The Toast salmonella outbreak is not the only major Salmonella outbreak to hit North Carolina in recent months.  At least 90 people from 4 states, including 88 in North Carolina, have become ill with with Salmonella Paratyphi B infections—most of them in the Ashville, North Carolina-area—since February 28, 2012. At least 8 people have been hospitalized with Salmonella Paratyphi B infections since the outbreak began.

On May 9, 2012, public health officials announced that starter culture used in Smiling Hara tempeh products was the source of the Salmonella Paratyphi B contamination within the Smiling Hara facility. The starter culture was distributed by Tempeh Online (also known as Indonesianfoodmart.com), a Rockville, Maryland, company.

And then, of course, there's the biggest current outbreak of them all, which has sickened 10 North Carolina residents, and several hundred other people from around the country.  The outbreak has been linked to Yellowfin Tuna.  When the Salmonella outbreak was first announced, the CDC and FDA suspected sushi to be the source of the Salmonella outbreak. On April 13, 2012, the CDC announced that a frozen raw yellowfin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation, is the source of the Salmonella outbreak. According to the CDC, information indicates that the Salmonella-contaminated yellowfin tuna product came from a single tuna processing facility in India.  Spicy tuna rolls were a common food eaten by Salmonella outbreak victims, as was yellowfin sushi or ceviche.

The Asheville Citizen Times reported that the number of reported cases in a three-month Buncombe-based – Tempeh caused – Salmonella Paratyphi B outbreak is still climbing. The total number of reported cases linked to the outbreak was over 80 as of last Friday afternoon, 62 of which involved residents of Buncombe County.

Casey Blake of the Asheville Citizen Times reported today that the number of reported cases in a three-month Buncombe-based – Tempeh caused – Salmonella Paratyphi B outbreak is still climbing. The total number of reported cases linked to the outbreak was 83 as of Friday afternoon, 62 of which involved residents of Buncombe County. The total count includes cases of people who visited or otherwise had connections to Buncombe County and were believed to have been exposed to the bacteria here.

Agriculture officials have isolated the strain of salmonella that struck in late February — called paratyphi B — to one ingredient: A starter culture distributed by Tempeh Online of Rockville, Maryland to local company Smiling Hara Tempeh.

Paratyphi B is a rare type of salmonella in part because it has a 30-day incubation period as opposed to one to 10 days found in more common types. The disease causes diarrhea that may be bloody, high fever, headache and abdominal pain. It is rarely fatal but can be dangerous to the young, elderly or people with weak immune systems.

According to the California Department of Food and Agriculture, raw milk products produced by Organic Pastures of Fresno County have been released from a statewide quarantine that began May 10. CDFA imposed the quarantine in response to the detection of campylobacter bacteria, and notification from the California Department of Public Health of reported campylobacter food-borne illnesses in persons consuming Organic Pastures raw milk. CDPH also isolated Campylobacter jejuni from six samples of the dairy’s raw cream, one sample of raw butter and four samples of cow manure from the milking herd.

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.

It is becoming a harder for Organic Pastures to defend raw milk so vehemently after the dairy has now been linked to 4 outbreaks and 6 recalls.

In 2006, three strains of E. coli O157:H7 were cultured from Organic Pastures' heifers' feces.  That same year, the dairy was quarantined after six children became ill with E. coli infections - two with hemolytic uremic syndrome - linked to its raw milk.

In 2007, fifty strains of Campylobacter jejuni plus Campylobacter coli, Campylobacter fetus, Campylobacter hyointetinalis, and Campylobacter lari were cultured from OPDC dairy cow feces after eight people were sickened.  See the state report here. 

In 2007, Listeria monocytogenes was cultured from Organic Pastures Grade A raw cream.

In 2008, Campylobacter was cultured from Organic Pastures Grade A raw cream.

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. All five children reported drinking commercially available raw (unpasteurized) milk from a single dairy (Organic Pastures) and had no other common exposures. The epidemiological findings led to a quarantine and recall of all Organic Pastures products except cheese aged more than 60 days. Environmental samples collected at Organic Pastures yielded E. coli O157:H7 isolates that had PFGE patterns indistinguishable from the patient isolates.  

