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Lucky Peach – Marler Profile – Attorney, Lawyer, Food Safety Advocate

marlerAttorney Bill Marler has won more than $600 million for clients since he and his partners formed Marler Clark in 1998. Marler rose to fame—or notoriety, if you’re a food producer—in 1993, when he successfully litigated a series of suits against Jack in the Box on behalf of children who contracted E. coli from eating the fast food joint’s tainted beef. Undercooked hamburger patties contaminated with E. coli 0157:H7 (“the nasty form,” Marler points out) sickened more than seven hundred people in five states, killing four people and hospitalizing hundreds—mostly kids. Investigations revealed that Foodmaker, Inc., Jack in the Box’s parent company, had been warned about undercooking patties by health departments, but decided to continue the two-minute cook time for business reasons, and to maintain a better texture. Marler resolved cases for more than one hundred victims.

Bill Marler isn’t a lawyer with a focus on foodborne illnesses: he is the foodborne-illness lawyer. Marler Clark owns twenty-eight different websites, from Food Safety News to Listeria Blog. In a 2011 case involving Listeria in cantaloupe, Marler represented fifty of the sixty-six claimants. In a 2006 spinach-based E. coli outbreak, he represented 104 of 105. There are other lawyers out there who take on similar cases but, according to Marler, “there aren’t four lawyers in the world that have as much experience” in the field as the core attorneys of Marler Clark. “Twenty-two years into this,” Marler says, “I’ve taken tens of thousands of cases. Some outbreaks might have a hundred people, or some twenty. I can say I’ve been involved in every major foodborne-illness outbreak that’s occurred in the U.S. since 1993.”

See full article By Naomi Tomky March 24, 2015 with Illustration by Celeste Byers

Future Food 2050 – Chat with Food Safety Lawyer William Marler

The ‘simple’ solution to safer food – Making the food system less complex could be key to cutting down on food contamination, says veteran food safety attorney William Marler.

CYNTHIA GRABER: This is Cynthia Graber reporting for FutureFood 2050. Food safety in the U.S. is still a huge issue today. According to the Centers for Disease Control [and Prevention (CDC)], 48 million Americans a year are sickened by foodborne illnesses, which leads to 128,000 hospitalizations and 3,000 deaths. In addition to the loss of life, the government estimates the cost from such illnesses in the billions of dollars in terms of lost wages and productivity and medical expenses.

William Marler is a well-known lawyer whose practice, Marler Clark, is called The Food Safety Law Firm. He’s won a number of key lawsuits that have advanced food policy in the U.S. In one of his most famous, he won a landmark case for victims of E. coli contamination from hamburgers purchased at Jack in the Box restaurants in 1993. I asked him about the current state of food safety.

If I got to be the guy with the magic wand, I would do exactly with salmonella what the government did with E. coli 20 years ago, and I would say that you can’t have salmonella in chicken. And industry would adjust.”

—William Marler

WILLIAM MARLER: There’s a lot of things going on sort of simultaneously. I mean, you know, these bugs are constantly evolving. They’re dealing with more virulence than we’ve seen—you know, especially in bugs like antibiotic-resistant salmonellas and Listeria. These are kind of bugs that we didn’t see 30 years ago, so you have to really look a lot at how food is produced and then balance that against, you know, a growing world population. And it does make it very complex. And then when you add on to that 25, 30 years ago, you know, you couldn’t get bananas certain times of the year. Now you get them whenever you want them. And so food’s coming in from all over the world. So, I mean, it’s a global food economy. It’s difficult to control, and human beings are not necessarily the best at dealing with very, very complex problems. And the food system has become incredibly complex.

GRABER: So what do you think some of the biggest holes in the system are, both here and overseas?

MARLER: I think we really have to ask ourselves about how complex do we really need to make food. Do we really have to have bagged salad 12 months of the year? I mean, you look at the outbreaks that have occurred—the large outbreaks. They’re usually in highly processed products that are shipped long distances. So when you’re trying to figure out ways to make your food supply safer, sometimes simpler is better. Now that doesn’t necessarily mean that local organic grown products are not going to sicken you if that local farmer is not using good manufacturing processes. But the more a product is manufactured, remanufactured, shipped, and you having cold-chain issues and keeping things hot or keeping things cold, it just makes for the entry of a bacterium or a virus into that process that can cause people to get sick.

GRABER: So based on what you said, it seems like there are a few different things. You mentioned kind of too many steps in the processing and the cold chain in which, you know, bugs can kind of grow and proliferate. Is it also an issue that there aren’t enough inspectors or that there are no repercussions for, um, food safety issues?

MARLER: Let me, let me give you an example. If you look at Food Safety Inspection Service, which is the FSIS, it’s the USDA, it’s the meat side of the food equation, um. That was a entity that really grew up, you know, at the post-Upton Sinclair “The Jungle.” And, and you have an inspector in every plant. And they’re public employees and they’re in the plant. They’re monitoring what’s going on, um. But yet we still had the horrific E. coli outbreaks in the ’90s and, you know, early part of the 2000s, even though that product was being inspected. But we had not brought sort of the new technologies of testing meat and test-and-hold and, and interventions to get E. coli off the meat.

Those things still had not been sort of implemented. Once those things got implemented, you know, we’ve seen a dramatic decrease in, in the number of E. coli cases linked to red meat and hamburger. And that’s a good thing. The FDA side of the ledger is, you know, everything else. It’s fish. It’s vegetables, cereals, you know, and imports—non-meat. They don’t have inspectors, and some of the worst foodborne illness outbreaks that I’ve been involved in, the plants that I got court orders to go into, had never been visited by an FDA inspector, ever. And so we’ve created this sort of enormous food manufacturing industry, all of which really has sort of come about post-World War II. And we really don’t have sort of the level of inspection that is, I think, required even though we still mandate companies to do food safety planning and testing and, you know, recall.

I really feel strongly that you’ve got to have a public employee in the plant or at least inspecting the plants on a regular basis. And that’s just a real failure on the part of, you know, our government to do that and, frankly, the taxpayer to pay for it.

GRABER: You mentioned technology. Are there technological innovations or developments that you think, you know, that you see coming down the pipe that will help make consumers safer?

MARLER: There’s always new interventions and innovations. You know, we’ve seen that once the government made the decision that you could not have E. coli in hamburger, the industry figured out a way to try to eradicate it, and they did it by a variety of interventions, um, and cleaning up the process of the slaughter plant. And again, we’ve seen O157, that nasty form of E. coli, just almost disappear from the meat side of the equation.

And that’s…again, it’s a great thing. So I really think what needs to happen is industry and government need to set goals of zero tolerance for these bugs in food and then, you know, let innovation happen. And they can happen. We’re seeing the ability to trace products, you know, when we know there’s a problem either through barcodes or even some really interesting innovations about putting inactive DNA in products. So if there’s a, an outbreak, you can link it immediately back to where the source is. But, you know, what it really, really comes down to, in my view, to create a food safety system is to really try to simplify the number of steps so you limit the opportunity for bugs to be introduced and human error to occur.

