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

Foodborne Illness Outbreaks

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Watch the Internet for Salmonella Tainted Garden of Life RAW Meal

According to the Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) Salmonella has been confirmed in one person in Wisconsin likely associated with recalled Garden of Life RAW Meal. DATCP is collaborating with Wisconsin Department of Health and the U.S. Food and Drug Administration (FDA) to investigate the latest illness, including tracing the source of the contaminated product. The product, an organic shake and meal replacement, was recalled earlier this year by the company, but consumers have acquired recalled product from internet retailers such as eBay and Amazon. Contaminated product may still be for sale from eBay, Amazon and other internet retailers.

Earlier, the CDC had announced the outbreak over after a total of 33 people infected with the outbreak strain of Salmonella Virchow were reported from 23 states. Epidemiologic and laboratory evidence indicated that RAW Meal Organic Shake & Meal products made by Garden of Life, LLC were the likely source of this outbreak.

On January 29, 2016, Garden of Life, LLC voluntarily recalled a limited quantity of its RAW Meal Organic Shake & Meal products available in chocolate, original, vanilla, and vanilla chai because they had the potential to be contaminated with Salmonella Virchow. The recalled products were available for purchase nationwide in many retail stores and online.

The Utah Public Health Laboratory and Oklahoma Public Health Laboratory isolated the outbreak strain of Salmonella Virchow from open containers of Garden of Life RAW Meal collected from ill people’s homes in Utah and Oklahoma.  Both products that were tested were from lots covered under the recalls announced by Garden of Life, LLC.

FDA sampling confirmed the presence of the outbreak strain of Salmonella Virchow in Organic Moringa Leaf powder used in RAW Meal Organic Shake & Meal Replacement products. On February 12, 2016, Garden of Life, LLC issued an expanded recall of its RAW Meal Organic Shake & Meal products available in chocolate, original, vanilla, and vanilla chai to include additional lots that contained the contaminated Organic Moringa Leaf powder.

Minnesota Salmonella Outbreak Linked to Taylor Farms Organic Kale Medley

OrganicKaleMedley-1web-216x300Pacific Coast Fruit Company posted the following recall notice:

Reason:  Salmonella

Pack/Codes:  The Minnesota Department of Health (MDH) and the Minnesota Department of Agriculture (MDA) are investigating an outbreak of foodborne illnesses associated with eating Taylor Farms Organic Kale Medley “power greens” mix in Minnesota. The mix contains spinach, kale, chard, and shredded carrots.

Distribution:  Sam’s Club pulled Taylor Farms Organic Kale Medley from store shelves nationwide on April 4 and is notifying customers who purchased the product in Minnesota since March 1.

Illnesses:  Six people with Salmonella Enteritidis infections with the same rare DNA fingerprint pattern were reported to MDH in April. The people range in age from 7 to 69 and are from Dakota, Hennepin, Itasca, Olmsted and St. Louis counties. Their illnesses began between April 3 and April 26. One person was hospitalized, and all are recovering. Five of the ill people in Minnesota reported eating Taylor Farms Organic Kale Medley purchased at several Sam’s Club locations, and the source of the sixth person’s illness is under investigation.

According to the FDA website, Kale was also recalled by Trader Joe’s due to Salmonella concerns.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella 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 Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

Sprouts Behaving Badly – Again with Salmonella

big-map-5-9-16The CDC reports today that a total of 26 people infected with the outbreak strains of Salmonella Muenchen (25 people) or Salmonella Kentucky (1 person) were reported from 12 states. A list of states and the number of cases in each can be found on the Case Count Map page.

Among people for whom information was available, illnesses started on dates ranging from November 26, 2015 to April 7, 2016. Ill people ranged in age from 12 years to 73, with a median age of 38. Seventy-six percent of ill people were female. Among 26 ill people with available information, 8 (31%) were hospitalized, and no deaths were reported.

Collaborative investigative efforts of state, local, and federal public health and regulatory officials indicated that alfalfa sprouts produced by multiple sprouters from one lot of contaminated seeds were the likely source of this outbreak.

State and local public health officials interviewed ill people to obtain information about foods they might have eaten and other exposures in the week before they became ill. Of the 22 ill people who were interviewed, 17 (77%) reported eating or possibly eating sprouts in the week before illness started. When asked about the type of sprouts eaten, 16 (94%) of these 17 ill people reported eating alfalfa sprouts.

In February 2016, state and local health and regulatory officials in several states performed traceback investigations from multiple restaurants  where ill people ate sprouts. These investigations indicated that Sweetwater Farms of Inman, Kansas supplied alfalfa sprouts to all of these locations.

FDA and Kansas Department of Agriculture conducted an inspection at Sweetwater Farms and collected samples of irrigation water and alfalfa sprouts. Testing of these samples isolated Salmonella Kentucky and Salmonella Cubana. Salmonella Muenchen was not isolated. A review of the CDC PulseNet database identified one recently reported person infected with the same DNA fingerprint of Salmonella Kentucky and this ill person was added to the outbreak case count.

On February 19, 2016, the Kansas Department of Health and Environment issued a warning to consumers to not eat alfalfa sprouts produced by Sweetwater Farms and the company withdrew alfalfa sprouts from the market. On February 26, 2016, Sweetwater Farms informed FDA that it would withdraw all of its sprout products from the market.

After the actions by Sweetwater Farms were taken, people infected with the outbreak strain of Salmonella Muenchen continued to be reported. Many of these ill people reported eating alfalfa sprouts before they got sick. Traceback investigations indicated that several sprouters other than Sweetwater Farms produced the alfalfa sprouts consumed by these ill people. Additional investigation determined that all of these sprouters, as well as Sweetwater Farms, had used a common lot of alfalfa seeds to produce alfalfa sprouts. FDA tested samples of seeds from this lot and isolated Salmonella Cubana with the same DNA fingerprint of the Salmonella Cubana isolated in irrigation water from Sweetwater Farms. FDA reports that the seed supplier contacted sprouters who received the lot of contaminated seeds and asked that they return them. According to FDA, no sprouts from the contaminated seed lot are expected to be on the market.

Massive Vegetable Recall Linked to Listeria Tainted Onions

The FDA, CDC and state and local officials are investigating a multi-state outbreak of listeriosis identified in March 2016.

The CDC reports that eight people infected with the outbreak strains of Listeria monocytogenes have been reported from three states (California, Maryland and Washington) from September 2013 – March 2016. Ill people ranged in age from 56 to 86, with a median age of 76. Epidemiology and laboratory evidence available at this time indicates that frozen vegetables produced by CRF Frozen Foods of Pasco, Washington, and sold under various brand names are one likely source of illnesses in this outbreak. As discussed further below, CRF Frozen Foods has initiated a recall of certain products.

As part of a routine product sampling program the Ohio Department of Agriculture collected packages of frozen vegetable products from a retail location and isolated Listeria monocytogenes from True Goodness by Meijer brand frozen organic white sweet cut corn and frozen organic petite green peas. Both products were produced by CRF Frozen Foods.

Whole genome sequencing showed that the Listeria monocytogenes isolate from the frozen corn was closely related genetically to seven bacterial isolates from ill people, and the Listeria monocytogenes isolate from the frozen peas was closely related genetically to one isolate from an ill person. This close genetic relationship provides additional evidence that the people in this outbreak became ill from eating frozen vegetables produced by CRF Frozen Foods.

Based on the positive findings by the Ohio Department of Agriculture, on April 22, 2016, CRF recalled 11 frozen vegetable products because they may be contaminated with Listeria monocytogenes. On May 2, 2016, following a conversation between FDA, CDC and the firm, CRF Frozen Foods expanded its recall to include all of its frozen organic and traditional fruit and vegetable products manufactured or processed in CRF Frozen Foods’ Pasco facility since May 1, 2014. Approximately 358 consumer products sold under 42 separate brands were recalled.