On May 18, 2012, Diamond Pet Foods expanded its earlier recalls to include Diamond Naturals Small Breed Adult Dog Lamb & Rice Formula (samples, 6-lb and 18-lb bags; Manufactured Aug 26, 2011).

Diamond Pet Foods had previously recalled nine brands of dry pet food formulas that were manufactured in Gaston. All batches manufactured between December 9, 2011 and April 7, 2012 are affected.

Consolidated list of recalled dry pet food products (as of May 18, 2012)

• Apex Chicken and Rice Dog (20-lb and 40-lb bags; Production code ACD0101B32; Best by date 24-Jan-2013)
• Canidae Dog Dry Dog Food, All Life Stages (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Canidae Dog Dry Dog Food, Chicken Meal & Rice (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Canidae Dog Dry Dog Food, Lamb Meal & Rice (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Canidae Dog Dry Dog Food, Canidae Platinum (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Chicken Soup for the Pet Lover’s Soul (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Country Value (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Diamond (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Diamond Naturals (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Diamond Naturals Small Breed Adult Dog Lamb & Rice Formula (Samples, 6-lb bags, 18-lb bags; Manufactured Aug 26, 2011; Production Code DSL0801; Best before 26-Aug-2012, 27-Sept-2012 (manufactured on Aug. 26, 2011 and packaged on Sept. 27, 2011), and 18-Oct-2012 (manufactured on Aug. 26, 2011 and packaged on Oct. 18, 2011))
• Kirkland Signature Super Premium Adult Dog Lamb, Rice & Vegetable Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Adult Dog Chicken, Rice & Vegetable Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Mature Dog Chicken, Rice & Egg Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Healthy Weight Dog Formulated with Chicken & Vegetables (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Maintenance Cat Chicken & Rice Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Healthy Weight Cat Formula (December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Nature’s Domain Salmon Meal & Sweet Potato Formula for Dogs (December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Natural Balance Sweet Potato & Venison Dog (5 lb bag; Best by December 12, 2012; December 13, 2012; March 13, 2013)
• Natural Balance Sweet Potato & Venison Dog (15 lb bag; Best by December 12, 2012; December 13, 2012; December 14, 2012; March 5, 2013; March 6, 2013)
• Natural Balance Sweet Potato & Venison Dog (28 lb bag; Best by December 12, 2012; December 13, 2012; December 14, 2012; March 5, 2013; March 6, 2013; March 7, 2013; March 8, 2013; March 12, 2013)
• Natural Balance Lamb Meal & Brown Rice Dog (5 lb, 15 lb, and 28 lb bags; Best by December 10, 2012; December 21, 2012; December 22, 2012)
• Natural Balance Sweet Potato & Bison Dog (5 lb bag; Best by December 17, 2012; December 18, 2012; December 28, 2012; December 29, 2012)
• Natural Balance Sweet Potato & Bison Dog (15 lb and 28 lb bags; Best by December 9, 2012; December 17, 2012; December 18, 2012; December 28, 2012; December 29, 2012)
• Natural Balance Vegetarian Dog (5 lb bag; Best by December 9, 2012)
• Natural Balance Lamb Meal & Brown Rice Dog Large Breed Bites (28 lb bag; Best by December 12, 2012; December 20, 2012; December 21, 2012)
• Natural Balance Lamb Meal & Brown Rice Dog Small Breed Bites (5 lb and 12.5 lb bags; Best by December 21, 2012)
• Premium Edge (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Professional (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• 4Health (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Solid Gold WolfKing Large Breed Adult Dog Food (4-lb pkg; Batch code starting with SGL1201A32X; Best before December 30, 2012; UPC 093766750050)
• Solid Gold WolfKing Large Breed Adult Dog Food (15-lb bag; Batch code starting with SGL1201A32X; Best before December 30, 2012; UPC 093766750067)
• Solid Gold WolfKing Large Breed Adult Dog Food (28.5-lb bag; Batch code starting with SGL1201A32X; Best before December 30, 2012; UPC 093766750081)
• Solid Gold WolfCub Large Breed Puppy Food (4-lb pkg; Batch code starting with SGB1201A31X; Best before December 30, 2012; UPC 093766750005)
• Solid Gold WolfCub Large Breed Puppy Food (15-lb bag; Batch code starting with SGB1201A31X; Best before December 30, 2012; UPC 093766750012)
• Solid Gold WolfCub Large Breed Puppy Food (33-lb bag; Batch code starting with SGB1201A31X; Best before December 30, 2012; UPC 093766750029)
• Taste of the Wild (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Wellness Complete Health® Super5Mix® Large Breed Puppy (15 lb. and 30 lb. bags and 5 oz. sample bags; best by dates of JAN 9 2013 through JAN 11 2013)

Thanks to efoodalert.

