blood samples of children with diarrhea, and in 1972, clinical microbiologists in Belgium first isolated campylobacters from stool samples of patients with diarrhea. The development of selective growth media in the 1970s permitted more laboratories to test stool specimens for Campylobacter. Soon Campylobacter [species] were established as common human pathogens. [1]

Campylobacter jejuni is a gram-negative, microaerophilic, thermophilic rod that grows best at 42°C (107°F) and low oxygen concentrations. [5, 22] These characteristics are adaptations for growth in its normal habitat—the intestines of warm-blooded birds and mammals. [1, 5] Several closely related species with similar characteristics, C. coli, C. fetus, and C. upsalienis, may also cause disease in humans, but are responsible for less than 1% of human infections annually. [1, 5, 12] “Campylobacters multiply more slowly than do the usual bacteria of the enteric flora and therefore cannot be isolated from fecal specimens unless selective techniques are used.” [5] Campylobacter is the most commonly isolated bacterial pathogen from persons suffering diarrheal illnesses, and C. jejuni is the most commonly isolated of the species. [28]

The Incidence of Campylobacter Infections

From the time of its initial discovery, through the ensuing period of investigation and study, Campylobacter jejuni has come to be understood as one of the leading causes of bacterial gastroenteritis. [1, 5, 7] In the United States, these bacteria are the most common cause of bacterial foodborne illness, ahead of Salmonella—the second most common cause. [1, 10, 25] According to the CDC, based on data collected through its Foodborne Disease Active Surveillance Network (or FoodNet),

Campylobacter is one of the most common causes of diarrheal illness in the United States. The vast majority of cases occur as isolated, sporadic events, not as part of recognized outbreaks. Active surveillance through FoodNet indicates that about 13 cases are diagnosed each year for each 100,000 persons in the population. Many more cases go undiagnosed or unreported, and campylo-bacteriosis is estimated to affect over 2.4 million persons every year, or 0.8% of the population. [12]

In 2006, 5,712 confirmed cases of Campylobacter infection were reported to the CDC through FoodNet. [10] Three years later, in 2009, there were 6,033 confirmed cases of Campylobacter infections, which represented an incidence rate of 13.02 cases for every 100,000 persons in the United States. [11] The 2009 numbers represented a reported 30% decrease in the number of infections compared to the 1996—1998 rates of infection. Although the nature and degree of underreporting is subject to dispute, all agree that the confirmed cases represent just the tip of the iceberg. Indeed, one study estimates the annual incidence rate for Campylobacter to be around 1,000 cases per 100,000 persons. [6] As early as 1990, it was noted that annual reports to the CDC of Campylobacter infections was as high as 10,000 lab-confirmed cases. [15] 

The Prevalence of Campylobacter in Food and Elsewhere

Although most cases of Campylobacter infection in humans are sporadic, a substantial number of outbreaks—30 outbreaks by one report, and 50 by another—have been linked to the consumption of unpasteurized (raw) milk. [1, 5] Since 1992, food remains the most common vehicle for the spread of Campylobacter, and chicken is the most common food implicated. [5, 25, 28] As one authority points out, “commercially raised poultry is nearly always colonized with C. jejuni, slaughterhouse procedures amplify contamination, and chicken and turkey in supermarkets, ready for consumers to take home, frequently is contaminated.” [5] Similarly, prominent USDA researchers have noted:

Most retail chicken is contaminated with C. jejuni; one study reported an isolation rate of 98% for retail chicken meat. C. jejuni counts often exceed 103 per 100 g. Skin and giblets have particularly high levels of contamination. In one study, 12% of raw milk samples from dairy farms in eastern Tennessee were contaminated with C. jejuni. Raw milk is presumed to be contaminated by bovine feces; however, direct contamination of milk as a consequence of mastitis also occurs. Campylobacters are also found in red meat. In one study, C. jejuni was present in 5% of raw ground beef and in 40% of veal specimens. [1]