Additionally, March 2016 environmental samples collected by FDA from Oregon Potato Company, located in Pasco, WA, were found to be closely related genetically to seven of the isolates of ill people associated with this outbreak. Based on this information, Oregon Potato Company voluntarily recalled wholesale onion products, which led to subsequent downstream customer recalls, one of which publicly disclosed Oregon Potato Company as its product source. FDA is working to identify other parts of the relevant supply chain that may have product relating to this outbreak.

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

If you or a family member became ill with a Listeria infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Listeria attorneys for a free case evaluation.

What we need to know during a Listeria Outbreak

With dozens of different brand name frozen vegetable products being recalled, and the sick stretching from Washington, California and Maryland (with the numbers and places likely to rise), what do you need to know about this very nasty bug?

An Introduction to Listeria

Listeria (pronounced liss-STEER-ē-uh) is a gram-positive rod-shaped bacterium that can grow under either anaerobic (without oxygen) or aerobic (with oxygen) conditions. [4, 18] Of the six species of Listeria, only L. monocytogenes (pronounced maw-NO-site-aw-JUH-neez) causes disease in humans. [18] These bacteria multiply best at 86-98.6 degrees F (30-37 degrees C), but also multiply better than all other bacteria at refrigerator temperatures, something that allows temperature to be used as a means of differentiating Listeria from other contaminating bacteria. [18]Called an “opportunistic pathogen,” Listeria is noted to cause an estimated 2,600 cases per year of severe invasive illness. [26] Perhaps not surprisingly then, “foodborne illness caused by Listeria monocytogenes has raised significant public health concern in the United States, Europe, and other areas of the world.” [3] As one noted expert observed, summarizing the history of these bacteria and their significance for public health,Although L. monocytogenes was recognized as an animal pathogen over 80 years ago, the first outbreak confirming an indirect transmission from animals to humans was reported only in 1983, in Canada’s Maritime provinces. In that outbreak, cabbages, stored in the cold over the winter, were contaminated with Listeria through exposure to infected sheep manure. A subsequent outbreak in California in 1985 confirmed the role of food in disseminating listeriosis. Since then Listeria has been implicated in many outbreaks of food-borne illness, most commonly from exposure to contaminated dairy products and prepared meat products, including turkey and deli meats, pâté, hot dogs and seafood and fish. [4]Given its widespread presence in the environment and food supply, the ingestion of Listeria has been described as an “exceedingly common occurrence.”
[18]

The Incidence of Listeria Infections 

Listeria bacteria are found widely in the environment in soil, including in decaying vegetation and water, and may be part of the fecal flora of a large number of mammals, including healthy human adults. [4, 18] According to the FDA, “studies suggest that 1-10% of humans may be intestinal carriers of Listeria.” [14] Another authority notes that the “organism has been isolated from the stool of approximately 5% of healthy adults.” [18] Overall, seasonal trends show a notable peak in total Listeria cases and related-deaths from July through October. [3]Ingested by mouth, Listeria is among the most virulent foodborne pathogens, with up to 20% of clinical infections resulting in death. [3] These bacteria primarily cause severe illness and death in persons with immature or compromised immune systems. [13, 18] Consequently, most healthy adults can be exposed to Listeria with little to any risk of infection and illness. [4, 11]A study published in 1995 projected Listeria infection-rates to the U.S. population, suggesting that an estimated 1,965 cases and 481 deaths occurred in 1989 compared with an estimated 1,092 cases and 248 deaths in 1993, a 44% and 48% reduction in illness and death, respectively. [25] In comparison, a USDA study published in 1996 estimated that there had been 1,795-1860 Listeria-related cases in 1993, and 445-510 deaths, with 85-95% of these attributable to the consumption of contaminated food. [28] Listeriosis-related mortality rates decreased annually by 10.7% from 1990 through 1996, and by 4.3% from 1996 through 2005. [3]Among adults 50 years of age and older, infection rates were estimated to have declined from 16.2 per 1 million in 1989 to 10.2 per 1 million in 1993. [25] Perinatal disease decreased from 17.4 cases per 100,000 births in 1989 to 8.6 cases per 100,000 births in 1993. [25] Neonatal infections are often severe, with a mortality rate of 25-50%. [4]

According to the CDC’s National Center for Zoonotic, Vector-Borne, and Enteric Diseases:Listeriosis was added to the list of nationally notifiable diseases in 2001. To improve surveillance, the Council of State and Territorial Epidemiologists has recommended that all L. monocytogenes isolates be forwarded to state public health laboratories for subtyping through the National Molecular Subtyping Network for Foodborne Disease Surveillance (PulseNet). All states have regulations requiring health care providers to report cases of listeriosis and public health officials try to interview all persons with listeriosis promptly using a standard questionnaire about high risk foods. In addition, FoodNet conducts active laboratory- and population-based surveillance. [7]In 2006, public health officials from 48 states reported 1,270 foodborne disease outbreaks, with a confirmed or suspect source in 884 of the outbreaks (70%). [8] Only one of the outbreaks with a confirmed source was attributed to Listeria, with this outbreak involving eleven hospitalizations and one death. [8] The next year, of 17,883 lab-confirmed infections, the CDC attributed 122 to Listeria. [9] In 2009, there were 158 confirmed Listeria infections, representing an incidence-rate of .34 cases for every 100,000 persons in the United States. [10] Such data revealed an incidence-rate of 0.27 cases per 100,000 persons, a decrease of 42% compared with 1996—1998. [10] But, according to CDC’s Technical Information website, it is estimated that there are 1,600 cases of Listeria infection annually in the United States, based on data through 2008. [7]The 2009 numbers represented a reported 30% decrease in the number of infections compared to the 1996—1998 rates of infection. [10] Although the nature and degree of underreporting is subject to dispute, all agree that the confirmed cases represent just the tip of the iceberg. [6, 13] Indeed, one study estimates the annual incidence rate for Listeria to be around 1,795-1,860 cases per 100,000 persons, with 445-510 of the cases ending in death. [28]Finally, in a study of FoodNet laboratory-confirmed invasive cases—where infection is detected in blood, cerebrospinal fluid, amniotic fluid, placenta or products of conception—the number of listeriosis cases decreased by 24% from 1996 through 2003. [33] During this same period, pregnancy-associated disease decreased by 37%, while cases among those fifty years old and older decreased by 23%. [33]

The Prevalence of Listeria in Food and the EnvironmentListeria is a common presence in nature, found widely in such places as water, soil, infected animals, human and animal feces, raw and treated sewage, leafy vegetables, effluent from poultry and meat processing facilities, decaying corn and soybeans, improperly fermented silage, and raw (unpasteurized) milk. [18, 23, 27]  Foods commonly identified as sources of Listeria infection include  improperly pasteurized fluid milk, cheeses (particularly soft-ripened varieties, such as traditional Mexican cheeses, Camembert and ricotta), ice cream, raw vegetables, fermented raw-meat sausages, raw and cooked poultry, and cooked, ready-to-eat (RTE) sliced meats—often referred to as “deli meats”. [18, 21, 23, 28] One study found that, over a five-year period of testing, in multiple processing facilities, Listeria monocytogenes was isolated from 14% of 1,080 samples of smoked finfish and smoked shellfish. [16]Ready-to-eats foods have been found to be a notable and consistent source of Listeria. [14, 21] For example, a research-study done by the Listeria Study Group found that Listeria monocytogenes grew from at least one food specimen in the refrigerators of  64% of persons with a confirmed Listeria infection (79 of 123 patients), and in 11% of more than 2000 food specimens collected in the study. [21] Moreover, 33% of refrigerators (26 of 79) contained foods that grew the same strain with which the individual had been infected, a frequency much higher than would be expected by chance. [21] A widely cited USDA study that reviewed the available literature also summarized that:In samples of uncooked meat and poultry from seven countries, up to 70 percent had detectable levels of Listeria [13].  Schuchat [23] found that 32 percent of the 165 culture-confirmed listeriosis cases could be attributed to eating food purchased from store delicatessen counters or soft cheeses.  In Pinner [21] microbiologic survey of refrigerated foods specimens obtained from households with listeriosis patients, 36 percent of the beef samples and 31 percent of the poultry samples were contaminated with Listeria.