The CDC just announced that a total of 316 individuals infected with the outbreak strains of Salmonella Bareilly or Salmonella Nchanga have been reported from 26 states and the District of Columbia. The 58 new cases are from Alabama (1), California (2), Colorado (1), Georgia (3), Illinois (4), Indiana (1), Louisiana (1), Maryland (3), Massachusetts (6), New Jersey (1), New York (10), North Carolina (6), Pennsylvania (5), Tennessee (2), Texas (3), Virginia (6), and Wisconsin (3).

Three hundred and four persons infected with the outbreak strain of Salmonella Bareilly have been reported from 26 states and the District of Columbia. The number of ill persons with the outbreak strain of Salmonella Bareilly identified in each state is as follows: Alabama (3), Arkansas (1), California (4), Colorado (1), Connecticut (9), District of Columbia (2), Florida (1), Georgia (13), Illinois (27), Indiana (1), Louisiana (4), Maryland (27), Massachusetts (33), Mississippi (2), Missouri (4), Nebraska (1), New Jersey (26), New York (48), North Carolina (10), Pennsylvania (25), Rhode Island (6), South Carolina (3), Tennessee (4), Texas (7), Virginia (22), Vermont (1), and Wisconsin (19).

Twelve persons infected with the outbreak strain of Salmonella Nchanga have been reported from 5 states. The number of ill persons with the outbreak strain of Salmonella Nchanga identified in each state is as follows: Georgia (2), New Jersey (2), New York (6), Virginia (1), and Wisconsin (1).

Among 316 persons for whom information is available, illness onset dates range from January 28 to May 3, 2012. Ill persons range in age from <1 to 86 years, with a median age of 30. Fifty-nine percent of patients are female. Among 217 persons with available information, 37 (17%) reported being hospitalized. No deaths have been reported.

The FDA Inspection on Moon Marine found that tanks used for storage of process waters have apparent visible debris, filth and microbiological contamination. Sand and activated carbon filter units used in manufacturing of water are not sanitized, and ventilation for tanks is not filtered to protect against contamination. There is no laboratory analysis for water used in ice manufacturing at the REDACTED facility to show the water used to make ice is potable. Ice manufacturing lacks sanitary controls: ice manufacturing equipment at the Moon Fishery facility is located outside and is susceptible to adulteration from pests and the environment. Apparent bird feces were observed on the ice manufacturing equipment at Moon Fishery; insects and filth were observed in and on the equipment. Ice manufacturing equipment at your REDACTED facility is rusty and situated so that the ice cannot be protected against adulteration, as the ice manufacturing process is constructed into the flooring of the ice facility. Tuna processed at your facility, which is consumed raw or cooked, comes in direct contact with water and ice.

Some of the floor and wall tiles in the tuna processing area are broken and cracked, not allowing for proper cleaning.  After cleaning, the ceiling directly above the in-process tuna line was observed to have visible product residue. After cleaning, product residues and rust were observed on knives and utensil storage boxes. These knives are used to cut raw tuna.  Peeling paint was observed directly above the in-process tuna line.  There was no hand drying devices available in the employee rest rooms on the first floor.

As disturbing as the above were the pictures posted on the FDA website that clearly should on the exterior of the boxes that Tuna Scape was supposed to be cooked, not served raw as a “sushi-like” product.

"While it is our policy not to release information during a pending investigation unless it affects the health of the citizens of South Carolina, the El Mexicano on East Main Street in Spartanburg has voluntarily agreed to release its name to the public." DHEC Director Catherine Templeton said. "We’ve found no conclusive link between the restaurant and those who have gotten sick during this outbreak."