Since 1998, the publisher of Consumer Reports magazine has conducted surveys and tested chicken at retail for Salmonella and Campylobacter. While the first study identified Campylobacter in 63% of more than 1000 chickens obtained in grocery stores, a 2009 study found only a 1% improvement, with 62% of the 382 chickens tested positive for Campylobacter. [14] A USDA Baseline Data Collection Program done in 1994 documented Campylobacter contamination on 88.2% of broiler-chicken carcasses [30]. Subsequent USDA data collection has shown an estimated 46.7% prevalence of Campylobacter in chicken [31], and 1.46% in turkeys. [32] Campylobacter is also prevalent in wild birds of all kinds. [1, 5]

As already noted, contamination occurs during slaughter and processing when meat comes into contact with animal feces. Consequently,

Slaughter and processing provide opportunities for reducing C. jejuni counts on food-animal carcasses. Bacterial counts on carcasses can increase during slaughter and processing steps. In one study, up to a 1,000-fold increase in bacterial counts on carcasses was reported during transportation to slaughter. In studies of chickens and turkeys at slaughter, bacterial counts increased by approximately 10- to 100-fold during defeathering and reached the highest level after evisceration. However, bacterial counts on carcasses decline during other slaughter and processing steps. In one study, forced-air chilling of swine carcasses caused a 100-fold reduction in carcass contamination. In Texas turkey plants, scalding reduced carcass counts to near or below detectable levels. Adding sodium chloride or trisodium phosphate to the chiller water in the presence of an electrical current reduced C. jejuni contamination of chiller water by 2 log10 units. In a slaughter plant in England, use of chlorinated sprays and maintenance of clean working surfaces resulted in a 10- to 100-fold decrease in carcass contamination. In another study, lactic acid spraying of swine carcasses reduced counts by at least 50% to often undetectable levels. A radiation dose of 2.5 KGy reduced C. jejuni levels on retail poultry by 10 log10 units. [1]

Further, with poultry, contamination levels peak during the summer months [1, 5, 28], and this seasonal pattern is reflected in the number of reported Campylobacter infections. [5, 28]

Transmission of and Infection with Campylobacter

Most Campylobacter infections in humans are caused by the consumption of contaminated food or water. [5]  Direct contact with infected animals, including pets, is also a well-documented means of disease-transmission. [1, 6] Although not common, person-to-person transmission can also occur. [5, 6] Males and females appear to be equally affected, although the prevalence of infection in otherwise healthy people is quite low. [5] Population-based studies show that the peak incidence of infection is in children one year of age and under, and in persons between 15 and 29 years of age. [26] Incidence of Campylobacter infection in HIV-positive individuals is higher than in the general population. [1, 5]

The infective dose—that is, the amount of bacteria that must be ingested to cause illness—is relatively small. [5, 28]  Ingestion of as few as 500 organisms, an amount that can be found in one drop of chicken juice, has been shown to cause human infection. [5, 12, 28]  Despite this low infectious dose, and the ubiquity of Campylobacter in the environment, most cases of Campylobacter infection occur as isolated, sporadic events, and are not usually part of large outbreaks. [1, 26] But, very large outbreaks (greater than 1,000 illnesses) have been documented, most often from consumption of contaminated milk or unchlorinated water supplies. [1, 5, 6, 28]

Symptoms of Campylobacter infection

Not all Campylobacter infections cause the infected person to fall ill or develop symptoms. [5] The lack of symptoms can be the result of two things—the relative susceptibility (or immunity) of the person infected, and the dose of organisms that reach the small intestines. [5, 28] When a person is infected and develops symptoms, the illness is called campylobacteriosis. [12, 28]

The amount of time from infection to the onset of symptoms—typically referred to as the incubation period—can vary to a significant degree.  According to one authoritative text, “the incubation period varies from 1 to 7 days, a characteristic that is probably inversely related to the dose ingested.” [5]  Others note that the “incubation period is 1 to 10 days, with most cases occurring 3 to 5 days after exposure.” [28] Most agree, however, that incubation periods of greater than 7 days are not uncommon. [1, 5, 6, 26, 28]

Diarrhea is the most consistent and prominent manifestation of campylobacteriosis, and is often bloody. [1, 6, 9] As one article summarizes,

Campylobacteriosis symptoms can range from diarrhea and lethargy that lasts a day to severe diarrhea and abdominal pain (and occasionally fever) that lasts for several weeks.  Diarrhea and abdominal pain are the most common symptoms and the vast majority of cases are mild.  [Two researchers] report that abdominal pain from campylobacteriosis can be so strong that it has been misdiagnosed as originating from appendicitis and has led to unnecessary appendectomy… [28]