The prevalence of Listeria in ready-to-eat meats has not proven difficult to explain. [26, 29] As one expert in another much-cited article has noted:

The centralized production of prepared ready-to-eat food products…increases the risk of higher levels of contamination, since it requires that foods be stored for long periods at refrigerated temperatures that favour the growth of Listeria. During the preparation, transportation and storage of prepared foods, the organism can multiply to reach a threshold needed to cause infection. [4]

The danger posed by the risk of Listeria in ready-to-eat meats has prompted the USDA to declare the bacterium an adulterant in these kinds of meat products and, as a result, to adopt a zero-tolerance policy for the presence of this deadly pathogen. [7, 29]

A USDA Baseline Data Collection Program done in 1994 documented Listeria contamination on 15.0% of broiler-chicken carcasses [30]. Subsequent USDA data-collection did not test for the prevalence of Listeria in chicken or in turkeys. [31, 32]

Transmission and Infection

Except for the transmission of mother to fetus, human-to-human transmission of Listeria is not known to occur. [18] Infection is caused almost exclusively by the ingestion of the bacteria, most often through the consumption of contaminated food. [18, 21, 23] The most widely-accepted estimate of foodborne transmission is 85-95% of all Listeria cases. [23, 28]

The infective dose—that is, the amount of bacteria that must be ingested to cause illness—is not known. [4, 18, 26] In an otherwise healthy person, an extremely large number of Listeria bacteria must be ingested to cause illness—estimated to be somewhere between 10–100 million viable bacteria (or colony forming units “CFU”) in healthy individuals, and only 0.1–10 million CFU in people at high risk of infection. [4, 18, 26] Even with such a dose, a healthy individual will suffer only a fever, diarrhea, and related gastrointestinal symptoms. [4, 18].

The amount of time from infection to the onset of symptoms—typically referred to as the incubation period—can vary to a significant degree.  Symptoms of Listeria infection can develop at any time from 2 to 70 days after eating contaminated food. [4, 5] According to one authoritative text,

The incubation period for invasive illness is not well established, but evidence from a few cases related to specific ingestions points to 11 to 70 days, with a mean of 31 days. In one report, two pregnant women whose only common exposure was attendance at a party developed Listeria bacteremia with the same uncommon enzyme type; incubation periods for illness were 19 and 23 days. [18]

Adults can get listeriosis by eating food contaminated with Listeria, but babies can be born with listeriosis if their mothers eat contaminated food during pregnancy. [4, 24] The mode of transmission of Listeria to the fetus is either transplacental via the maternal blood stream or ascending from a colonized genital tract. [24] Infections during pregnancy can cause premature delivery, miscarriage, stillbirth, or serious health problems for the newborn. [18, 24]

Incidence of Listeria infection in HIV-positive individuals is higher than in the general population. [17, 18] One study found that:

The estimated incidence of listeriosis among HIV-infected patients in metropolitan Atlanta was 52 cases per 100,000 patients per year, and among patients with AIDS it was 115 cases per 100,000 patients per year, rates 65–145 times higher than those among the general population. HIV-associated cases occurred in adults who were 29–62 years of age and in postnatal infants who were 2 and 6 months of age. [17]

Pregnant women make up around 30% of all infection cases, while accounting for 60% of cases involving the 10- to 40-year age group. [18]

Those Most Susceptible to Infection

Several segments of the population are at increased risk and need to be informed so that proper precautions can be taken. [19,20, 27] The body’s defense against Listeria is called “cell-mediated immunity” because the success of defending against infection depends on our cells (as opposed to our antibodies), especially lymphocytes called “T-cells.” [12] Therefore, individuals whose cell-mediated immunity is suppressed are more susceptible to the devastating effects of listeriosis, including especially HIV-infected individuals, who have been found to have a Listeria-related mortality of 29%. [12, 17, 18]

Pregnant women naturally have a depressed cell-mediated immune system. [18, 24] In addition, the immune systems of fetuses and newborns are very immature and are extremely susceptible to these types of infections. [24] Other adults, especially transplant recipients and lymphoma patients, are given necessary therapies with the specific intent of depressing T-cells, and these individuals become especially susceptible to Listeria as well. [7, 18, 27]

According to the CDC and other public health organizations, individuals at increased risk for being infected and becoming seriously ill with Listeria include the following groups:

  • Pregnant women: They are about 20 times more likely than other healthy adults to get listeriosis. About one-third of listeriosis cases happen during pregnancy.
  • Newborns: Newborns rather than the pregnant women themselves suffer the serious effects of infection in pregnancy.
  • Persons with weakened immune systems
  • Persons with cancer, diabetes, or kidney disease
  • Persons with AIDS: They are almost 300 times more likely to get listeriosis than people with normal immune systems.
  • Persons who take glucocorticosteroid medications (such as cortisone)
  • The elderly [11, 20, 21]

Symptoms of Listeria infection

When a person is infected and develops symptoms of Listeria infection, the resulting illness is called listeriosis. [4, 11, 18] Only a small percentage of persons who ingest Listeria fall ill or develop symptoms. [18] For those who do develop symptoms as a result of their infection, the resulting illness is either mild or quite severe—sometimes referred to as a “bimodal distribution of severity.” [13, 28]

On the mild end of the spectrum, listeriosis usually consists of the sudden onset of fever, chills, severe headache, vomiting, and other influenza-type symptoms. [18, 28]  Along these same lines, the CDC notes that infected individuals may develop fever, muscle aches, and sometimes gastrointestinal symptoms such as nausea or diarrhea. [11] When present, the diarrhea usually lasts 1-4 days (with 42 hours being average), with 12 bowel movements per day at its worst. [18]

Most healthy adults and children who consume contaminated food experience only mild to moderate symptoms. The infection is usually self-limited, since, in healthy hosts, exposure to Listeria stimulates the production of tumour necrosis factor and other cytokines, which activate monocytes and macrophages to eradicate the organism.  Few people with normal immune function go on to have more severe, life-threatening forms of listeriosis, characterized by septic shock, meningitis and encephalitis. [4]

As already noted, when pregnant, women have a mildly impaired immune system that makes them susceptible to Listeria infection. [19] If infected, the illness appears as an acute fever, muscle pain, backache, and headache. [18, 24] Illness usually occurs in the third trimester, which is when immunity is at its lowest. [18] Infection during pregnancy can lead to premature labor, miscarriage, infection of the newborn, or even stillbirth. [24, 28] Twenty-two percent of such infections result in stillbirth or neonatal death. [18]

Newborns may present clinically with early-onset (less than 7 days) or late-onset forms of infection (7 or more days). [3] Those with the early-onset form are often diagnosed in the first 24 hours of life with sepsis (infection in the blood). [3, 18] Early-onset listeriosis is most often acquired through trans-placental transmission. [18, 24] Late-onset neonatal listeriosis is less common than the early-onset form. [4, 18, 24] Clinical symptoms may be subtle and include irritability, fever and poor feeding. [24] The mode of acquisition of late-onset listeriosis is poorly understood. [18, 24]

Diagnosis and Treatment of Listeria Infections

Because there are few symtpoms that are unique to listeriosis, doctors must consider a variety of potential causes for infection, including viral infections (like flu), and other bacterial infections that may cause sepsis or meningitis. [4, 18, 19]

Early diagnosis and treatment of listeriosis in high-risk patients is critical, since the outcome of untreated infection can be devastating. This is especially true for pregnant women because of the increased risk of spontaneous abortion and preterm delivery. Depending on the risk group, rates of death from listeriosis range from 10% to 50%, with the highest rate among newborns in the first week of life. [4]

Methods typically used to identify diarrhea-causing bacteria in stool cultures interfere or limit the growth of Listeria, making it less likely to be identified and isolated for further testing. [18] On the other hand, routine methods are effective for isolating Listeria from spinal fluid, blood, and joint fluid. [4, 18] Magnetic-resonance imaging (MRI) is used to confirm or rule out brain or brain stem involvement. [18]

Listeriosis is usually a self-limited illness—which means that a majority of infected individuals will improve without the need for medical care. [4, 11, 14, 18] But for those patients with a high fever, a stool culture and antibiotic-treatment may be justified for otherwise healthy individuals. [4, 18] Although there have been no studies done to determine what drugs or treatment duration is best, ampicillin is generally considered the “preferred agent.” [18] There is no consensus on the best approach for patients who are allergic to penicillins.[18]

Invasive infections with Listeria can be treated with antibiotics. [18] When infection occurs during pregnancy, antibiotics given promptly to the pregnant woman can often prevent infection of the fetus or newborn. [18, 24] Babies with listeriosis receive the same antibiotics as adults, although a combination of antibiotics is often used until physicians are certain of the diagnosis.