Templeton said the management of El Mexicano #6 has cooperated fully with DHEC inspectors, who found no substantial violations during the restaurant’s most recent inspection on May 11 where the facility scored an “A” rating. The restaurant also scored an “A” rating during an unannounced routine inspection in February.

"We've willingly answered all questions, as well as reviewed our menu items practices since DHEC inspectors first approached us in the early stages of their investigation," El Mexicano #6 Owner Martin Mata said. "We're glad that DHEC has found that our restaurant presents no health threat to our valued customers. This is the first problem we've had like this in more than 15 years in the business.

“In the interest of all Mexican restaurants in Spartanburg, we felt it was important to come forward and share what DHEC has determined so far in its investigation and our willingness to assist the agency any way that we can,” Mata said. “We’ll continue to work with DHEC to get to the bottom of this situation.”

According to Templeton, DHEC’s investigation will continue in an effort to determine a possible link between these cases of human illness and a food product.

The ongoing investigation includes one lab-confirmed case of E. coli O157:H7, two cases of Hemolytic Uremic Syndrome, which often follows E. coli infection in children, and seven other cases of diarrheal illness. The most recent case began experiencing symptoms on May 3.

Anyone experiencing severe stomach cramps, diarrhea and vomiting should seek care from their health care provider.

It has been a bad few months for raw milk hucksters and even worse for their customers.

• January to April – Campylobacter in raw milk from Organic Pastures in California – 10 Ill.

• April – E. coli O157:H7, Campylobacter and Cryptosporidium in raw milk from Foundation Farm in Oregon – 21 Ill including 4 with HUS.

• March to April – E. coli in raw milk from Stroupe Farm in Missouri – 14 Ill including 1 with HUS.

• March – Campylobacter in raw milk from Claravale Farm in California – 9 Ill.

• January to February – Campylobacter in raw milk from Family Cow Dairy in Pennsylvania – 80 Ill.

• January – Campylobacter in raw goat milk from unnamed dairy in Kansas – 18 Ill.

Raw Dairy Outbreaks and Recalls from 1998 to the present:

119 total outbreaks

86 fluid milk: 18 cow, 4 goat, 64 unspecified milk type

27 cheese: 2 aged, 3 homemade, 17 Mexican-style queso fresco, 1 goat chevre, 1 curds, 3 unspecified

6 multiple raw dairy products (fluid milk, cheese, and/or colostrum)

2,147 total illnesses, 2 deaths

1,514 fluid milk-related illnesses, no deaths: 249 cow, 63 goat, 1,202 unspecified

576 cheese-related illnesses: 46 aged, 80 homemade, 324 Mexican-style queso fresco (2 deaths), 5 goat chevre, 63 curds, 58 unspecified cheese type

57 multiple raw dairy products-related illnesses (fluid milk, cheese, and/or colostrum)

A risky elixir! For the facts about raw milk, see Real Raw Milk Facts.

Consolidated list of recalled dry pet food products (as of May 11, 2012)

• Apex Chicken and Rice Dog (20-lb and 40-lb bags; Production code ACD0101B32; Best by date 24-Jan-2013)
• Canidae Dog Dry Dog Food, All Life Stages (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Canidae Dog Dry Dog Food, Chicken Meal & Rice (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Canidae Dog Dry Dog Food, Lamb Meal & Rice (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Canidae Dog Dry Dog Food, Canidae Platinum (All packages sizes; Best before date between December 9, 2012 through January 31, 2013; Production code must have the number “3″ in the 9th digit AND the letter “X” in the 10th or 11th digit)
• Chicken Soup for the Pet Lover’s Soul (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Country Value (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Diamond (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Diamond Naturals (All package sizes and formulas; Best before dates between December 9, 2012 and April 7, 2013; Production codes have a number “2″ or “3″ in the 9th digit and the letter “X” in the 10th or 11th digit)
• Kirkland Signature Super Premium Adult Dog Lamb, Rice & Vegetable Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Adult Dog Chicken, Rice & Vegetable Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Mature Dog Chicken, Rice & Egg Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Healthy Weight Dog Formulated with Chicken & Vegetables (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Maintenance Cat Chicken & Rice Formula (Best Before December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Super Premium Healthy Weight Cat Formula (December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Kirkland Signature Nature’s Domain Salmon Meal & Sweet Potato Formula for Dogs (December 9, 2012 through January 31, 2013; Production codes have a number “3″ in the 9th digit and the letter “X” in the 11th digit)
• Natural Balance Sweet Potato & Venison Dog (5 lb bag; Best by December 12, 2012; December 13, 2012; March 13, 2013)

Thanks to efoodalert.