Although most cases of campylobacteriosis are self-limiting, up to 20% have a prolonged illness (longer than 1 week) or a relapse [5], and 2% to 10% may be followed by chronic sequelae. [6, 15] Other typical symptoms of C. jejuni infection include fever, nausea, vomiting, abdominal pain, headache, and muscle pain. [1, 15] Such infections can also be severe and life-threatening. [5, 6]  Death is more common when other diseases (e.g., cancer, liver disease, and immuno-deficiency diseases) are present. [1, 5, 28] One often-cited study estimates that 200 to 730 persons dies as a result of Campylobacter infections each year. [8, 26]

The illness usually lasts no more than one week; however, severe cases may persist for up to three weeks, and roughly 25% of individuals experience symptom relapse. [5, 15, 28] In most cases, the worst of the illness, which is to say the most intense and painful of the symptoms, lasts 24-48 hours, before then taking a week to fully resolve. [6]

Complications of Campylobacter infection

For those persons who suffer a Campylobacter infection that does not resolve on its own, the complications (or sequelae) can be many. [5] The complications can include septicemia (bacterial pathogens in the blood, also known as bacteremia), meningitis, inflammation of the gall bladder (cholecystitis), urinary tract infections, and appendicitis. [1, 6, 28].

Guillain-Barré Syndrome (GBS)

“Each year, there are an estimated 2,628 to 9,575 people who develop GBS in the United States.” [8] A sizeable percentage of persons who suffer Campylobacter infections develop GBS. [1, 8, 28]  Since the vaccination programs have eliminated polio in the United States, GBS is the leading cause of acute neuromuscular paralysis. [8] Over time, the paralysis is to some extent typically reversible; nonetheless, approximately 20% of patients with GBS are left disabled, and approximately 5% die. [1, 28]

An estimated one case of GBS occurs for every 1,000 Campylobacter infections. [1] Along these same lines, researchers estimate that between 20% and 40% of all GBS cases are caused by Campylobacter infections. [28] Indeed, up to 40% of GBS patients have evidence of recent Campylobacter infection. [1, 23] “Assuming that 20 to 40 percent of all patients with GBS have prior Campylobacter infections, there are an estimated 526 to 3, 830 new patients diagnosed with Campylobacter-associated GBS each year in the United States.” [8]

GBS occurs when an infected person’s immune system makes antibodies against components of Campylobacter, and these antibodies attack components of the body’s nerve cells because they are chemically similar to bacterial components. [1, 2, 8] Miller Fisher Syndrome is another, related neurological syndrome that can follow campylobacteriosis, and is also caused by a triggered immune-response. [2] Overall, there is no one factor that appears to cause a greater percentage of GBS cases other than Campylobacter infections. [8]

The annual cost of Campylobacter-associated GBS in the United States is estimated to be between $0.2 to $1.8 billion (in 1995 dollars). [8]

Reactive Arthritis

Another chronic condition that may be associated with Campylobacter infection is a condition formerly known as Reiter’s syndrome, a form of reactive arthritis. [1, 6, 28] “Multiple joints can be affected, particularly the knee joint. Pain and incapacitation can last for months or become chronic.” [1] Reactive Arthritis is a complication that is strongly associated with a particular genetic make-up—that is, persons who have the human lymphocyte antigen B27 (HLA-B27) are most susceptible. [1, 5] Most often, the symptoms of reactive arthritis can occur up to several weeks after infections. [5]

Diagnosis of a Campylobacter Infection

Diagnosis of infection is usually based on the isolation of Campylobacter jejuni from a stool culture. [1, 7] A diagnosis can also be established by the direct examination of a stool sample using contrast microscopy or Gram’s strain. [5, 6] This direct examination provides for a rapid presumptive diagnosis that must still be confirmed by stool culture. [5]