Complications of Listeria infection

For those persons who suffer a Listeria infection that does not resolve on its own, the complications (or sequelae) can be many. [4, 28] The most common is septicemia (bacterial pathogens in the blood, also known as bacteremia), with meningitis being the second most common. [4, 18] Other complications can include inflammation of the brain or brain stem (encephalitis), brain abscess, inflammation of the heart-membrane (endocarditis), and localized infection, either internally or of the skin. [18]

Death is the most severe consequence of listeriosis, and it is tragically common. [3] For example, based on 2009 FoodNet surveillance data, 89.2% of Listeria patients ended up in the hospital, the highest hospitalization rate for pathogenic bacterial infection. [10] In persons 50 years of age and older, there was a 17.5% fatality rate—also the highest relative to other pathogens. [10, 18]

The Economic Impact of Listeria Infections

The USDA Economic Research Service (ERS) published its first comprehensive cost estimates for sixteen foodborne bacterial pathogens in 1989. [22]  Five years later, it was estimated that, in 1993, there were 1,795 to 1,860 Listeria infections that required hospitalization, with 295-360 of these cases involving pregnant women. [28]  Based on these estimates, the medical costs that Listeria infections had caused each year were said to run from $61.7 to $64.8 million, including those individuals who ultimately died as a result of their infections. [28] For these same acute cases, productivity costs were estimated to run from $125.8 to $154.4 million a year. [28] The productivity costs associated with Listeria-related chronic illness was estimated to be an additional $38 million a year. [28] In sum, “[e]stimates of total costs for the 1,795 to 1,860 cases of listeriosis range from $232.7 million to $264.4 million annually.” [28]

In 2000, USDA updated the cost-estimates for four pathogens:  Campylobacter, Salmonella, E. coli O157:H7, and Listeria monocytogenes. [28a] The 2000 estimates were based on the CDC’s then newly-released estimates of annual foodborne illnesses, and put the total cost in the United States for these four pathogens at $6.5 billion a year. [28a] For Listeria specifically, it was estimated that costs amounted to $2.3 billion per year, based on 2,493 cases, which involved 2,298 hospitalizations and 499 deaths. [28a]  More recently, in 2007, it was estimated that the worldwide cost of all foodborne disease was $1.4 trillion per year. [6]

Real Life Impacts of Listeria Infection

Because Listeria infection is most severe in elderly persons, pregnant women and newborns, the symptoms of infection vary greatly.

  • In older adults or immunocompromised individuals, septicemia (Listeria bacteria in the blood stream) and meningitis are the most common indicators of illness.
  • In pregnant women, a mild, flu-like illness can be followed by miscarriage, premature delivery or stillbirth.
  • In newborns, bacteremia (Listeria bacteria in the blood stream) and meningitis are the most common indicators of Listeria infection.

Antimicrobial Resistance in Bacteria

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

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

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

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

The Prevention of Listeria infection

Given its widespread presence in the environment, and the fact that the vast majority of Listeria infections are the result of consuming contaminated food or water, preventing illness and death is necessarily (and understandably) a food safety issue.

L. monocytogenes presents a particular concern with respect to food handling because it can grow at refrigerator temperatures (4°C to 10°C), temperatures commonly used to control pathogens in foods. Freezing also has little detrimental effect on the microbe. Although pasteurization is sufficient to kill Listeria, failure to reach the desired temperature in large packages can allow the organism to survive. Food can also be contaminated after processing by the introduction of unpasteurized material, as happens during the preparation of some cheeses. Listeria can also be spread by contact with contaminated hands, equipment and counter tops. [4]

The use of irradiation to reduce Listeria to safe levels in foods has many proponents. [26] As noted by an eminent CDC researcher, Robert V. Tauxe,

Ready-to-eat meats, such as hot dogs, have already been subjected to a pathogen-killing step when the meat is cooked at the factory, so contamination is typically the result of in-plant contamination after that step. Improved sanitation in many plants has reduced the incidence of infection by half since 1986, but the risk persists, as illustrated by a large hot dog-associated outbreak that occurred in 1999. Additional heat treatment or irradiation of meat after it is packaged would eliminate Listeria that might be present at that point. [26]

The CDC provides a comprehensive list of recommendations and precautions to avoid becoming infected with Listeria, which are as follows:

· Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature. For a list of recommended temperatures for meat and poultry, visit http://www.fsis.usda.gov/PDF/IsItDoneYet_Magnet.pdf.

· Rinse raw vegetables thoroughly under running tap water before eating.

· Keep uncooked meats and poultry separate from vegetables and from cooked foods and ready-to-eat foods.

· Do not drink raw (unpasteurized) milk, and do not eat foods that have unpasteurized milk in them.

· Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.

· Consume perishable and ready-to-eat foods as soon as possible.

Recommendations for persons at high risk, such as pregnant women and persons with weakened immune systems, in addition to the recommendations listed above, include:

· Meats

  • Do not eat hot dogs, luncheon meats, cold cuts, other deli meats (e.g., bologna), or fermented or dry sausages unless they are heated to an internal temperature of 165°F or until steaming hot just before serving.
  • Avoid getting fluid from hot dog and lunch meat packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats.
  • Do not eat refrigerated pâté or meat spreads from a deli or meat counter or from the refrigerated section of a store. Foods that do not need refrigeration, like canned or shelf-stable pâté and meat spreads, are safe to eat. Refrigerate after opening.

· Cheeses

  • Do not eat soft cheese such as feta, queso blanco, queso fresco, brie, Camembert, blue-veined, or panela (queso panela) unless it is labeled as made with pasteurized milk. Make sure the label says, “MADE WITH PASTEURIZED MILK.”

· Seafood

  • Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole, or unless it is a canned or shelf-stable product. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna, and mackerel, is most often labeled as “nova-style,” “lox,” “kippered,” “smoked,” or “jerky.” These fish are typically found in the refrigerator section or sold at seafood and deli counters of grocery stores and delicatessens. Canned and shelf stable tuna, salmon, and other fish products are safe to eat.

Recommendations to keep food safe

· Be aware that Listeria monocytogenes can grow in foods in the refrigerator. Use an appliance thermometer, such as a refrigerator thermometer, to check the temperature inside your refrigerator. The refrigerator should be 40°F or lower and the freezer 0°F or lower.

· Clean up all spills in your refrigerator right away–especially juices from hot dog and lunch meat packages, raw meat, and raw poultry.

· Clean the inside walls and shelves of your refrigerator with hot water and liquid soap, then rinse.

· Divide leftovers into shallow containers to promote rapid, even cooling. Cover with airtight lids or enclose in plastic wrap or aluminum foil. Use leftovers within 3 to 4 days.