The South Carolina Department of Health and Environmental Control (DHEC) is requesting heightened surveillance for persons presenting with symptoms consistent with Shiga toxin producing E. coli (i.e., enterohemorrhagic E. coli), including diarrhea that is often bloody, hemolytic uremic syndrome (HUS) in children or thrombocytopenia purpura in adults.

Summary

DHEC is investigating an outbreak of Shiga toxin-producing Escherichia coli (STEC) related to dining at a Spartanburg-area Mexican restaurant during the last week of April, 2012. Preliminary lab results indicate the E. coli serotype being O157:H7. Of the 3 cases interviewed thus far, two reported the infection has progressed to hemolytic uremic syndrome (HUS), a severe condition associated with STEC infection that can lead to kidney failure. Interviews with an additional 8 cases are in progress.

Guidance for Clinicians

Symptoms

DHEC recommends a high index of suspicion for STEC infection for patients presenting with STEC symptoms and a history of dining at a Spartanburg- area Mexican restaurant near the end of April, 2012.

Clinical syndromes associated with a Shiga toxin producing E. coli infection include

Gastroenteritis with diarrhea and abdominal cramps (fever and bloody stools may or may not be 
present), and/or Hemolytic uremic syndrome (HUS) with or without gastroenteritis, which typically develops a week after the onset of diarrhea. 
Hemolytic uremic syndrome (HUS) is characterized by the triad of acute onset of microangiopathic hemolytic anemia, renal injury, and low platelet count. Most cases of HUS occur after an acute gastrointestinal illness (usually diarrheal). 
Management 
Management of STEC is typically supportive, as most patients recover within 5-7 days. Antibiotics for gastroenteritis are generally not recommended, as there have been reports of increased incidence of post-diarrheal HUS when antibiotics are used to manage STEC infections. 
The CDC does not recommend the use of antibiotics for patients with suspected STEC infections until complete diagnostic testing can be performed and STEC infection is ruled out. However, clinical decision making must be tailored to each individual patient. There may be indications for antibiotics in patients with severe intestinal inflammation if perforation is of concern.

Testing

•  All stools submitted for testing from patients with acute community-acquired diarrhea should be cultured for STEC O157:H7. These stools should be simultaneously assayed for non-O157 STEC with a test that detects the Shiga toxins or the genes encoding these toxins.

•  Clinical laboratories should report and send E. coli O157:H7 isolates and Shiga toxin- positive samples to the SC DHEC Bureau of Laboratories (BOL) as soon as possible for additional characterization.

•  Specimens or enrichment broths in which Shiga toxin or STEC are detected, but from which O157:H7 STEC isolates are not recovered should be forwarded as soon as possible to the SC DHEC BOL so that non-O157:H7 STEC can be isolated.

•  It is often difficult to isolate STEC in stool by the time a patient presents with HUS. Immunomagnetic separation (IMS) has been shown to increase recovery of STEC from HUS patients. For any patient with HUS without a culture-confirmed STEC infection, stool can be sent to the SC DHEC BOL for IMS or to the CDC (through the BOL). In addition, serum can be sent to CDC (through the BOL) for serologic testing of common STEC serogroups. 
The benefits of adhering to the recommended testing strategy include early diagnosis, improved patient outcome, and detection of all STEC serotypes. 
Reporting of Cases 
Cases of bloody diarrhea or a clinical presentation consistent with STEC, coupled with the epidemiologic criteria described above, should be reported to your local health department via the phone numbers listed below. DHEC will arrange for collection of stool samples for testing, as appropriate. 
Any laboratory confirmed acute case associated with Shiga toxin producing E. coli or E. coli identified as serogroup O157:H7 should be reported within 24 hours to DHEC, as per the current DHEC List of Reportable Conditions.