GRABER: So what’s the role for public policy in this? Are there changes in policy that we need that can also help keep us safer?

MARLER: Again, I think simplifying things as opposed to making things more complex, at least in my view, makes it easier for humans to do the right thing. Presently, you know, we have somewhere between a dozen and 20 different organizations in government that have some level of oversight for food. And it gets really difficult when you think about, you know, the cheese pizzas overseen by FDA, but cheese pizza with sausage is overseen by the USDA, and fish is overseen by FDA except for catfish, which is overseen by USDA. So one of the things that I think needs to happen, you know, is a really hard re-look at how we regulate things. You know, I think USDA has done a great job. FSIS has done a great job in how they regulate meat. FDA through the Food Safety Modernization Act is sort of taking those first steps. But part of the ongoing problem is, you know, cross-jurisdictional issues between FSIS and FDA.

You know, in a perfect world, I’d certainly like to see, you know, one single agency that was specifically charged with…focused on, you know, like a laser on making our food supply safe.

GRABER: I’m wondering what you think will be the biggest food safety challenges in the decades ahead.

MARLER: Well, I think it’s going to be, you know…more food is going to be imported, so there’s going to be greater distances. Either it’s going to be a lot more pressure, I think, as the population gets larger. There’s going to be a lot more pressure on businesses to produce food potentially cheaper and, you know, we may have pressure to, you know, sort of put food safety to the side. And I think that would be sort of wrongheaded.

So I think those are things that we really have to pay attention to make sure that don’t happen, you know, as we’re paying attention to things that come around the corner.

GRABER: So you had great success with E. coli contamination cases. And since the lawsuits, there have been changes in the food system in terms of beef and improvements in health. But there doesn’t seem to be the same political will today. There are still high rates of salmonella in raw chicken. It seems that there’s been a challenge in passing the same types of legislation that made beef so safe.

MARLER: Um, yeah. I mean, that’s why I still have a job. There’s certainly more to do, and if I got to be the guy with the magic wand, I would do exactly with salmonella what the government did with E. coli 20 years ago, and I would say that you can’t have salmonella in chicken. And industry would adjust. They wouldn’t like it, but they would adjust. And, you know, in the long run, the industry would be better off. Consumers would be better off, and I wouldn’t have anything to do.

GRABER: But that’s not happening yet.

MARLER: Not yet.

GRABER: That was William Marler, a food safety lawyer with Marler Clark. Thanks for listening to this podcast for FutureFood 2050. More information on this subject can be found at www.futurefood2050.com. I’m Cynthia Graber.

1,500 to 2,000 Exposed to Hepatitis A at Casa Di Pizza

CASA-DI-PIZZA-MULVILLE-01-625x375Perhaps Casa Di Pizza should have vaccinated its employees?

WIVB Buffalo reports that the Buffalo Niagara Convention Center drew a crowd of hundreds of pizza lovers Monday, looking for protection against possible exposure to hepatitis A.  Casa Di Pizza, a popular Elmwood Avenue restaurant in Buffalo, had a server diagnosed with the disease on Friday. The Erie County Health Department encouraged 1,500 patrons to receive vaccinations if they ate at the restaurant or banquet room between March 9th and March 19th — Monday they vaccinated 766 people. The bar and take-out service were not involved with the server in question.

WIVB also reported on inspection records at Casa Di Pizza going back to 2013 that showed the business has been cited for violations before.

·       In September 2014, health department inspectors cited Casa-Di-Pizza for 6 violations, including one critical for food not maintained at proper hot holding temperatures. A follow- up inspection later in the month found no violations;

·       In February 2014, inspectors cited the business for eight violations, including two critical. Again, food not maintained at a proper hot holding temperature was cited. A follow-up inspection in March found no violations;

·       In August 2013, the restaurant was hit with eight violations, including six critical. Once again, food not maintained at a proper hot holding temperature was among the violations listed. A re-inspection the following month found no violations;

·       In April 2013, inspectors acting on a complaint found one violation for adequate hair restraint not used by persons in food preparation area. A follow-up inspection three weeks later found no violations.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food. The law firm has brought Hepatitis A lawsuits against such companies as Subway, McDonald’s, Chipotle, Quiznos and Carl’s Jr.

Hepatitis A Vaccines Urged For Pizza Patrons

Today, Erie County Executive Mark C. Poloncarz was joined by Erie County Health Commissioner Dr. Gale Burstein to announce two precautionary public health clinics being held by the Erie County Department of Health (“ECDOH”) in response to the recent identification of the hepatitis A virus in a local restaurant worker, a server at Casa di Pizza on Elmwood Avenue in Buffalo. The point-of-distribution (“POD”) clinics will allow ECDOH to provide post-exposure prophylaxis (“PEP”) to prevent infection to individuals who may have been exposed.

“The county is activating these response clinics to ensure any dining room patron who may have been exposed to hepatitis A can speak to qualified health care professionals about their chance of being infected and receive an immunization shot if necessary. It is another example of how our Department of Health safeguards the public’s health,” said Poloncarz. “While the risk of transmission is low, anyone who may have dined at the restaurant during the time in question should check their immunization status and come to the clinics if necessary.”

Dine-in patrons of Casa-di-Pizza during a specific time frame may have been exposed to hepatitis A virus,” stated Dr. Gale Burstein, Erie County Commissioner of Health. “Customers in the restaurant or banquet rooms are considered potentially exposed, not individuals who ordered take-out food or consumed food or drink from the bar. The risk of actually acquiring a hepatitis A infection from consuming food or drink at Casa-di-Pizza is extremely low,” emphasized Dr. Burstein. “Persons who have already completed the hepatitis A vaccine series are not at risk of developing hepatitis A virus infection from this potential exposure.”

Persons Who Dined in & Consumed Food/Drink from Casa-di-Pizza — only on the dates  below — are Candidates for Hepatitis A Vaccine or Immune Globulin:

Monday March 9, 2015 Tuesday March 10, 2015
Wednesday March 11, 2015 Thursday March 12, 2015
Friday March 13, 2015 Saturday March 14, 2015
Sunday March 15, 2015 Monday March 16, 2015
Tuesday March 17, 2015 Wednesday March 18, 2015
Thursday March 19, 2015

ONLY persons who consumed food/drink within the Casa-di-Pizza restaurant are affected.

NO take-out orders or bar food/drink were at risk.

The Hepatitis A vaccine or immune globulin is only effective within two weeks of exposure to the virus. Patrons who ate in Casa-di-Pizza restaurant or banquet room on the specified dates (and have not been previously vaccinated against hepatitis A) should receive the hepatitis A vaccine or immune globulin as soon as possible.