· Use precooked or ready-to-eat food as soon as you can. Do not store the product in the refrigerator beyond the use-by date; follow USDA refrigerator storage time guidelines:

  • Hot Dogs – store opened packages no longer than 1 week and unopened packages no longer than 2 weeks in the refrigerator.
  • Luncheon and Deli Meat – store factory-sealed, unopened packages no longer than 2 weeks. Store opened packages and meat sliced at a local deli no longer than 3 to 5 days in the refrigerator. [11]

Additional preventive steps and precautions can be found on the websites of most State Departments of Health, including, for example, the Minnesota Department of Health. [20] There is also excellent information to be found at the Extension Service website of the Institute of Food and Agricultural Sciences at University of Florida. [27]

References

  1. Angulo, F.J., et al., “Antimicrobial Use in Agriculture: Controlling the Transfer of Antimicrobial Resistance to Humans,” SEMINARS IN PEDIATRIC INFECTIOUS DISEASES, Vol. 15, No. 2, pp. 78-85 (April 2004).
  2. Angulo, F.J., et al., “Evidence of an Association Between Use of Anti-microbial Agents in Food Animals and Anti-microbial Resistance Among Bacteria Isolated from Humans and the Human Health Consequences of Such Resistance, JOURNAL OF VETERINARY MEDICINE, Series-B, Vol. 51, Issue 8-9, pp. 374-79 (Oct. 2004).
  3. Bennion, J.R., et al., “Decreasing Listeriosis Mortality in the United States, 1990-2005,” CLINICAL INFECTIOUS DISEASES, Vol. 47, No. 7, pp. 867-74 (2008), available online at http://cid.oxfordjournals.org/content/47/7/867.long
  4. Bortolussi, R, “Listeriosis: A Primer,” CANADIAN MEDICAL ASSOCIAION JOURNAL, Vol. 179, No. 8, pp. 795-7 (Oct. 7, 2008), online at http://www.cmaj.ca/content/179/8/795.long
  5. Bryan, Frank, “Procedures to Investigate Foodborne Illness,” International Association for Food Protection, p. 119 (5th ed. 1999).
  6. Buzby, Jean and Roberts, Tonya, “The Economics of Enteric Infections: Human Foodborne Disease Costs, GASTROENTEROLOGY, Vol. 136, No. 6, pp. 1851-62 (May 2009).
  7. CDC, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, “Listeriosis—Technical Information,” (last updated: April 6, 2011), available online at http://www.cdc.gov/nczved/divisions/dfbmd/diseases/listeriosis/technical.html
  8. CDC, “Surveillance for Foodborne Disease Outbreaks—United States, 2006,” MORBIDITY AND MORTALITY WEEKLY REPORT, Vol. 58, No. 22, pp. 609-15 (June 12, 2007) at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5822a1.htm
  9. CDC, “Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly through Food—10 States, 2007,” MORBIDITY AND MORTALITY WEEKLY REPORT, Vol. 57, No. 14, pp. 366-70 (April 11, 2008), available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5714a2.htm
  10. CDC, “Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly through Food—10 States, 2009,” MORBIDITY AND MORTALITY WEEKLY REPORT, Vol. 59, No. 14, pp. 418-22 (April 16, 2010) available online at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5914a2.htm
  11. CDC, National Center for Zoonotic, Vector-Borne, and Enteric Diseases, “Listeriosis—General Information and Frequently Asked Questions,” (last updated: April 6, 2011), available at http://www.cdc.gov/nczved/divisions/dfbmd/diseases/listeriosis/
  12. Cossart, P. and Bierne, H., “The Use f Host Cell Machinery in the Pathogenesis of Listeria monocytogenes,” CURRENT OPINIONS IN IMMUNOLOGY, Vol. 13, No. 1, pp. 96-103 (Feb. 2001).
  13. Council for Agriculture, Science and Technology (CAST), “Foodborne Pathogens: Risks and Consequences: Task Force Report No.122,” pp. 1-87 (Sept. 1994) download at http://www.castscience.org/publications/index.cfm/foodborne_pathogens_risks_and_consequences?show=product&productID=2852
  14. FDA, “Bad Bug Book: Foodborne Pathogenic Microorganisms and Natural Toxins Handbook—Listeria monocytogenes,” at http://www.cfsan.fda.gov/~mow/chap6.html (site last updated: June 18, 2009).
  15. FDA, Public Meeting, “Listeria monocytogenes Risk Assessment and Risk Management: December 4, 2003 Meeting,” Meeting Agenda and Presentations, available online at http://www.fda.gov/Food/ScienceResearch/ResearchAreas/RiskAssessmentSafetyAssessment/ucm209515.htm For Notice of Public Meeting, see 68 Fed. Reg., Vol. 68, No. 216, at 63108-09, online at http://www.fda.gov/OHRMS/DOCKETS/98fr/03-28045.pdf
  16. Heinitz, M.L. and Johnson, J.M., “The incidence of Listeria spp., Salmonella spp., and Clostridium botulinum in Smoked Fish and Shellfish,” Journal of Food Protection, Vol. 61, pp. 318-23 (March 1998).
  17. Jurado, R.L., et al., “Increased Risk of Meningitis and Bacteremia Due to Listeria monocytogenes in Patients with Human Immunodeficiency Virus Infection,” Clinical Infectious Diseases, Vol. 17, No. 2, pp. 224-7 (1993).
  18. Lorber, Bennett, “Listeria monocytogenes,” in Mandell, Douglas, And Bennett’s PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES, Fifth Edition, Chap. 195, pp. 2208-14 (2000, Mandell, Bennett, and Dolan, Editors).
  19. Mayo Clinic.  (2009). Listeria infection (listeriosis). Retrieved November 1, 2009 from Mayo Clinic website:  http://www.mayoclinic.com/health/Listeria-infection/DS00963.
  20. Minnesota Department of Health (MDH), “Preventing Listeriosis,” available online at http://www.health.state.mn.us/divs/idepc/diseases/listeriosis/prevention.html
  21. Pinner, R.W., et al., “Role of Foods in Sporadic Listeriosis. II. Microbiologic and epidemiologic investigation, JOURNAL OF AMERICAN MEDICAL ASSOCIATION, Vol. 267, No. 15, pp. 2046-50 (April 15, 1992).
  22. Roberts, T, “Human Illness Costs of Foodborne Bacteria,” AMERICAN JOURNAL OF AGRICULTURE ECONOMICS, Vol. 71, No. 2, pp. 468-474 (1989).
  23. Schuchat, A, et al., “Role of Foods in Sporadic Listeriosis. I. Case-control Study of Dietary Risk Factors,” JOURNAL OF AMERICAN MEDICAL ASSOCIATION, Vol. 267, No. 15, pp. 2041-5 (April 15, 1992).
  24. Silver, HM, “Listeriosis during pregnancy,” OBSTETRICAL AND GYNECOLOGICAL SURVEY, Vol. 53, Issue 12, pp. 737-740 (Dec. 1998).
  25. Tappero, JW, et al., “Reduction in the Incidence of Human Listeriosis in the United States: Effectiveness of Prevention Efforts,” JOURNAL OF AMERICAN MEDICAL ASSOCIATION, Vol.  273, No. 14, pp. 1118-22 (April 12, 1995).
  26. Tauxe, Robert, CDC, “Food Safety and Irradiation: Protecting the Public from Foodborne Infections,” EMERGING INFECTIOUS DISEASES, Vol. 7, No. 3, pp. 516-21 (June 2001) at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2631852/pdf/11485644.pdf
  27. University of Florida, IFIS Extension, “Preventing Foodborne Illness: Listeriosis,” Food Science and Human Nutrition Department, Florida Cooperative Extension Service, (Jan. 2003) online at http://edis.ifas.ufl.edu/fs102
  28. USDA Economic Research Service, “Bacterial Foodborne Disease—Medical Costs and Productivity Losses,” AER-741, August 1996 (authors: Jean C. Buzby, et al.) online athttp://www.ers.usda.gov/Publications/AER741/  28a. USDA Economic Research Service, S. Crutchfield and T. Roberts, “Food Safety Efforts Accelerate in the 90’s,” FOOD REVIEW, Vol. 23, No. 3, pp. 44-49 (Sept.-Dec. 2000), online at http://www.ers.usda.gov/publications/foodreview/septdec00/FRsept00h.pdf
  29. USDA Food Safety and Inspection Service (FSIS), “Assessing the Effectiveness of theListeria monocytogenes Interim Final Rule, Summary Report,” (Sept. 28, 2004), available online at http://www.fsis.usda.gov/Oppde/rdad/frpubs/97-013F/LM_Assessment_Report_2004.pdf
  30. USDA FSIS, NATIONWIDE BROILER CHICKEN MICROBIOLOGICAL BASELINE DATA COLLECTION PROGRAM, July 1994—July 1995, (April 1996), full report available online at http://www.fsis.usda.gov/OPHS/baseline/broiler1.pdf
  31. USDA FSIS, THE NATIONWIDE MICROBIOLOGICAL BASELINE DATA COLLECTION PROGRAM: YOUNG CHICKEN SURVEY, July 2007—June 2008, full report available online at http://www.fsis.usda.gov/PDF/Baseline_Data_Young_Chicken_2007-2008.pdf
  32. USDA FSIS, THE NATIONWIDE MICROBIOLOGICAL BASELINE DATA COLLECTION PROGRAM: YOUNG TURKEY SURVEY, Aug. 2008—July 2009, at http://www.fsis.usda.gov/PDF/Baseline_Data_Young_Turkey_2008-2009.pdf
  33. Voetsch, AC, et al., “Reduction in the Incidence of Invasive Listeriosis in Foodborne Diseases Active Surveillance Network Sites, 1996-2003,” CLINICAL INFECTIOUS DISEASES, Vol. 44, No. 4, pp. 513-20 (CDC Control & Prevention Emerging Infections Program, Foodborne Diseases Active Surveillance Network Working Group 2007).
  34. Wallinga, D, “Antimicrobial Use in Animal Feed:  An Ecological and Public Health Problem,” MINNESOTA MEDICINE, Vol. 85, No. 10 pp. 12-16 (Oct. 2002).