Resources for Additional Information

•  www.about-ecoli.com

•  CDC E. coli Investigation updates (www.cdc.gov/ecoli/2011/ecoliO104/index.html)

•  CDC E. coli Resources for Clinicians (www.cdc.gov/ecoli/clinicians.htm)

•  CDC E. coli General Information (http://www.cdc.gov/nczved/divisions/dfbmd/diseases/ecoli_157h7/)

•  MMWR – “Recommendations for Diagnosis of Shiga Toxin–Producing Escherichia coli Infections by Clinical Laboratories” (www.cdc.gov/mmwr/PDF/rr/rr5812.pdf)

•  WHO E. coli Investigation updates (www.who.int/csr/don/en/index.html)

•  FoodSafety.gov (www.foodsafety.gov/) 
DHEC contact information for reportable diseases and reporting requirements 
Reporting of confirmed and suspected Shiga Toxin-producing E. coli cases is consistent with South Carolina Law requiring the reporting of diseases and conditions to your state or local public health department. (State Law # 44-29-10 and Regulation # 61-20) as per the DHEC 2011 List of Reportable Conditions available at: http://www.scdhec.gov/administration/library/CR-009025.pdf Federal HIPAA legislation allows disclosure of protected health information, without consent of the individual, to public health authorities to collect and receive such information for the purpose of preventing or controlling disease. (HIPAA 45 CFR §164.512).

The number of ill persons identified in each state is as follows: Alabama (1), Connecticut (1), Michigan (1), Missouri (3), North Carolina (3), New Jersey (1), Ohio (2), Pennsylvania (2), and Virginia (1). One new ill person was reported from Pennsylvania.  Additionally, one ill person has been reported from Canada.

Among the 10 patients with available information, 5 (50%) were hospitalized. No deaths have been reported.

Multiple brands of dry dog food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections.

The number of ill persons identified in each state is as follows: Alaska (2), Alabama (1), Arizona (3), California (21), Colorado (5), Delaware (3), Georgia (3), Illinois (1), Indiana (1), Kentucky (1), Massachusetts (3), Maryland (6), Michigan (2), Minnesota (1), Nevada (4), New Jersey (7), New Mexico (3), New York (24), North Carolina (1), Ohio (2), Oregon (1), Pennsylvania (9), South Carolina (3), Texas (12), Virginia (3), Vermont (1), and West Virginia (1).

19 ill persons have been hospitalized, and no deaths have been reported.

67% of ill persons are children 10 years of age or younger.

Two new multistate outbreaks linked to small turtles have been identified since the prior update on April 5, 2012. Overall, 5 multistate outbreaks of human Salmonella infection are linked with exposure to small turtles.

Results of the epidemiologic and environmental investigations indicate exposure to turtles or their environments (e.g., water from a turtle habitat) is the cause of these outbreaks.

75% of ill persons reported exposure to turtles prior to their illness.

Small turtles (shell length less than 4 inches) were reported by 93% of cases with turtle exposure. Forty-three percent of ill persons with small turtles reported purchasing the turtles from street vendors.

Small turtles are a well-known source of human Salmonella infections, especially among young children. Because of this risk, the Food and Drug Administration has banned the sale and distribution of these turtles as pets since 1975. Turtles with a shell length of less than 4 inches in size should not be purchased as pets or given as gifts.

CDFA ANNOUNCES RECALL OF RAW MILK PRODUCTS AT ORGANIC PASTURES OF FRESNO COUNTY

Ten illnesses reported

SACRAMENTO, May 10, 2012 - 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. 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-Barre syndrome that causes weakness and paralysis can occur several weeks after the initial illness.

A Recent 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.  Final Report.

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. This is the state report from 2006: http://www.marlerblog.com/rawmilk(1)(1)(1)(1).pdf. 

See also, Raw Milk Myth Buster 1 - Organic Pastures 2006 Raw Milk E. coli Outbreak was caused by Spinach.