Point of Distribution Clinics

Monday, March 23, 2015         12 pm (noon) – 8:00 pm

Tuesday, March 24, 2015        8:00 am – 6:00 pm

Buffalo Niagara Convention Center 153 Franklin Street, Buffalo

Marler: Towards a Policy of Secrecy or Transparency in Public Health

tauxeI have a great deal of respect for Robert Tauxe, MD, MPH, Deputy Director of the Division of the CDC that is charged with prevention and control of foodborne, waterborne and fungal infections.  He has been in the diarrheal trenches for a very long time – since just after E. coli O157:H7 made its quiet entrance in McDonald’s restaurant (unnamed at the time) hamburgers in Michigan and Oregon to the deadliest Listeria outbreak linked to tainted Colorado cantaloupes.  Over many years he has had the responsibility for overseeing the 76 million (or is it 48 million) sickened, 325,000 (or it is 125,000) hospitalized, and 5,000 (or is it 3,000) deaths yearly due to foodborne illness – that is a lot of responsibility.I have had the pleasure over that last two decades to on occasion share the food safety stage with him (although you get the sense that the feeling is less than mutual).  And, I cannot think of anyone who looks better in a bow tie.It is therefore with mixed emotions, and the knowledge that I likely make my relationship with public health – both federal and state – even more tenuous, that I question his quotes in today’s MSNBC dust-up over the disclosure or non-disclosure of “Mexican-style fast food restaurant chain, Restaurant Chain A” that is a source of a Salmonella outbreak that sickened 68 people in 10 states.Here is what he had to say to MSNBC:
Dr. Robert Tauxe, a top CDC official, defended the agency’s practice of withholding company identities, which he said aims to protect not only public health, but also the bottom line of businesses that could be hurt by bad publicity. The CDC, the Food and Drug Administration and state health departments often identify companies responsible for outbreaks, but sometimes do not.“The longstanding policy is we publicly identify a company only when people can use that information to take specific action to protect their health,” said Tauxe, the CDC’s deputy director of the Division of Foodborne, Waterborne and Environmental Diseases. “On the other hand, if there’s not an important public health reason to use the name publicly, CDC doesn’t use the name publicly.”Because companies supply vital information about outbreaks voluntarily, CDC seeks to preserve cordial relationships.

“We don’t want to compromise that cooperation we’ll need,” Tauxe said. …

Tauxe acknowledged there’s no written policy or checklist that governs that decision, only decades of precedent.

“It’s a case-by-case thing and all the way back, as far as people can remember, there’s discussions of ‘hotel X’ or ‘cruise ship Y,” he said.

I too was quoted in the article above and was repeatedly asked if I thought that the CDC was bending to company pressure to keep the restaurant name quiet.  I said emphatically no!  But that did not make it into the article.  So, not to put words in Dr. Tauxe’s mouth (and granted he may have had more to say), but as best as I can tell, these are his arguments for disclosure and non-disclosure and my thoughts in italics:

A.  Although there is no written policy, it is the way we have done things for years;

Why do I hear my mom saying, “just because so and so does that does not mean you should too.” Like all government policies (and neckwear) – change is good.

B.  Since the outbreak has concluded, there is not an immediate public health threat;

Frankly, that is true in most foodborne illness outbreaks.  In nearly every single outbreak investigated by the CDC the outbreak is figured out far after the peak of the illnesses happened.  However, disclosure gives the public information on which companies have a strong or weak food safety record.

C.  Disclosing the name of the company jeopardizes cooperation from the company in this and future outbreaks; and

If a company will only cooperate if they are placed in a witness protection program and with promises of non-disclosure, it does not say much for our government’s and the company’s commitment to safe food.

D.  Bad publicity may cause economic hardship on the restaurant.

True, but not poisoning your customers is a better business practice.

I would also add a couple more reasons that I have received via email (mostly anonymously):

1.  The source was an unknown supplier, so naming the restaurant might place unfair blame on the restaurant;

This one does make some sense.  However, is this the unnamed restaurants first problem with a faulty supplier, or is this a pattern?  And, even if it is the first time, perhaps some of the unnamed product is still in the market?

2.  Since the outbreak involves a perishable item, by the time the CDC announces the outbreak, the tainted product has long been consumed;

This one I have heard a “bunch” of times – especially in leafy green outbreaks.  However, why should the public be left in the dark about the type of product that sickens as well as the likely grower and shipper so they can make future decision who to buy from?

3.  Going public with the name of the restaurant compromises the epidemiologic investigation by suggesting the source of the outbreak before the investigation is complete;

I completely agree with this one.  This is a tough call, and one that must create the most angst for public health officials – they decide the balance between having enough data to go forward to protect the public health or wait for more data.  The point is do not go forward until the investigation is complete.

4.  Public health is concerned of making an investigation mistake like, it’s the tomatoes, err, I mean peppers; and

See my answer to 3 above.  This is why under the law; public health officials are immune for liability for the decisions that they make in good faith to protect the public.

5.  Public health – especially surveillance – is under budgetary pressures and there is simply not the resources to complete investigations; and

There is no question that this is true.  I have seen it in dropped investigations over the last few years.  Labs are not doing genetic fingerprinting to help reveal links between ill people.  And, many tracebacks are stopped by the lack of peoplepower to do the research necessary to find the “root cause” of an outbreak.

For me it is easy – the public has a right to know and to use the information as it sees fit, and people – especially government employees – have no right to decide what we should and should not know.  CDC, FDA and the state health departments of Texas, Oklahoma, Kansas, Iowa, Michigan, Missouri, Nebraska, New Mexico, Ohio and Tennessee should do their jobs.

Lunch Lady with Hepatitis A

1_28_11lunchladyA Westchester school district is alerting parents that a cafeteria worker at one middle school was diagnosed with hepatitis A.

A letter sent to parents and employees from the Mamaroneck Union Free School District announced that a Hommocks Middle School cafeteria worker who worked for Aramark Food Service employee was diagnosed with Hepatitis A and is recovering.

“We have been working closely with the Westchester County Health Department, and the Westchester County Health Commissioner Sherlita Amler, MD, has assured us that it is unlikely that anyone at the school would become ill as a result,” the letter says.

“School nurses have been instructed to keep a watchful eye for any student or staff member who may exhibit symptoms,” the letter says.

It also describes hepatitis A symptoms as fever, fatigue, loss of appetite and nausea, and says that vaccination and hand-washing are the best protections.

“If you/your child develop these symptoms anytime from today through April 23, please do not send them to school and immediately notify the school nurse,” the letter says.

Hepatitis A Outbreak in Napa County

546b8ec85be23.imageWhat:

  • In the last two weeks five confirmed cases of Hepatitis A virus (HAV) have been reported to Napa County Public Health.
  • Napa County Public Health is giving out this information because people may have been exposed to the Hepatitis A virus and they need to watch their health for symptoms of Hepatitis A infection.
  • Right now we don’t know the source of the Hepatitis A infections. Public health is working to find the source.
  • The risk of getting Hepatitis A is low, but Public Health wants to be sure people have information to protect their health.

Who is at risk?