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

CRF Frozen Foods Tied to Listeria Outbreak in California, Maryland and Washington

big-map-5-3-16-300x193Since March 2016, CDC has been collaborating with public health officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Listeria monocytogenes infections (listeriosis).

Eight people infected with the outbreak strains of Listeria have been reported from three states since September 13, 2013. All eight people were hospitalized, including one from Maryland and one from Washington who died, although listeriosis was not considered to be a cause of death for either person.

Epidemiologic and laboratory evidence available at this time indicates that frozen vegetables produced by CRF Frozen Foods of Pasco, Washington and sold under various brand names are one likely source of illness in this outbreak.

Investigations are ongoing to determine if food sources used to manufacture CRF Frozen Foods products could explain some of the illnesses. On April 23, 2016, CRF Frozen Foods recalled 11 frozen vegetable products because they may be contaminated with Listeria. On May 2, 2016, CRF Frozen Foods expanded the initial recall to include all organic and traditional frozen vegetable and fruit products processed in its Pasco, Washington facility since May 1, 2014. Approximately 358 consumer products sold under 42 separate brands were recalled. Recalled items were sold nationwide and in Canada. A complete table of recalled products is on the FDA website.

CDC recommends that consumers do not eat, and restaurants and retailers do not serve or sell, recalled organic and traditional frozen vegetables and fruit products.

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

If you or a family member became ill with a Listeria infection after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Listeria attorneys for a free case evaluation.

C. Botulinum, a Nasty Bug

Botulism.jpg-550x0-225x300Botulism is a rare, life-threatening paralytic illness caused by neurotoxins produced by an anaerobic, gram-positive, spore-forming bacterium, Clostridium botulinum. Unlike Clostridium perfringens, which requires the ingestion of large numbers of viable cells to cause symptoms, the symptoms of botulism are caused by the ingestion of highly toxic, soluble exotoxins produced by C. botulinum while growing in foods.

Overview

These rod-shaped bacteria grow best under anaerobic (or, low oxygen), low-salt, and low-acid conditions. Bacterial growth is inhibited by refrigeration below 4° C., heating above 121° C, and high water-activity or acidity. And although the toxin is destroyed by heating to 85° C. for at least five minutes, the spores formed by the bacteria are not inactivated unless the food is heated under high pressure to 121° C. for at least twenty minutes.

The incidence of foodborne botulism is extremely low. Nonetheless, the extreme danger posed by the bacteria has required that “intensive surveillance is maintained for botulism cases in the United States, and every case is treated as a public health emergency.” This danger includes a mortality rate of up to 65% when victims are not treated immediately and properly. Most of the botulism events that are reported annually in the United States are associated with home-canned foods that have not been safely processed. Very occasionally, however, commercially- processed foods are implicated as the source of a botulism events, including sausages, beef stew, canned vegetables, and seafood products.

Symptoms

After their ingestion, botulinum neurotoxins are absorbed primarily in the duodenum and jejunum, and pass into the bloodstream and travel to synapses in the nervous system. There, the neurotoxins cause flaccid paralysis by preventing the release of acetylcholine, a neurotransmitter, at neuromuscular junctions, thereby preventing motor-fiber stimulation. The flaccid paralysis progresses symmetrically downward, usually starting with the eyes and face, and then moving to the throat, chest, and extremities. When the diaphragm and chest muscles become fully involved, respiration is inhibited and, unless the patient is ventilated, death from asphyxia results. Classic symptoms of botulism include nausea, vomiting, fatigue, dizziness, double vision, drooping eyelids, slurred speech, difficulty swallowing, and dryness of skin, mouth, and throat, lack of fever, muscle weakness, and paralysis. Infants with botulism appear lethargic, feed poorly, are constipated, and have a weak cry and poor muscle tone. Throughout all such symptoms, the victims are fully alert and the results of sensory examination are normal.

In foodborne botulism cases, symptoms usually begin anywhere between 12 and 72 hours after the ingestion of toxin-containing food. Longer incubation periods—up to 10 days—are not unknown, however. The duration of the illness is from 1 to 10 (or more) days, depending on host-resistance, the amount of toxin ingested, and other factors. Full recovery often takes from weeks to months. And, as earlier indicated, mortality rate can be from 30% to 65%, with rates generally lower in European countries than in the United States.

Detection and treatment

Although botulism can be diagnosed based on clinical symptoms, its differentiation from other diseases is often difficult—especially in the absence of other known persons affected by the condition. Once suspected, the most direct and effective way to confirm the diagnosis of botulism in the laboratory is testing for the presence of the botulinum toxin in the serum, stool, or gastric secretions of the patient. The food consumed by the patient can also be tested for the presence of toxins. Currently, the most sensitive and widely used method for the detection of the toxins is the mouse neutralization test, which involves injecting serum into mice and looking for signs of botulism. This test typically takes 48 hours, while the direct culturing of specimens takes 5-7 days. Some cases of botulism may go undiagnosed because symptoms are transient or mild, or are misdiagnosed as Guillain-Barre Syndrome.

If diagnosed early, foodborne botulism can be treated with an antitoxin that blocks the action of toxin circulating in the blood. This can prevent patients from worsening, but recovery still takes many weeks. The mainstay of therapy is supportive treatment in intensive care, and mechanical ventilation in case of respiratory failure, which is common.

Long-Term and Permanent Injury

Although a minority of botulism patients eventually recovers their pre-infection health, the majority does not. For those who fully recover, the greatest improvement in muscle strength occurs in the first three months after the acute phase of illness. The outside limit for such improvement appears, however, to be one year. Consequently, physical limitations that still exist beyond the one-year mark are more probably than not permanent. Recovery from acute botulism symptoms may also be followed by persistent psychological dysfunction that may require intervention.

According to a recently published study that tracked the long-term outcomes of 217 cases of botulism, a large majority of patients reported “significant health, functional, and psychosocial limitations that are likely the consequences of the illness.” These limitations included: fatigue, weakness, dizziness, dry mouth, and difficulty lifting things. The victims also reported difficulty breathing caused by moderate exertions, such as walking or lifting heavy items. They were also more likely to have limitations in vigorous activities, like running or playing sports, climbing up three flights of stairs, or carrying groceries. Summarizing its finding, the study concluded that:

Even several years after acute illness, patients who had botulism were more likely than control subjects to experience fatigue, generalized weakness, dizziness, dry mouth, difficulty lifting things, and difficulty breathing caused by moderate exertion.  In addition, patients reported worse overall psycho-social status than did control subjects, with patients being significantly less likely to report feeling happy, calm and peaceful, or full of pep.

There is, as a result, no question that the damaging effects of botulism are life-long.