Stool samples should be chilled, but not frozen, for transportation to the testing-lab. [1] Labs now routinely perform culture-procedures on stool specimens that are specifically designed to promote the growth and identification of Campylobacter jejuni and the other species of Campylobacter. [1, 11, 12] Only a small percentage of persons suffering from Campylobacter infections both present for medical care and have their infections culture-confirmed. [5, 12, 26] In the study of one Campylobacter outbreak, only 5.4% of the outbreak cases visited a physician. [28] It is estimated that 12,700 to 13,230 cases are hospitalized each year. [26, 28]

Many persons submit samples for culturing after they have started antibiotics, which may make it even more difficult for a lab to grow Campylobacter.  [5] Blood cultures are often not performed and in most cases the blood stream is not infected. [1, 5]

Treatment of a Campylobacter Infection

Patients with Campylobacter infection should drink plenty of fluids as long as the diarrhea lasts in order to maintain hydration. [5] Dehydration is a common consequence of the diarrhea that infection causes, and, when severe, requires the administration of intravenous fluids. [5] For those not severely dehydrated, taking fluids by mouth works well, especially fluids that contain glucose and electrolytes—e.g., Gatorade or Pedialyte. [5, 12]

Campylobacteriosis is usually a self-limited illness, with fewer than half of patients seen for medical care being good candidates for treatment with antibiotics. [5] But for those patients with a high fever, bloody diarrhea, or stools more frequent than eight times per day, antibiotic-treatment is deemed a “prudent course.” [5] When indicated, such treatment with antibiotics can reduce the average duration of the illness from ten to five days. [1]

In more severe cases of gastroenteritis, antibiotics are often begun before culture results are known.  Macrolide antibiotics (erythromycin, clarithromycin, or azithromycin) are the most effective agents for Campylobacter jejuni.  [5, 6] Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin) can also be used, but resistance to this class has been rising, at least in part due to the use of this class of antimicrobial in poultry feed. [1, 25]

Antimicrobial Resistance in Bacteria 

Antimicrobial resistance in bacteria is an emerging and increasing threat to human health. [1, 4] Physicians are increasingly aware that antimicrobial resistance is increasing in foodborne pathogens and that, as a result, patients who are prescribed antibiotics are at increased risk for acquiring antimicrobial-resistant foodborne infections. [1] Indeed, “increased frequency of treatment failures for acute illness and increased severity of infection may be manifested by prolonged duration of illness, increased frequency of bloodstream infections, increased hospitalization or increased mortality.” [3]

The use of antimicrobial agents in the feed of food animals is estimated by the FDA to be over 100 million pounds per year. [4] Estimates range from 36%  to 70% of all antibiotics produced in the United States are used in a food animal feed or in prophylactic treatment to prevent animal disease. [3, 4, 18] In 2002, the Minnesota Medical Association published an article by David Wallinga, M.D., M.P.H. who wrote:

According to the [Union of Concerned Scientists], 70 percent of all the antimicrobials used in the United States for all purposes—or about 24.6 million pounds annually—are fed to poultry, swine, and beef cattle for nontherapeutic purposes, in the absence of disease. Over half are “medically important” antimicrobials; identical or so closely related to human medicines that resistance to the animal drug can confer resistance to the similar human drug. Penicillin, tetracycline, macrolides, streptogramins, and sulfonamides are prominent examples. [33]

Moreover, the National Antimicrobial Resistance Monitoring System (NARMS) has reported that Campylobacter has been recovered from 47% of chicken breasts tested in recent studies. [34] According to the report of findings,

Antimicrobial resistance among these foodborne bacteria is not uncommon and often associated with the use of antimicrobial agents in food animals.  Retail food represents a point of exposure close to the consumer, and when combined with data from slaughter plants and on-farm studies, may provide an indication of the prevalence of resistance in foodborne pathogens. [34].

By way of further example, especially given that Salmonella is so often found co-present with Campylobacter in raw poultry, Ceftriaxone-resistant Salmonella has also been reported. [18] As such, the emergence of multidrug-resistant Salmonella Typhimurium in the United States is another example of a drug-resistant bacteria spreading from animals to humans. [19]

The use of antibiotics in feed for food animals, on animals prophylactically to prevent disease, and the use of antibiotics in humans unnecessarily must be reduced. [1, 25] European countries have reduced the use of antibiotics in animal feed and have seen a corresponding reduction in antibiotic-resistant illnesses in humans. [1, 4]