  • People who ate food or drink at La Toque restaurant and BANK Café and Bar, which are both inThe Westin Verasa Napa Hotel, between Feb. 9 and Feb. 26, may have been exposed to the Hepatitis A virus.
  • They should watch for symptoms of Hepatitis A for 50 days after their visit.
  • If they start having Hepatitis A symptoms they should call their healthcare immediately and tell them they may have exposed to Hepatitis in Napa
  • Anyone experiencing Hepatitis A symptoms should contact their healthcare provider immediately.

Symptoms of Hepatitis A

  • Fever
  • Fatigue
  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal discomfort
  • Dark urine
  • Clay-colored bowel movement
  • Joint pain
  • Jaundice (yellowing of the eyes or skin)

Wash your hands to stop the spread of Hepatitis A

  • Those possibly exposed should practice good hand washing habits after using the bathroom and prior to food preparation to avoid any further spread of illness.
  • Hand washing should include vigorous soaping of the hands. All surfaces should be washed including the back of the hands, wrists, between fingers and under fingernails.
  • Hands should then be thoroughly rinsed with running water.

How do you get Hepatitis A infections?

  • Person to person contact
  • Eating/drinking contaminated food or drink

What is Hepatitis A?

  • Hepatitis A is a contagious liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months.
  • People infected with the Hepatitis A virus can spread it to others during the two weeks before they know they are sick and in the seven days after they develop symptoms. Signs and symptoms of Hepatitis A start on average 28 days after exposure, although they may occur 15-50 days after exposure.

2005 Central Florida State Fair E. coli Outbreak

PettingZooThe outbreak was first recognized after two separate HUS case reports were posted on the Florida Department of Health EpiCom on March 18 and March 21, 2005. The two cases (a 5-yr-old girl and a 7-yr-old boy) both reported having visited a fair with a petting zoo (Agventure) a few days prior to becoming ill. The two children visited the same fair and did not have any other risk factors in common. The fair (the Central Florida Fair) was held from March 3-13, 2005.

The Orange CHD epidemiology on-call nurse was also contacted on March 20 by one of their local hospital administrators who reported a cluster of pediatric HUS cases in her hospital. Interviews with the parents of the hospitalized children revealed that all had attended a petting zoo (Agventure) at the Central Florida Fair or at a new fair (the Florida Strawberry Festival, also held March 3-13) within three weeks prior to becoming ill. E. coli O157:H7 isolates from the initial cases were sent to the Bureau of Laboratory in Jacksonville for PFGE typing (i.e., to determine if there was a match for the genetic fingerprints of the bacteria involved).

A conference call was held with county health department epidemiology staff in central and south Florida to discuss the initial results of the investigation, and to launch intensified E. coli O157:H7 case finding activities. A questionnaire with an extensive list of questions about potential risk factors for E. coli O157:H7 infections (including questions about exposures to foods, water and animals) was developed.

A list of animal vendors exhibiting at the Central Florida Fair and the Florida Strawberry Festival was obtained from management of the two fairgrounds. The two fairs had only one vendor in common, an exhibitor of a farm animal petting zoo (Agventure). The owner of Agventure was contacted on March 24, and the animals (sheep, goats and cattle) were placed under a voluntary quarantine for the duration of the outbreak investigation.

In conversations with the Agventure owner it was also revealed that the same animals had been exhibited once before, at the Florida State Fair, held between February 10-21, 2005.

An environmental investigation was undertaken at the three fair grounds and the Agventure petting zoo farm. Soil samples and environmental swabs were obtained from the petting zoo exhibit areas of the fairs. One hundred sixty eight animals exhibited at the fair, including the 37 animals exhibited at the farm animal petting zoo were also cultured.

The initial case definition was broad. As the outbreak investigation progressed, the case definition was made more specific and defined outbreak related cases by time, place and person as follows:

  1. Confirmed-persons who attended one of the three fairs by 3/13/05 and had a lab diagnosis of coli O157:H7 within 10 days of fair attendance and/or had a lab diagnosis of HUS within 21days of fair attendance;
  2. Suspect-persons who attended one of the three fairs and developed symptoms of coli O157:H7 within 10 days of fair attendance and/or developed symptoms of HUS within 21 days of fair attendance and did not have an alternative diagnosis; and
  3. Secondary-persons who developed symptoms of coli O157:H7 and/or had a lab diagnosis of E. coli O157:H7 within 2-10 days of having close contact to a case or persons who developed symptoms of HUS and/or had a lab diagnosis of HUS within 21 days of having close contact to a case.

A total of 22 confirmed, 45 suspect and 6 secondary cases from 20 Florida counties were identified as victims of this outbreak. All but one culture-confirmed case had isolates with matching PFGE patterns. Most cases were infected at either the Central Florida Fair or the Florida Strawberry Festival (only 3 cases associated with the Florida State Fair). Twelve cases developed HUS. There were no fatalities.

E. coli O157:H7 with matching PFGE patterns were also recovered from the animal exhibit areas of the Central Florida Fair and the Florida Strawberry Festival. E. coli O157:H7 with matching PFGE patterns were also recovered from 6 animals from the Agventure petting zoo.

PRIOR OUTBREAKS

While some diseases show host species specificity, meaning that they can only occur in one animal species, many other diseases can be spread between different animal species, including humans and animals. These diseases are collectively known as zoonotic diseases. The term zoonoses, is derived from Greek zoon (animals) and noses (diseases) that literally mean diseases from animals.

Zoonotic diseases can be transmitted by a variety of routes. Some documented ways include direct and indirect contact with infected animals, airborne exposure to infective agents shed by animals, consumption of animal products, consumption of water that has been contaminated by animal fecal material, or exposure to insect vectors such as fleas or ticks.

Previously, the primary mode of transmission of zoonotic diseases at agricultural fairs, petting zoos, and farm visits was thought to be fecal-oral, that is, by ingestion of bacteria-laden feces via contaminated food or water, or transfer by hand to mouth following contact with contaminated surfaces or animals. Conclusions reached by investigators in several recent fair-associated outbreaks of E. coli O157:H7 suggest that ingestion or perhaps even inhalation of contaminated dust particles may also be how fair attendees become infected with the bacteria.

Summaries of Known Cases of Zoonotic Pathogen Outbreaks Associated with State and County Fairs, Petting Zoos, and Community Activities Involving Human-Animal Contact

Outbreak Case 1: County Fair – Wisconsin

MMWR Weekly (November, 1988) reported that in September, 1988, a human was fatally infected with swine influenza virus in Wisconsin. A subsequent investigation found that the victim, a woman, had attended a county fair and visited the display area of the pig barn. Statements from the veterinarians at the fair indicated that pigs in the display area were found to show an illness consistent with swine influenza. A preliminary investigation found that there was no outbreak of influenza-like illness observed in the surrounding areas. Three healthcare personnel treating the case patient also developed influenza-like illness with laboratory evidence of Swine Influenza Virus (SIV) infection (Wells et al., 1991). The editorial note contained in the MMWR Weekly report indicated that the case suggested direct transmission of influenza virus from pig to human host.