2006: 3 strains of E. coli O157:H7 cultured from OPDC heifer feces - 

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

2007: 50 strains of Campylobacter jejuni plus Campylobacter coli, Campylobacter fetus, Campylobacter hyointetinalis, and Campylobacter lari cultured from OPDC dairy cow feces - 

http://www.marlerclark.com/pdfs/ClusterofCampylobacterinfectionsrawmilkEpi22007.pdf

2007: Listeria monocytogenes cultured from Organic Pastures Grade A raw cream - 

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

2008: Campylobacter cultured from Organic Pastures Grade A raw cream - http://www.cdfa.ca.gov/egov/Press_Releases/Press_Release.asp?PRnum=08-061

For more about the risks of raw milk, see Real Raw Milk Facts Dot Com.

The US Food and Drug Administration is already involved in tracing the origin of the ingredient to identify source of contamination as well as the potential for other Salmonella outbreaks in the US.

As of May 10 at 2 PM, Buncombe County Department of Health reports 58 cases associated with salmonella outbreak. Please keep in mind that this number does not include cases being reported in other counties or states.

NC Department of Public Health reports 63 cases, which includes cases in NC and other states; however there is a slight delay in reporting.

What is it with pet food?

As of July 29, 2010, a total of 34 individuals infected with a matching strain of Salmonella serotype I 4,[5],12:i:- have been reported from 17 states since January 1, 2010. The number of ill persons identified in each state with this strain is as follows: AL (1), AZ (1), CO (1), GA (7), IA (1), IL (3), MA (3), MI (1), MO (3), NC (3), NV (1), NY (2), SC (1), TN (1), VA (1), WI (3), and WY (1).  CDC and public health officials in multiple states are conducting an epidemiologic study. Preliminary analysis of this study has suggested an association with frozen rodents used for reptile feed.

And, its not like this has not happened before with dog and cat food:

Multistate Outbreak of Human Salmonella Infections Caused by Contaminated Dry Dog Food --- United States, 2006--2007

Update: Recall of Dry Dog and Cat Food Products Associated with Human Salmonella Schwarzengrund Infections --- United States, 2008

Moon Fisheries, the manufacturer of the previously recalled Nakaochi Scrape is recalling its 22 pound cases of "Tuna Strips" Product of India AA or AAA GRADE because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. 

Moon India became aware of the problem after the FDA sampled tuna strips from a lot not yet in distribution. However as a cautionary measure Moon India agreed to recall tuna strips that were already distributed, none of which is from the suspect lot sampled by FDA. Distribution of these AA or AAA Grade Tuna Strips Product of India is limited to 4 wholesalers: one in Georgia, one in Massachusetts, one in New Jersey and one in New York.

The wholesalers may have broken the shipments into smaller lots for further distribution. The frozen raw yellow fin tuna product was originally packaged in white boxes with black writing naming the importer as Moon Marine USA Corporation, a separate and independent company, and identifying the contents as Tuna Strips AA or AAA, Product of India. The boxes contain several vacuum-wrapped packages with no further labeling.

On May 4, the Salmonella attorneys at Marler Clark filed a lawsuit on behalf of a Portland man who contracted a Salmonella infection after consuming sushi contaminated with Salmonella serotype Bareilly.  According to a complaint (#cv-00794) filed in Oregon Federal District Court, Chris Fronzak, lead singer for the heavy metal band Attila, consumed a spicy tuna roll containing Nakaochi Scrape at a Metairie, Louisiana restaurant while his band was on tour. Within two days, Mr. Fronzak began to experience severe gastrointestinal symptoms including nausea, vomiting, diarrhea, stomach cramps, fever, headache, and muscle aches. After six days of attempting self-care without any improvement, Mr. Fronzak, who was without health insurance, was taken to the emergency room for treatment. While in the ER, a sample was taken that would ultimately test positive for Salmonella. The complaint alleges Mr. Fronzak suffered physically, emotionally, and economically.

The Salmonella lawyers at Marler Clark filed a lawsuit last week on behalf of Attila frontman Chris “Fronz” Fronzak against Moon Marine USA Corporation after @FRONZ1LLA contracted a Salmonella infection after consuming sushi contaminated with Salmonella serotype Bareilly. The defendant of the lawsuit is Cupertino, California-based Moon Marine USA, the producer of a recalled tuna product that has been linked to a recent multistate Salmonella outbreak by the Centers for Disease Control and Prevention (CDC).