Some background information on canning

The canning process dates back to the late 18th century in France when the Emperor Napoleon Bonaparte, concerned about keeping his armies fed, offered a cash prize to whoever could develop a reliable method of food preservation. Nicholas Appert conceived the idea of preserving food in bottles, like wine. After fifteen years of experimentation, he realized if food is sufficiently heated and sealed in an airtight container, it would not spoil. More than fifty years later, Louis Pasteur provided the explanation for effectiveness of canning when he was able to demonstrate that the growth of microorganisms is the cause of food spoilage.

An Englishman, Peter Durand, took the idea one step further and replaced the breakable glass bottles with cylindrical tinplate canisters (later shortened to “cans”). Durand did not can foods himself, but sold his patent to two other Englishmen, Bryan Donkin and John Hall, who set up a commercial canning factory. By 1813, Donkin and Hall were busily producing their first canned goods for the British army, thus continuing the connection of canning to the military.

The basic principles of canning have not changed dramatically since Nicholas Appert and Peter Durand developed the process. Heat sufficient to destroy microorganisms is applied to foods packed into sealed, or “airtight” containers. The canned foods are then heated under steam pressure at temperatures of 240-250°F (116-121°C). The amount of time needed for processing is different for each food, depending on the food’s acidity, density and ability to transfer heat.

Processing conditions are chosen and designed to be the minimum needed to ensure that the foods are made “commercially sterile,” while still retaining the greatest flavor and nutrition. The U.S. Food and Drug Administration must first approve all canning-processes. Once the cans are sealed and heat processed, the resulting canned food must maintain its high eating quality for more than two years and be safe to eat as long as the can is not damaged in any way. Historically, commercially canned food has a near-perfect track record, having caused only four outbreaks in over forty years. The last outbreak occurred in 1974 and involving beef stew.

Botulism Associated with Commercial Carrot Juice—Georgia and Florida, September 2006

On September 8, 2006, the Georgia Division of Public Health (GDPH) and CDC were notified of three suspected cases of foodborne botulism in Washington County, Georgia. On September 25, the Florida Department of Health and CDC were notified of an additional suspected case in Tampa, Florida. This report describes the joint effort.

On September 8, the three patients from Washington County, Georgia, went to a local hospital with cranial nerve palsies and progressive descending flaccid paralysis resulting in respiratory failure; the patients had shared meals on September 7. On the evening of September 8, physicians suspected foodborne botulism, notified the state health department, and collected clinical specimens for testing at CDC. On the same evening, CDC provided clinical consultation and dispatched botulinum antitoxin, which was administered to each of the patients the following morning. After receiving antitoxin, the patients had no progression of neurologic symptoms, but they remain hospitalized and on ventilators.

On September 9, the Washington County Health Department, Richmond County Health Department, and GDPH launched an investigation. The three patients had consumed several food items during their two meals together on September 7, including juice from a single 1-liter bottle of Bolthouse Farms carrot juice. The bottle had a “best if used by” date of September 18, 2006. Clinical specimens and leftover food and juice were collected and sent to CDC for testing. On September 13, botulinum toxin type A was identified in the serum and stool of all three patients. On September 15, leftover carrot juice recovered from the home of one of the patients also tested positive for botulinum toxin type A.

During September 8-15, FDA, the Georgia Department of Agriculture, the Georgia Hospital Association, and public health officials in all 50 states were notified of the outbreak and the implicated product as information became available. After these notifications, no additional cases of botulism in Georgia were reported to the state and local health departments or to CDC. During this time, FDA launched an investigation of the Bolthouse Farms, Inc., manufacturing plant in Bakersfield, California. FDA and CDC tested other bottles of the implicated brand of carrot juice, including bottles from different lots, and all were negative for botulinum toxin. Because botulinum toxin was found only in the bottle of carrot juice consumed by the three patients, a lapse in refrigeration of the carrot-juice bottle during transport or storage was suspected, which would have allowed for growth of Clostridium botulinum and subsequent production of botulinum toxin. Based on the CDC test results, on September 17, FDA issued a consumer advisory on the importance of keeping carrot juice refrigerated. However, information obtained from patient interviews regarding storage and transport of the carrot juice did not confirm mishandling by the patients.

On September 25, officials at the Florida Department of Health, the Hillsborough County Health Department, and CDC were notified that a patient had been hospitalized in Tampa, Florida, on September 16, with respiratory failure and descending paralysis. On September 28, botulinum toxin type A was identified in the patient’s serum. Circulating toxin persisted more than 10 days after illness onset in this completely paralyzed patient, indicating ingestion of a massive toxin dose. Accordingly, the patient was treated with antitoxin, which prevents binding of circulating botulinum toxin to nerve endings. The patient remains hospitalized, paralyzed, and on a ventilator. The Hillsborough County Health Department collected an open, 450-milliliter bottle of Bolthouse Farms carrot juice, which had been found by a family member in the hotel room where the patient had been staying during the month before being hospitalized. The hotel room had no refrigerator. The bottle, which had a “best if used by” date of September 19, 2006, had a different lot number than the bottle associated with the Georgia cases. On September 29, botulinum toxin was identified in carrot juice from the bottle found in the patient’s hotel room; the toxin was subsequently identified as botulinum toxin type A. The Hillsborough County Health Department and CDC notified FDA, public health officials in all 50 states, and infection-control practitioners in Hillsborough County about the botulism case and implicated product.

The carrot juice consumed by these four patients was manufactured by Bolthouse Farms, Inc., and distributed in all 50 states, Mexico, Canada, and Hong Kong with the labels “Bolthouse Farms 100% Carrot Juice,” “Earthbound Farm Organic Carrot Juice,” and “President’s Choice Organics 100% Pure Carrot Juice.” Investigations of these cases by state and local health departments and investigations of the manufacturer by FDA are ongoing. On September 29, GDPH and the Georgia Department of Agriculture recommended that Georgia residents not purchase or consume Bolthouse Farms carrot juice. The same day, the FDA warned consumers not to drink Bolthouse Farms carrot juice with “best if used by” dates of November 11, 2006 or earlier (i.e., all bottles produced before the date the warning was issued), and Bolthouse Farms issued a voluntary recall of these products.

The 2007 Castleberry Botulism Outbreak

On July 7, 2007, the Centers for Disease Control and Prevention (“CDC”) learned that two siblings in Texas were critically ill with botulism and that their illnesses were likely acquired by eating contaminated food. The two children were admitted to pediatric intensive care, and there required mechanical ventilation. The CDC released doses of botulinum antitoxin, which was administered to the children the next morning.

Four days later on July 11, public health officials in Indiana reported to the CDC that a married couple in Indiana were suspected of having foodborne botulism. Serum samples were collected from each of them on July 10 and then sent to the Botulism Reference Laboratory at the CDC. On July 16, one day after the lab received the serum samples, botulinum toxin type A was detected by mouse bioassay in the man’s serum sample. Botulinum toxin was also detected by mouse bioassay in serum submitted by the wife, but the sample volume was insufficient to determine the toxin type. Investigations conducted by state and local health departments in both Texas and Indiana revealed that all four patients had eaten types of Castleberry’s hot dog chili before symptom onset.

Texas investigators found an unopened can of Castleberry’s Austex Hot dog Chili Sauce Original date stamped with a manufacture date and time of May 7 at 9:41 p.m. at the children’s home and tested it for botulism. The Texas Department of Health Services laboratory tested an aliquot from this can using an enzyme-linked immunosorbent assay (ELISA) for botulinum toxin and did not detect the toxin.

The Indiana couple had an unlabeled, sealed plastic bag of leftover chili mixture in their refrigerator that local health officials collected and sent to the CDC for C. botulinum toxin testing. On July 16 the CDC detected botulinum toxin type A by mouse bioassay in the chili mixture. Empty, well-rinsed cans of Castleberry’s Hot Dog Chili Sauce Original and chili made by another company were found in the couple’s recycling bin. CDC re-rinsed the two cans and tested the rinse water for botulinum toxin by mouse bioassay; both were negative. The label on the can of Castleberry’s Hot Dog Chili Sauce Original indicated a production-date of May 8, and a time of 2:23 AM—less than five hours after the production-time indicated on the can collected from the Texas home.