Outbreak Case 2: Farm Visitor Center – Leicestershire, United Kingdom

Shukla et al (1995) investigated an outbreak of seven cases of E. coli O157:H7 infection associated with a visit to a farm in Leicestershire, United Kingdom, during the summer of 1994. A joint study was conducted between environmental health officers and the local veterinary investigation center of the Ministry of Agriculture, Fisheries and Food. A questionnaire was sent to all cases. Samples were collected from the farm, and the associated facilities for food preparation and hygiene were also assessed. The investigation found that the common factor linking all the cases was a visit to a farm visitor center in the three weeks before the onset of the illnesses. The epidemiological data supported this link, as the strains of E. coli O157:H7 isolated from nine animals on the farm were indistinguishable from those isolated from the human samples. This report concluded that the most likely cause of this outbreak was direct human contact with animals. The probability of contracting disease was increased by poor hand washing facilities, and a lack of information provided to the visitors on the importance of maintaining personal hygiene.

Outbreak Case 3: Farm Visit – Wales

In April 1995, an outbreak of Cryptosporidiosis was reported among 43 children and four staff after visiting a rural farm (Evans and Gardner, 1996). Out of the 43 cases reported, 7 were confirmed by laboratory cultures. The investigation indicated that the highest likelihood of source of contamination was contact with calves.

Outbreak Case 4: Farm Visit – Dublin

Sayers et al (1996) reported a Cryptosporidium outbreak the summer of 1995, involving 13 children identified as cases. The children had been to a summer project and visited an open farm in Dublin, Ireland. The second part of this study also included a case control study of 52 out 55 people who had visited the open farm.

The researchers concluded that the outbreak was significantly associated with playing in the sand on a picnic area beside the stream where animals had access. This outbreak emphasizes the risk associated with children visiting open farms.

Outbreak Case 5: Farms – Cornwall and West Devon, United Kingdom

Milne et al (1999) investigated an E. coli O157:H7 outbreak associated with a farm in the United Kingdom during the period of June to July, 1997. A Vero cytotoxins producing Escherichia coli O157:H7 infection was observed in three children, one who lived on an open farm and two who visited the farm during school parties. Two of the three children developed HUS and one suffered from severe neurological impairment. Isolates collected from the three children and from all environmental samples were indistinguishable by molecular typing, providing evidence of the link between the human contact with the farm and the outbreak.

The farm was closed voluntarily for six weeks, while recommendations to reduce the risk of transmission were implemented. These recommendations included reassessing provisions made for general hygiene, including making sure adequate hand washing facilities were available; strict segregation of eating and drinking areas from the animal contact area; reinforcement of precautions to be taken by visitors; reassessment of the species type and age of animals kept in the touching barn; prohibition of visitor exposure to fecal contamination (e.g. manure heaps, etc.); elimination of visitor use of cattle trails unless devoid of fecal contamination; implementing a “no touch” policy in various parts of the farm trail, like the calf pen area; enhancing decontamination of the goat paddock by putting it out of use a few weeks before the visits and keeping the grass short; performing rigorous detergent cleaning in areas of public access and appropriate use of disinfectants; and prohibiting public asses to the milking parlors, and calving barns.

Outbreak Case 6: Zoo Water Fountain – Minnesota

In July 1997, the Minnesota Department of Health (MDH) reported an outbreak of Cryptosporidiosis among children who visited the Minnesota Zoo (MMWR Weekly, October, 1998). A total of 369 cases were reported, of which 73 were subsequently confirmed by means of laboratory cultures. The report by MDH indicated case onset of vomiting or diarrhea 3 to 15 days after exposure to the zoo fountain. However, the fountain was not confirmed as the source. Exclusion of people from the suspect water fountain was suggested to reduce the risk of contamination to the public.

Outbreak Case 7: Agricultural Fair – British Columbia

During August and September of 1998 the British Columbia Center for Disease Control sent all E. coli O157:H7 isolates to an outside laboratory for molecular sub-typing (BC Center for Disease Control, March, 1999). On September 17 it was reported that nine of the 69 referred isolates had a common genotype. Three individuals were hospitalized, though none developed hemolytic-uremic syndrome (HUS). Seven of the nine had onset of illness within ten days of visiting a large agricultural fair. Despite in-depth interviews, no common source of infection could be identified. No environmental investigation of the fair could be carried out; because by the time laboratory results were available the fair had closed.

Outbreak Case 8: County Fair – Puyallup, Washington

An outbreak of hemorrhagic colitis due to E. coli O157:H7 was identified among visitors to the Puyallup Fair in Puyallup, Washington, during September of 1998 (CDC Memorandum, March 1999). Two children were initially confirmed as being ill from E. coli O157:H7. The Communicable Disease State Epidemiologist at the Washington State Department of Health mentioned in a news release immediately after the detection of two confirmed cases at the Puyallup fair that health officials were looking for food borne exposure as well as possible contamination at the animal petting areas and on water rides (Kobayashi, 1998).

The CDC conducted an investigation, and concluded that out of 80 ill people reporting, there were three confirmed and five probable cases of E. coli O157:H7 illness. Of these eight cases, seven reported consuming hamburgers, though purchased from multiple vendors. The environmental investigation suggested that exposure could have resulted from consuming food without washing hands after petting the animals in the petting zoo. The internal temperature of the cooked hamburgers tested ranged between 155 to 195° F although a number of situations of potential cross contamination were observed among the food handlers.

The CDC memorandum stated that compelling circumstantial, but not conclusive, evidence was found that the outbreak was a result of consumption of contaminated hamburgers. The memorandum also recommended enforcing proper food handling practices among food vendors, installing a large number of hand washing facilities at the animal petting zoo, and also throughout the fair. It also recommended performing a hazard evaluation of all the food sold at the fair for potential risk of foodborne illnesses.

Outbreak Case 9: Farm – North Wales, London

Payne et al (2003) reported an outbreak of Vero toxin producing E. coli O157:H7 (VTEC O157:H7) causing gastroenteritis among people visiting an open farm in North Wales, London in June 1999. A case-control study was designed which included 16 primary case patients and 36 controls. The preliminary investigation indicated a significant association between attendance on the second day of the festival, eating ice cream or cotton candy and contact with cows or goats. Further multivariable analysis of the data indicated that the only the association of the illness with eating ice cream and cotton candy remained significant. The researchers suggested that foods on open farms should be eaten only in the dedicated clean areas, and sticky food should be avoided in such events.