The Economic Impact of Campylobacter Infections

The USDA Economic Research Service (ERS) published its first comprehensive cost estimates for sixteen foodborne bacterial pathogens in 1989. [24]  Five years later, it was estimated that the medical costs and productivity losses that Campylobacter infections caused each year ran from $907 million to over $1 billion, based on an estimate of 2.1 million cases and between 120-360 deaths. [15] Using a different kind of economic analysis, this same 1996 study estimated that the average cost of each Campylobacter infection to be $920, with this estimate based on a much lower incidence and death rate. [15]

In 1996, ERS updated the cost-estimates for six bacterial pathogens, including Campylobacter. [28] ERS continued to use cost-of-illness (COI) methodology for nonfatal illnesses, but adopted two different health valuation methodologies for premature deaths: the individualized human capital approach and the willingness-to-pay (WTP) approach. This report concluded as follows:

We assumed that 55-70 percent of all estimated human illness cases of Campylobacter in the United States are foodborne (1,375,000 to 1,750,000 cases).  Estimates of those who do not visit a physician range from 1,293,765 to 1,646,239 cases annually.  A low of 74,250 and a high of 94,500 visit a physician. The number of hospitalized cases (including those who died) ranges from 6,985 to 9,261. Foodborne deaths caused by Campylobacter range from 110 to 511 annually. Given our assumption that 55-70 percent of all U.S. campylobacteriosis cases are attributed to food, estimated costs of foodborne campylobacteriosis range from $0.6-$1.0 billion annually.

ERS updated the cost-estimates for four pathogens (Campylobacter, Salmonella, E. coli O157:H7, and Listeria monocytogenes) again in 2000. The 2000 estimates were based on newly released estimates of annual foodborne illnesses by the CDC, and put the total cost in the United States for these four pathogens at $6.5 billion a year. More recently, in 2007, it was estimated that the annual costs of all foodborne disease in the United States was $1.4 trillion. [8]

Real Life Impacts of Campylobacter Infection

Because the illnesses caused by the ingestion of Campylobacter bacteria range from mild to severe, the real life impacts of Campylobacter infection vary from person to person.

While anyone can become ill with Campylobacter infection, very young children, the elderly, and persons with compromised immune systems are most likely to develop severe illness.

  • An estimated 1 in 1,000 patients with Campylobacter infection develop a rare disease called Guillain-Barre syndrome, or GBS. GBS typically sets in several weeks after acute Campylobacter  During GBS, a person’s immune system attacks the body’s nerves, resulting in paralysis that can last for several weeks or years.  According to the CDC, as many as 40% of Guillain-Barre syndrome cases in the U.S. may be triggered by Campylobacter infection.[12]
  • An unknown percentage of patients with Campylobacter infections develop reactive arthritis.

How can I prevent the spread of Campylobacter food poisoning?

Campylobacter jejuni grows poorly on properly refrigerated foods, but does survive refrigeration and will grow if contaminated foods are left out at room temperature. [1, 7] The bacterium is sensitive to heat and other common disinfection procedures; pasteurization of milk, adequate cooking of meat and poultry, and chlorination or ozonation of water will destroy this organism. [1, 5, 12] Infection control measures at all stages of food processing may help to decrease the incidence of Campylobacter infections, but the single most important and reliable step is to adequately cook all poultry products. [17, 27]

The most reliable method to ensure this is to use a digital food thermometer. [17] Document that the thickest part of the chicken, turkey, duck or goose (the center of the breast) reaches 180°F or higher, as recommended by the U.S. Food and Drug Administration. [14, 17] The FDA and its Model Food Code recommends at least 165°F for stuffing, 170°F for ground poultry products, and that thighs and wings be cooked until juices run clear. [17, 27]

Most cases of campylobacteriosis are sporadic or involve small family groups, although some common-source outbreaks involving many people have been traced to contaminated water or milk. [1,5, 26] Other sources of Campylobacter include children prior to toilet training, especially in childcare settings [20], and intimate contact with other infected individuals. [5]  C. jejuni is commonly present in the gastrointestinal tract of healthy cattle, pigs, chickens, turkeys, ducks, and geese, and direct animal exposure can lead to infection. [1] Pets that may carry Campylobacter include birds, cats, dogs, hamsters, and turtles. [1, 5, 16] The organism is also occasionally isolated from streams, lakes and ponds. [1]