The complaint alleges that at least 258 Salmonella illnesses, including 32 hospitalizations, have been linked to a multi-strain Salmonella outbreak associated with Nakaochi Scrape. The product, also known as tuna scrape, is ground tuna meat scraped from the backbone and ribs of tuna and used in various sushi dishes, chiefly spicy tuna rolls.

According to a complaint (#cv-00794) filed in Oregon Federal District Court, Chris Fronzak, lead singer for the heavy metal band Attila, consumed a spicy tuna roll containing Nakaochi Scrape at a Metairie, Louisiana restaurant while his band was on tour. Within two days, Mr. Fronzak began to experience severe gastrointestinal symptoms including nausea, vomiting, diarrhea, stomach cramps, fever, headache, and muscle aches. After six days of attempting self-care without any improvement, Mr. Fronzak, who was without health insurance, was taken to the emergency room for treatment. While in the ER, a sample was taken that would ultimately test positive for Salmonella. The complaint alleges Mr. Fronzak suffered physically, emotionally, and economically.

"Mr. Fronzak's favorite food was sushi and he has eaten frequently for years without issue. When he sat down to eat a tuna roll, he was expecting to enjoy a few bites of comfort food while on the road with his band," said Fronzak's attorney William Marler. "What he did not expect was to become dangerously ill - taking on heavy financial strain and jeopardizing both his health and his tour."

14 Ill with Salmonella Infantis Linked to Diamond Pet Food

It is not like this has not happened before:

Multistate Outbreak of Human Salmonella Infections Caused by Contaminated Dry Dog Food --- United States, 2006--2007

Update: Recall of Dry Dog and Cat Food Products Associated with Human Salmonella Schwarzengrund Infections --- United States, 2008

Human Salmonellosis Associated with Animal-Derived Pet Treats --- United States and Canada, 2005

The CDC reports a total of 14 individuals infected with the outbreak strain of Salmonella Infantis have been reported from 9 states. The number of ill persons identified in each state is as follows: Alabama (1), Connecticut (1), Michigan (1), Missouri (3), North Carolina (3), New Jersey (1), Ohio (2), Pennsylvania (1), and Virginia (1).

Multiple brands of dry pet food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections. People who think they might have become ill after contact with dry pet food or with an animal that has eaten dry pet food should consult their health care providers.

According to the FDA Diamond has been recalling pet food over the last few weeks:

Diamond Pet Foods Voluntarily Recalls Limited Number of Dry Dog Food Bags Due to a Potential Health Risk Recall is limited to one formula of Diamond Naturals distributed to 12 states

Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination

On May 1, 2012, Smiling Hara recalled its unpasteurized soybean tempeh.  Smiling Hara Tempeh, which makes black bean, black eyed pea, and soy versions of tempeh, pulled the its tempeh products from store shelves after tests came back positive for Salmonella Paratyphi contamination.  The company is warning customers not to eat tempeh with best by dates of July 11 through October 25, 2012.

The tempeh was widely distributed to more than 30 stores and restaurants in North Carolina, including Earth Fare supermarket and the Laughing Seed restaurant.

Salmonella serotype Paratyphi generally causes a bacteremic illness—Salmonella found in the blood—of long duration. This illness is called paratyphoid fever. Symptoms of Salmonella Paratyphi infection start gradually, and include fever, headache, malaise, lethargy, and abdominal pain. In children, it can present as a non-specific fever. The incubation period for Salmonella Paratyphi infections, or time between exposure to the bacterium and illness, is 1 to 10 days.

Multiple brands of dry pet food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections. People who think they might have become ill after contact with dry pet food or with an animal that has eaten dry pet food should consult their health care providers.

Diamond has been recalling pet food over the last few weeks:

Diamond Pet Foods Voluntarily Recalls Limited Number of Dry Dog Food Bags Due to a Potential Health Risk Recall is limited to one formula of Diamond Naturals distributed to 12 states

Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination

And, Diamond has been in the recall news before:  List of recalls for Pet Food Products from Diamond due to Melamine