Outbreak Case 10: County Fair – Washington County, New York

The New York State Department of Health investigated what is believed to be the largest outbreak of waterborne E. coli O157:H7 illness in United States history. The outbreak occurred at a fair in Washington County, New York, in August of 1999 (New York State Department of Health, March, 2000). A total of 781 persons were identified with suspected infections of E. coli O157:H7 and/or Campylobacter jejuni. Of these cases 127 persons were culture confirmed to be ill with E. coli O157:H7, 71 individuals were hospitalized, 14 persons exhibited hemolytic uremic syndrome (HUS), and 2 people died. A household telephone survey indicated that the number of people infected by either pathogen after visiting the Washington County Fair might be as high as 2,800. The environmental and site investigation indicated that unchlorinated water from a well serving the southwestern portion of the fairgrounds was contaminated with E. coli O157:H7 (DOH News, 1999). Samples of manure collected from a barn located 50 feet from the well and samples from the groundwater flow from the manure storage area located 80 feet from the well tested negative for E. coli O157:H7. However, samples from the septic system tested positive for E. coli O157:H7.

The shape of the epidemic curve suggested a point source outbreak with the peak of symptom onset occurring on September 1. Considering a typical incubation period of 2-4 days, this suggested that most exposures took place towards the end of the fair. This matched information provided by the patients, 88% of whom visited the fair in the final week. Consumption of only two food or beverage items, soda with ice or ice in any drink, was reported by a majority of the culture-confirmed case patients. MMWR Weekly (1999) reported that the pulsed-field gel electrophoresis testing by the Wadsworth center indicated that the DNA fingerprints of E. coli O157:H7 isolates from the well, the water distribution system, and most confirmed cases were similar.

The epidemiological investigation of this outbreak concluded that a significant relationship was associated with the incidence of the outbreak and the consumption of beverages purchased from vendors supplied with water from the unchlorinated well. MMWR Weekly (1999) reported that letters were sent to nursing homes, hospitals and schools to exclude the symptomatic personnel and also follow careful hygienic practices to prevent secondary transmission.

Outbreak Case 11: Agricultural Fair – Ontario, Canada

Warshawsky et al (2002) investigated an outbreak of E. coli O157:H7 associated with a large agricultural fair conducted between September 10 and 19, 1999, in Ontario, Canada. This study indicated that 7 cases of E. coli O157:H7 infections were associated with animal contact at the agricultural pavilion of the regional fair. Sub-typing revealed that five of the seven cases were extremely uncommon E. coli O157:H7 PT 27 while the remaining two were common E. coli O157:H7 PT 14. The E. coli O157:H7 PT 27 pattern matched with three samples from goats and one sample from sheep from the traveling petting zoo. The researchers further noted that the clustering of positive cases on the two weekends of the fair indicated that exposures could be a result of difficulty in manure disposal and environmental cleaning due to high volumes of visitors. The results from this case control study strongly suggested that the goats and sheep from the petting zoo were the source of the E. coli O157:H7. The detailed history from two primary sources indicated that the rails and the environment surrounding the petting zoo could also have been contaminated and could have acted as a source of transmission. The researchers recommended that standards should be outlined for adequate hand washing facilities, appropriate disposal of manure, proper cleaning environment surrounding the petting zoos, including the rails and floors.

Outbreak Case 12: Social Event in Cow Pasture – Petersburg, Illinois

An outbreak of E. coli bacteria was reported in Petersburg, Illinois inn 1999 (Nando Times, 1999). The outbreak took place among 1,800 people who attended a party called “Cornstalk” held in a cow pasture. State health officials reported that 202 individuals became ill, and that 20 were hospitalized. However, none of the reported illnesses were considered serious. The source of contamination was not found.

Outbreak Case 13: Petting Zoo – Snohomish County, Washington

A press release by the Snohomish Health District, Communicable Disease Control (June, 2000) reported five cases of bacterial diarrhea caused by E. coli O157:H7 in children in Snohomish County in May 2000. Three of the children visited a petting zoo several days before they became sick. The fourth child did not visit the petting zoo, but was found to live on another farm where cattle were raised (MMWR Weekly, April 2001) reported an investigation of the farm by Snohomish Health District (SHD) and Washington Department of Health revealed that the children were allowed to touch young poultry, rabbits and goats. Children brought their own lunches and ate approximately 50 feet from the penned animals. The study also indicated that the animal stool samples collected from the farm tested negative for E. coli O157:H7. The Health District believed that the three children visiting the petting zoo acquired the bacterial diarrhea due to a lack of adequate hand washing facilities available. MMWR weekly (April 2001) also reported that no signs were posted to instruct the visitors to wash their hands after touching the animals.

Outbreak Case 14: County Fair – Medina County, Ohio

Crump et al (2000) discussed county fairs as risk factors for E. coli O157:H7 infections. The researchers investigated a cluster of E. coli O157:H7 isolates observed in Medina County, Ohio, in August of 2000. In this case control study 43 culture confirmed E. coli O157:H7 cases were identified. The environmental investigation suggested that contamination of a section of the water distribution system supplying various vendors was most consistent with the localization of the pathogenic exposure. Water samples collected for this study did not indicate any coliforms. However, a Halloween event was arranged on the same fairgrounds where the Medina County Fair was held, during which five children developed E. coli O157:H7 infection. These children consumed water-based products during the party and showed the same PFGE pattern as that observed in the Medina County Fair outbreak. The researchers concluded that the county fair exposure was significantly associated with the E. coli O157:H7 outbreaks. The report recommended that guidelines be developed for safer interactions between animals, humans, and the environment. These recommendations could include improving public awareness of risk and prevention strategies, identifying high-risk animals, and controlling their contact with humans through identifying interaction activities and groups at greater risk.

Outbreak Case 15: Dairy Farm – Pennsylvania

Crump et al (2002) discussed an outbreak of E. coli O157:H7 among visitors to a dairy farm in Pennsylvania in September, 2000. A case control study among the visitors was conducted to identify the risk factors of infection, along with a household survey to determine the rates of diarrheal illness. The total number of confirmed or suspected E. coli O157:H7 cases were determined to be fifty-one. The median age among the patients was four. Eight of the cases developed hemolytic uremic syndrome (HUS). The environmental investigation indicated that 28 of 216 cattle (13%) on the farm were carrying E. coli O157:H7 that yielded an identical pattern when analyzed by pulsed field gel electrophoresis to that observed for the isolates of the patients. The organism was also recovered from various surfaces in public access areas of the farm.

MMWR Weekly (April 2001) reported that a case control study among the farm visitors was conducted jointly by the CDC, Pennsylvania Department of Health, and Montgomery County Health Department to identify the risk factors. A “confirmed case” was defined as diarrhea in a person within 10 days of visiting the farm on or after September 1, with either E. coli O157 isolated from stool or HUS. A “probable case” was defined as diarrhea in a person within 10 days of visiting the farm on or after September 1. A “control” was defined as a person visiting the farm after September 1 who did not develop diarrhea within 10 days of the visit. Fifty-one case patients and ninety two controls were interviewed for this case control study. The research concluded that this large outbreak of E. coli O157:H7 was most likely a result of contamination of both animal hides and the environment. This study also reported that the data showed hand washing as providing protection against transmission of the pathogen.