There are a large number of control measures of import that are available to consumers and foodservice personnel to prevent the transmission of Campylobacter. [17, 21, 27] These control measures include the following:

  • Choose the coolest part of the vehicle (generally the trunk in winter and cab in summer) to transport meat and poultry home from the market.
  • Defrost meat and poultry in the refrigerator. Place the item on a low shelf, on a wide pan, lined with paper towel; ensure that drippings do not land on foods below. If there is not enough time to defrost in the refrigerator, then use the microwave.
  • Do not cook stuffing actually inside the bird.
  • Rapidly cool leftovers.
  • Never leave food out at room temperature (either during preparation or after cooking) for more than 2 hours.
  • Avoid raw milk and products made from raw milk. Drink only pasteurized milk products.
  • Wash hands thoroughly using soap and water, concentrate on fingertips and nail creases, and dry completely with a disposable paper towel at the following times:
    • after contact with pets, especially puppies, or farm animals. [16]
    • before and after preparing food, especially poultry.
    • after changing diapers or having contact with an individual with an intestinal infection.
    • children on arrival home from school or day-care.
  • Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.
  • Use pasteurized eggs.

References (more…)

Clif Bars Urged Destroyed Over Listeria Fears

lineupClif Bar & Company is initiating a voluntary recall of CLIF BAR® Nuts & Seeds energy bars, CLIF BAR® Sierra Trail Mix energy bars, and CLIF® Mojo® Mountain Mix® trail mix bars, sold nationally, after its ingredient supplier, SunOpta, was found to have distributed sunflower kernels that may be contaminated with Listeria monocytogenes (L.mono).

Clif Bar has not received any reports of illness; however, the company is initiating the voluntary recall in an abundance of caution.

Only the flavors meeting the following criteria are affected by the recall:

  • CLIF BAR® Nuts & Seeds energy bar all pack configurations with “best by” date ranges starting 08JUN16 through 21JAN17
  • CLIF BAR® Sierra Trail Mix energy bar all pack configurations with “best by” date ranges starting 05JUN16 through 24MAR17
  • CLIF® Mojo® Mountain Mix® trail mix bar all pack configurations with “best by” date ranges starting 16JUN16 through 02FEB17

Pictures of the products listed above will be available here.

Listeria monocytogenes is an organism, which can cause serious and sometimes fatal infections in pregnant women, 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 monocytogenes infection can cause miscarriages and stillbirths among pregnant women.

People who have purchased any of the above products are urged not to consume the products and to destroy it.

Alabama, Arkansas, Arizona, California, Colorado, Iowa, Illinois, Massachusetts, Maryland, Michigan, Minnesota, Missouri, Montana, New York, Oklahoma, Pennsylvania, Texas, Virginia, Washington and Wisconsin Tied to Flour E. coli Outbreak

The CDC reports that thirty-eight people infected with the outbreak strain of STEC O121 have been reported from 20 states – Alabama 1, Arkansas 1, Arizona 2, California 1, Colorado 4, Iowa 1, Illinois 4, Massachusetts 2, Maryland 1, Michigan 4, Minnesota 3, Missouri 1, Montana 1, New York 1, Oklahoma 2, Pennsylvania 2, Texas 2, Virginia 2, Washington 2 and Wisconsin 1.  Illnesses started on dates ranging from December 21, 2015 to May 3, 2016. Ill people range in age from 1 year to 95, with a median age of 18. Seventy-eight percent of ill people are female. Ten ill people have been hospitalized.

large-map-6-2-2016

WGS showed that isolates from ill people are closely related genetically. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Collaborative investigative efforts of state, local, and federal health and regulatory officials indicate that flour produced at General Mills’ Kansas City, Missouri facility is a likely source of this outbreak. This investigation is ongoing.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Sixteen (76%) of 21 people reported that they or someone in their household used flour in the week before they became ill. Nine (41%) of 22 people reported eating or tasting raw homemade dough or batter. Twelve (55%) of 22 people reported using Gold Medal brand flour. Three ill people reported eating or playing with raw dough at restaurants.

These investigations indicated that the flour used by ill people or used in restaurant locations was produced in the same week in November 2015 at the General Mills facility in Kansas City, Missouri. General Mills produces Gold Medal brand flour. On May 31, 2016, General Mills recalled several sizes and varieties of Gold Medal Flour, Gold Medal Wondra Flour, and Signature Kitchens Flour due to possible E. coli contamination. The recalled flours were produced in the Kansas City facility during a time frame identified by traceback and sold nationwide. CDC recommends that consumers, restaurants, and retailers do not use, serve, or sell the recalled flours.

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.

38 people sickened by E. coli in 20 state General Mills flour outbreak

recalled-General-Mills-flour-406x250Food Safety News reports that General Mills Inc. has initiated a nationwide recall of three brands of flour, totaling about 10 million pounds, in response to a 20-state E. coli outbreak that has sickened 38 people.

Although government officials have reportedly been investigating the outbreak, no state or federal agencies had released any information about it at the point Tuesday when the Minneapolis-based company announced the recall.

“State and federal authorities have been researching 38 occurrences of illnesses across 20 states related to a specific type of E. coli O121, between Dec.21, 2015, and May 3, 2016,” according to a news release from General Mills.

“While attempting to track the cause of the illness, CDC (Centers for Disease Control and Prevention) found that approximately half of the individuals reported making something homemade with flour at some point prior to becoming ill. Some reported using a General Mills brand of flour.”

The recall includes six SKUs (stock keeping units or UPC codes) of Gold Medal branded flour, two SKU’s of Signature Kitchens branded flour and one SKU of Gold Medal Wondra branded flour.

Retailers that received shipments of the recalled flour include Safeway, Albertsons, Jewel, Shaws, Vons, United, Randalls, and Acme.

“To date, E. coli O121 has not been found in any General Mills flour products or in the flour manufacturing facility, and the company has not been contacted directly by any consumer reporting confirmed illnesses related to these products,” according to the news release.

“As a leading provider of flour for 150 years, we felt it was important to not only recall the product and replace it for consumers if there was any doubt, but also to take this opportunity to remind our consumers how to safely handle flour,” Liz Nordlie, president of General Mills Baking division, said in the release.

Some of the outbreak victims may have eaten raw dough or batter. Nordlie said in the news release and a separate blog posting that no one, especially young children, should ever eat raw dough or batter because of potential pathogens.

“Consumers are reminded to not consume any raw products made with flour. Flour is an ingredient that comes from milling wheat, something grown outdoors that carries with it risks of bacteria which are rendered harmless by baking, frying or boiling,” according to the news release.

“Consumers are reminded to wash their hands, work surfaces, and utensils thoroughly after contact with raw dough products or flour, and to never eat raw dough or batter.”

The recalled flour can be identified by the following label information:

  • 13.5-ounce Gold Medal Wondra — Package UPC 000-16000-18980; Better if Used by Dates 25FEB2017 thru 30MAR2017
  • 2-pound Gold Medal All Purpose Flour — Package UPC 000-16000-10710; Better if Used by Dates 25MAY2017KC thru 03JUN2017K
  • 5-pound Gold Medal All Purpose Flour — Package UPC 000-16000-10610; Better if Used by Dates 25MAY2017KC, 27MAY2017KC thru 31MAY2017KC, 01JUN2017KC, 03JUN2017KC thru 05JUN2017KC, 11JUN2017KC thru 14JUN2017KC
  • 10-pound Gold Medal All Purpose Flour — Package UPC 000-16000-10410; Better if Used by Dates 02JUN2017KC,03JUN2017KC
  • 10-pound Gold Medal All Purpose Flour Banded Pack — Package UPC 000-16000-10410; Better if Used by Dates 03JUN2017KC, 04JUN2017KC, 05JUN2017KC
  • 5-pound Gold Medal Unbleached Flour — Package UPC 000-16000-19610; Better if Used by Dates 25MAY2017KC, 27MAY2017KC, 03JUN2017KC, 04JUN2017KC
  • 5-pound Signature Kitchens All Purpose Flour Enriched Bleached — Package UPC 000-21130-53001; Better if Used by Dates BB MAY 28 2017
  • 5-pound Signature Kitchens Unbleached Flour All Purpose Enriched —Package UPC 000-21130-53022; Better if Used by Dates BB MAY 27 2017
  • 2-pound Gold Medal Self Rising Flour — Package UPC 000-16000-11710; Better if Used by Dates 23AUG2016KC

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.