Outbreak 16: Petting Zoo – Worcester, Pennsylvania

An article published by WebMD Medical News on April 23, 2001 (Bloomquist, 2001), reported an outbreak of E. coli O157:H7 among visitors to the Merrymead Farm petting zoo in Worcester, Pennsylvania. In all, 16 children who had visited the zoo contracted E .coli, and it was suspected that another 45 people became ill from the bacteria. The report indicated that one week after visiting the zoo, one of the children came down with violent stomach cramps and was hospitalized. A few days later, and after being released from the hospital, the patient was diagnosed with kidney failure. It is believed that 26 cows on the farm were carrying the E. coli bacteria, and that exposure may have occurred as visitors rode in a wagon which was caked with mud and animal manure, or as they touched animals that may have been infected.

Outbreak 17: County Fair – Ozaukee County, Wisconsin

The Ozaukee County Public Health Department and Wisconsin Department of Health and Family Services (2001) investigated an outbreak of E. coli O157:H7 associated with animals at the Ozaukee County Fair in August, 2001. A total of 59 E. coli O157:H7 cases were identified in this outbreak, with 25 laboratory confirmed cases (25 “primary cases” and 34 probable cases). Bacteriological testing of water at the Ozaukee County fairgrounds and the Fireman’s park did not indicate presence of E. coli O157:H7, though 10 of the 36 samples collected from the Ozaukee County Property showed elevated levels of total coliforms. The environmental investigation focused primarily on testing water samples from the livestock buildings, livestock washing stations, runoffs from settling basin, grass filter strip, manure storage area, fishing pond, and streams. A total of 19 surface water samples, and 8 sediment samples, were collected from the pond and stream on the fairgrounds property. All tested negative for E. coli O157:H7. Public health officials attributed the outbreak to animal contact in the petting zoo at the county fair (Cole et al, 2001).

As a consequence of this outbreak, the Wisconsin Division of Public Health, Wisconsin Department of Agriculture, Trade and Consumer Protection, and the Dane County Division of Public Health developed a list of voluntary guidelines for animal exhibitions at Wisconsin. The general precautions for livestock on public displays included providing hand-washing stations at strategic places around livestock barns, and posting signs encouraging their use. Actions included developing and implementing manure collection, handling, and storage procedures. It was recommended that runoffs into places where water was pulled be avoided. A written policy should be developed on handling animal bites and should be discussed with the corresponding county fair health authorities. Visitors should be prohibited from being in contact with baby animals, including newborns, if an animal birthing display is available. The recommendations regarding the food and hygiene practices included keeping food and beverage service away from the livestock, providing adequate hand washing facilities, and encouraging their usage. The guidelines also recommended keeping of records of all the vendors, vendor locations, and schedule of events.

Outbreak Case 18: County Fair – Lorain County, Ohio

The Department of Health and Human Services, Public Health Services (CDC memorandum, February, 2002) reported that 23 cases of E. coli O157:H7 infection were identified associated with the attendance at the Lorain County Fair, Ohio, in September, 2001. A number of additional cases of diarrhea were identified as likely due to secondary transmission from primary cases. The memorandum strongly associated presence at the Cow Palace, Lorain County, with bacterial diarrhea. The environmental and site investigation indicated that visible manure was present on the ground in at least one area of the barn floor. Out of 54 environmental samples, 23 tested positive for Shiga toxin producing E. coli O157:H7. Samples from the doorways, rails, bleachers, and sawdust exhibited an identical fingerprint pattern when analyzed by PFGE. Environmental samples of water obtained by the Health Department in the week before and during the fair tested positive for total coliforms for two spigots.

The CDC memorandum clearly associated the Lorain County Fair with the E. coli O157:H7 outbreak in the county. The possible mechanisms proposed for disease transmission included contamination of human hands with residual cow manure and/or aerosolized dispersion of E. coli O157:H7 in the sawdust. The memorandum also hypothesized that the patients became contaminated at the cow palace and were subsequently infected while eating or drinking at the various vendors. The case control study of this memorandum did not support an alternative hypothesis, that the fairground water was related with the outbreak. This investigation strongly supported the previous incidences of E. coli O157:H7 outbreaks associated with the county fair attendance. This memorandum also stressed the need for collaborative efforts between various public agencies to develop clear guidelines for ensuring the disinfection of the temporary facilities housing the animals. The recommendations provided in this memorandum included considering the banning of large dusty events, and the development of guidelines for disinfecting surfaces in the Cow Palace prior to events or to replace sawdust with non particulate ground covering. They also suggested that the fairgrounds should be provided with adequate hand washing facilities with hand sanitizers. Measures should be provided to prevent intermixing of water.

Outbreak Case 19: County Fair – Wyandot County, Ohio

The Ohio Wyandot County Health Department received a report of an E. coli O157 outbreak in September, 2001 (CDC memorandum, February, 2002). A total of 92 cases were identified, including 27 laboratory-confirmed E. coli O157 infections. Two cases were diagnosed with hemolytic uremic syndrome. Eighty-eight cases reported attending Wyandot County Fair before becoming ill. The source of the outbreak was not fully identified; however, the most likely source was believed to be contact with infected cattle. Disinfecting areas that house cattle, removal of fecal contamination from contact surfaces, and exclusion of calves or cows from petting areas were recommended. Active surveillance at the fairgrounds during the local fair or at large gatherings, along with strengthening measures to prevent water contamination, was suggested.

Outbreak Case 20: Farm – Wellington, New Zealand

An outbreak of Cryptosporidiosis was linked to a two-day farm educational event in the Wellington region of New Zealand. The total number of cases is unknown, but 23 cases were laboratory-confirmed. The most likely route of infection was determined to be from an infected animal. The outbreak was discussed in a report released in 2001 (Stefanogiannis et al, 2001).

Outbreak Case 21: County Fair – Lane County, Oregon

A news release from the Oregon Department of Human Services (Oregon, 2002) reported on hemorrhagic colitis from the Lane County Fair held during August, 2002, in Oregon. The report indicated that 56 primary and 14 presumptive secondary cases were identified. This is believed to be the largest E. coli O157:H7 outbreak in Oregon history. Two-thirds (66%) of the confirmed cases were <6 years old, and 56 % were <19 years old.

Although not confirmed, health officials postulated that possible exposures leading to the outbreak occurred at animal enclosures, including the cattle tent, horse barn, and exposition halls that housed goats, sheep, rabbits, chickens, ducks, and guinea pigs. Investigators tried to trace the transmission path of the bacteria to develop a strategy to prevent the outbreak in the future. Capital Press, an agricultural magazine, discussed this event (September, 2002). The article mentioned that scientists discovered a virulent strain of bacteria on the pipes 15 feet above the goat pens in a fair exhibition hall, where about 75 people, including 12 children, were believed to be infected. A state epidemiologist from the Oregon Department of Human Services suggested that the microorganisms must have been present in the dirt and dust, and henceforth accumulated on the tops of the pipes 15 feet in the air.

Outbreak Case 22: Petting Zoo – Zutphen, The Netherlands

Heuvelink, et al (2002) reported that a young child developed a Shiga toxin 2 producing strain of Escherichia coli (STEC) O157 infection after visiting a petting zoo in Zutphen, The Netherlands. The STEC strains were isolated from the fecal samples from goats and sheep on the farm. Molecular sub-typing proved that the human and animal isolates were identical.

Outbreak Case 23: County Fair – Fort Bend County, Texas

In 2003 twenty-five people – fair visitors and animal exhibitors – became ill with E. coli O157:H7 after attending the Fort Bend County Fair in Rosenberg, Texas. There were four cases of Hemolytic Uremic Syndrome and one case of Thrombotic Thrombocytopenic Purpura. All seven laboratory-confirmed cases had an indistinguishable PFGE pattern which matched with ten isolates obtained from environmental samples taken at four animal husbandry sites. Case-patients ranged in age from 18 months to 67 years. Eighteen other environmental specimens were positive for E. coli O157:H7 but were determined by PFGE analyses to be different strains from the outbreak strain. Investigators concluded that both the rodeo and animal exhibit areas were heavily contaminated with E. coli O157:H7. There was no association between illness and food or beverage consumption (Reynolds et al, 2004; Durso et al, 2005).

Outbreak Case 24: State Fair – Raleigh, North Carolina E. coli Outbreak, North Carolina State Fair

In late October 2004, the North Carolina Department of Health and Human Services (NCDHHS) conducted an E. coli O157:H7 outbreak investigation among attendees at the 2004 State Fair. The health department received over 180 reports of illness; the majority of cases occurring in children five years old and younger. Fifteen children developed hemolytic uremic syndrome.

A preliminary report issued by the NCDHHS in December 2004 identified multiple risk factors for infection with E. coli O157:H7 among visitors to four animal exhibits. Direct contact with goats and sheep was strongly associated with illness. Ill children age three years or less were seven times more likely to have contact with manure than children who were not ill. Ill children were also five times more likely to fall or sit on the ground than children who were not ill.

Cultures from 33 ill fair attendees had the same PFGE patterns. Environmental samples obtained from four fairground areas grew E. coli O157:H7. Nineteen of thirty specimens obtained from a particular petting zoo grew E. coli O157:H7 and were a PFGE match to ill patients.

Charlotte North Carolina Hepatitis A Scare

The Mecklenburg County Health Department is encouraging patrons who visited a SouthPark restaurant between Feb. 4 and 10 to get vaccinated for hepatitis A.

An employee at Dogwood Southern Table & Bar, located in the Sharon Square development, was confirmed to have a case of the hepatitis A virus over the weekend.  That employee did not prepare food but was responsible for cleaning and polishing silverware and glassware and delivering food to tables. The employee stopped working at the restaurant on Feb. 10.

The restaurant is open for business and is not considered a public health threat, the health department says.  But patrons who ate at Dogwood between Feb. 4 and 10 are at risk for developing hepatitis A if they have not previously been vaccinated, the department says. Health department officials say the risk of a secondary infection is low.

Dogwood owner Jon Dressler says all restaurant employees have been vaccinated, and guests who visited the restaurant during those dates should have been contacted by the health department.

“I’m sorry for the guests, and we can just apologize for the inconvenience,” Dressler says.

Vaccinations for individuals who ate at the restaurant during dinner shift on Feb. 4 and Feb. 5 will be given until 5 p.m. today at the Mecklenburg County Health Department office at 249 Billingsley Road.  On Thursday and Friday, those who ate at the restaurant Feb. 7 through Feb. 10 can receive vaccinations.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Hepatitis A outbreaks. The Hepatitis A lawyers of Marler Clark have represented thousands of victims of Hepatitis A and other foodborne illness outbreaks and have recovered over $600 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Hepatitis A lawyers have litigated Hepatitis A cases stemming from outbreaks traced to a variety of sources, such as green onions, lettuce and restaurant food.  The law firm has brought Hepatitis A lawsuits against such companies as Subway, McDonald’s, Chipotle, Quiznos and Carl’s Jr.

Seattle Food Safety Litigator, William Marler, Named as One of The Daily Meal’s Top 50 Most Powerful People in Food

Popular online food site The Daily Meal has announced their fifth annual list of the Top 50 Most Powerful People in Food, which includes William Marler of Seattle-based Marler Clark, The Food Safety Law Firm. Marler was ranked #43, up from last year’s #47. In 2013, he was ranked #48 and in 2012 he was ranked #46.

The Daily Meal editors rank the Top 50 Most Powerful People in Food List after extensive research, including reading news stories, annual statements, and editorial analyses. They also consult with experts in various food-related fields and debate the picks  in sometimes-contentious editorial discussion.

“This year, we attempted to bring more order to the process,” wrote Colman Andrews, editor of The Daily Meal, in the introduction of the list. “Once we came up with a long initial roster, we graded each nominee on five criteria: the number of people the candidate reaches, the number of venues through which the candidate can reach people, past accomplishments, potential for future accomplishments, and proven ability to reach and influence people through their actions.”

The list represents an interesting mix of chefs, restaurateurs, legislators, culinary activists and foodies. In addition to Marler, other notable honorees include Ingrid Newkirk (President and Co-Founder of PETA, #49), Jimmy Fallon (Host of The Tonight Show, #41),  Ben Silbermann (Founder and CEO of Pinterest, #29), Barack and Michelle Obama (President and First Lady, #13), Howard Schultz (CEO of Starbucks, #6), and Thomas Vilsack (USDA Secretary, #1).

“Certainly, over the years, some people have had mixed feelings about my involvement in the food industry, but I’m glad that my work has been able to have a positive influence, helping as many victims as I have, and pushing the industry to recognize the steps that need to be taken to keep people safe,” said Marler.

Marler’s food safety career began back in 1994, when he represented Brianne Kiner, the most seriously injured victim in the industry-changing Jack in the Box E. coli outbreak. After a lot of hard work, as well as representing 100 other victims in the case, Marler negotiated a settlement of $15.6 million for Brianne Kiner. This was the largest settlement in the case, which totaled more than $50 million in individual and class action settlements– the largest payments ever involving food-borne illness.

In 1998, Marler founded his own firm, Marler Clark, focused solely on food safety advocacy and litigation. Marler and the firm’s other attorneys have handled cases involving every major foodborne illness and outbreak in the last 20 years.

When not litigating, Marler spends much of his time traveling to address food industry groups, fair associations, and public health groups about foodborne illness, related litigation, and surrounding issues. He has testified before Congress as well as State Legislatures. He is a frequent author of articles related to foodborne illness in food safety journals and magazines as well as on his personal blog, www.marlerblog.com. Bill is also the founder and publisher of Food Safety News (www.foodsafetynews.com), a one-stop resource for global food safety news and information.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of foodborne outbreaks such as E. coli, Salmonella, Shigella, and Listeria. The lawyers of Marler Clark have represented thousands of victims of 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. The law firm has brought lawsuits against such companies as Jack in the Box, Dole, Taco Bell, Peanut Corporation of America, ConAgra, Subway, Wal-Mart, and Jimmy John’s.