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.

THE 2016 ORGANIC PASTURES RAW MILK E. COLI O157:H7 OUTBREAK

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.

PAST OUTBREAKS LINKED TO ORGANIC PASTURES RAW MILK

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.

References

Advisory Committee on Immunization Practices (ACIP), Fiore AE, Wasley A, Bell BP. (2006). Prevention of hepatitis A through active or passive immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep.55(RR-7):1-23.

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.

Butot S, Putallaz T, Sánchez G. (2008). Effects of sanitation, freezing and frozen storage on enteric viruses in berries and herbs. Int J Food Microbiol. 126(1-2):30-35.

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.

Centers for Disease Control and Prevention (2009a). Disease Burden from Viral Hepatitis A, B, and C in the United States. Available at http://www.cdc.gov/hepatitis/PDFs/disease_burden.pdf).

Centers for Disease Control and Prevention (2009b). Surveillance for Acute Viral Hepatitis—- United States, 2007. Surveillance Summaries. 58 (SS03):1-27.

Centers for Disease Control and Prevention (2009c). Hepatitis A. In: Epidemiology and Prevention of Vaccine-Preventable Diseases. Atkinson W, Wolfe S, Hamborsky J, McIntyre L, eds. 11th ed. Washington DC: Public Health Foundation, pp. 85-97.

Centers for Disease Control and Prevention (2009d). Updated recommendations from the Advisory Committee on Immunization Practices (ACIP) for use of hepatitis A vaccine in close contacts of newly arriving international adoptees. Centers for Disease Control and Prevention (CDC); Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 58(36):1006-7.

CDC (2007). Update: Prevention of Hepatitis A after Exposure to Hepatitis A Virus and in International Travelers. Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 56(41);1080-1084.

Detry O, De Roover A, Honore P, Meurisse M. (2006). Brain edema and intracranial hypertension in fulminant hepatic failure: pathophysiology and management. World J Gastroenterol. 12: 7405-7412.

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.

Fiore, AE. ( 2004). “Hepatitis A Transmitted by Food.” Clinical Infectious Diseases. 38:705-715.

Gilkson M, Galun E, Oren R, Tur-Kaspa R, Shouval D. (1992). Relapsing hepatitis A. Review of 14 cases and literature survey. Medicine. 71:14-23.

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

Jaykus L. (1997). Epidemiology and Detection as Options for Control of Viral and Parasitic Foodborne Disease. Emerg Infect Dis. 3(4):529-539.

Mayo Clinic. (2009). Hepatitis A. Available at http://www.mayoclinic.com/health/hepatitis-a/DS00397.

Piazza M, Safary A, et al. (1999). Safety and immunogenicity of hepatitis A vaccine in infants: a candidate for inclusion in the childhood vaccination program. Vaccine. 17:585-588.

Rawls RA and Vega KJ (2005). Viral Hepatitis in Minority America. J Clin Gastroenterol. 39:144–151.

Sagliocca L, Amoroso P, et al. (1999). Efficacy of hepatitis A vaccine in prevention of secondary hepatitis A infection: A randomized trial. Lancet. 353:1136-39.

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

Schiff ER. (1992). Atypical Manifestations of hepatitis-A. Vaccine. 10(Suppl. Vol. 1): 18-20.

Taylor R, Davern T, Munoz S, Han S-H, McGuire B, Larson AM, et al. (2006). Fulminant hepatitis A virus infection in the United States: incidence, prognosis, and outcomes. Hepatology. 44:1589-1597.

Todd EC, Greig JD, Bartleson CA, Michaels BS. (2009). 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. J Food Prot. 72(1):202-219.

Wheeler C, Vogt TM, Armstrong GL, et al. (2005). An Outbreak of Hepatitis A Associated with Green Onions. N Engl J Med. 353: 890-897.

Willner IR, Uhl MD, Howard SC, Williams EQ, Riely CA, Waters B. (1998). Serious hepatitis A: an analysis of patients hospitalized during an urban epidemic in the United States. Ann Intern Med. 128:111-114.

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.”