On July 17, CDC staff provided information regarding the production-dates and times to the FDA. The evidence strongly suggested that brands of Castleberry’s hot dog chili sauce were the common source of the four ill persons with botulism. On July 18, FDA issued a consumer advisory. On that same day, after being informed about the outbreak, and findings from the FDA investigation of the canning facility, Castleberry’s Food Company issued a voluntary recall that included a limited number of production dates of Castleberry’s Hot Dog Chili Sauce Original, Castleberry’s Austex Hot Dog Chili Sauce Original, and Kroger Hot Dog Chili Sauce. The recall was expanded on July 21 to include all production dates for 91 types of canned chili sauce, chili, other meat products, chicken products, and dog food that were manufactured in the same set of cookers, or “retorts” as the hot dog chili sauce at the Castleberry’s facility in Augusta, Georgia.

By August 24, eight cases of botulism had been reported to the CDC. In addition to the Indiana couple, the mother of the children in Texas had developed symptoms of botulism, which brought the total number of Castleberry-associated cases in Texas to three. There was also three unrelated residents of Ohio who had developed botulism consuming Castleberry’s hot dog chili sauce in the week before symptom onsets. Botulinum toxin was identified in leftover chili sauce collected from the refrigerator belonging to one of the Ohio cases.

The Castleberry’s manufacturing facility in Georgia produces products regulated both by the FDA and USDA-FSIS. Initial reports of illnesses were linked to meatless hot dog chili sauce and thus, fell under the jurisdiction of the FDA. The agency’s Atlanta District Office took the lead in the investigation of facilities.

The inspection started on the evening of July 17. FDA investigators requested company maintenance records, which were not immediately available because they were stored on a laptop of a vacationing employee. Finally, three days later, under threat of severe penalty, the company produced some of the requested records. Included in records provided to federal investigators was a 42-page report written by a consultant hired by Castleberry’s to investigate swollen cans of stew, chili, and hash produced in April and May 2007. The consultant had attributed spoilage to post-process handling operations in one of the plant’s cooking equipment. Reports by two other company-hired consultants would also implicate post processing as the reason for swollen cans. Unfortunately, Castleberry’s had not investigated the issues further.

On July 18 and 19, a team of federal investigators were sent to the firm’s warehouse. Samples of Castleberry’s Austex and Castleberry’s brand Hot Dog Chili Sauce with the “best by May 7, 2009” and “best by May 8, 2009” lot codes were collected and sent to FDA laboratories for testing.[42] FDA testing of sample 428113, consisting of 17 swollen cans, found C. Botulinum toxin in 16 of the cans. This sample included the same time-stamp and lot code from the May 8, 2007 production as the can found in the Indiana home. FDA testing of sample 420352, consisting of six swollen cans, found C. Botulinum in four cans. FDA sample 420353 included one swollen can, and its contents tested positive for C. Botulinum toxin.

Federal investigators conducted extensive tests on Castleberry equipment. The findings are presented in an FDA report issued on August 10, 2007, Attachment No. 1, FDA Inspectional Observations dated 08/10/2007, (Summary pages only). Noted observations include:

The system, equipment, and procedures used for thermal processing of foods in hermetically sealed containers were not operated and administered in a manner that ensures commercial sterility is achieved.

Each retort did not have an accurate temperature records device.

Failure to supply a suitable water valve used for water cooling to prevent leakage of water into the retort during processing.

The condensate bleeder was not checked with sufficient frequency to ensure removal of condensate or equipped with an automatic alarm system for the continuous monitoring of condensate bleeder functioning.

Required information was not entered on designated forms at the time the observation was made by the retort or processing system operator or designated person.

Failure to maintain fixtures in repair sufficient to prevent food from becoming adulterated.

Failure to properly adjust the temperature-recording device. The temperature recorded on the temperature-recording device chart was higher than the mercury-in-glass thermometer during processing.

The report ultimately placed blame on Castleberry management saying there was no commitment from employees in making the products and there was not adequate management oversight. As one Castleberry employee noted: “Two years ago the [implicated retorts] were maintained very well, but they are maintained poorly now.” The FDA plainly agreed, citing Castleberry’s for the “failure to maintain fixtures in repair sufficient to prevent food from becoming adulterated.”

Castleberry made substantial fixes at its plant and then reopened in the fall of 2007. The company re-branded its line to American Originals, and redesigned product labels. But in March, 2008, the plant was forced to close again after a February 27 joint-inspection by the FDA and USDA revealed deviations in some equipment operations on the processing line. The line was not related to deficiencies noted in the summer of 2007 but because under-processing caused the botulism outbreak, the plant’s operating permit was suspended.

The 2014 Villa Romano Green Farms Botulism Outbreak

In late May 2014 John Napierski, purchased seven jars of VR Greens Farms (VRGF) Basil Pine Nut Pesto at a Farm Stand operated at the Bella Collina Towne and Golf Club in San Clemente, California.  While on a road trip east, Mr. Napierski gave two jars to friends in Denver, Colorado. He then continued his trip to Ohio and gave two jars to his daughter, Kathryn (“Katy”), who was a nursing student working and attending college in Cincinnati.  Katy and her friend, Arielle Allen, used a portion of one jar of pesto as an ingredient in a chicken pasta dish they cooked at home and shared on July 13. On July 15 Katy complained of a sore throat and difficulty swallowing. Arielle started to have similar symptoms on July 17.  Over the next ten days both women continued to experience neurological symptoms.  Both women had multiple medical encounters before botulism was suspected as the cause of their symptoms. Katy was admitted to Bethesda North Hospital on July 17 and transferred to the University of Cincinnati Medical Center on July 18. Arielle was admitted to the University of Cincinnati Medical Center on July 27 due to worsening bulbar and facial weakness. Arielle’s admission to the hospital prompted the attending neurologist to note her friendship with Katy and similarity in symptoms between the two women.  He diagnosed both Katy and Arielle as having suspected botulism and notified public health authorities. Botulism antitoxin was obtained from the Centers for Disease Control and Prevention (CDC) and administered to Arielle on the evening of July 28. Serum and stool collected from Arielle and Katy did not test positive for C. botulinum. The toxin, however, was found in pesto sauce leftover from the chicken pasta meal.

Investigators at the City of Cincinnati Health Department and the Ohio Department of Health quickly determined that Katy and Arielle had shared a meal of pasta with chicken and jarred pesto sauce. During a visit to Arielle’s apartment, investigators found leftover chicken pasta with pesto in the apartment refrigerator. This was collected for laboratory testing for the presence of Clostridium botulinum toxin as was an unopened jar of pesto that Katy had. On July 29 Ohio investigators notified the CDC, the Food and Drug Administration (FDA), and the California Department of Public Health (CDPH) Food and Drug Branch (FDB) that two Ohio residents had botulism and that the suspected source was VRGF Basil Pine Nut Pesto.  CDPH FDB contacted Dominic Romano, owner of VRGF, and informed him of the illnesses.

On July 30 California investigators conducted a site visit at the VRGF Farm Stand.  A variety of canned products were produced seasonally and sold at the farm location. Most of the products sold at the farm stand were produced at unregistered/unpermitted locations.  Mr. Romano was advised that he must immediately cease the unlicensed manufacturing and sale of low-acid canned and acidified foods.  A Notice of Violations was issued to Mr. Romano for lack of license/registration. The firm initiated a voluntary recall of all suspect low-acid canned and acidified foods.  The California Department of Public Health issued an alert on July 30 advising consumers to not eat VR Green Farms jarred products because of improper production making them susceptible to contamination with Clostridium botulinum.

California investigators learned that in April or May the pesto had been made by Rose Schwinn dba Rose’s Artesian Creations.  Ms. Schwinn was a family friend of Dominic Romano.  According to Mr. Romano only 10-12 jars were produced and were intended to be a test product.  This was later found to be inaccurate. On July 31 CDPH FDB investigator, Melissa DeHart, contacted Ms. Schwinn to discuss manufacturing processes. Ms. Schwinn reported that she manufactured the product in her home kitchen and that she had made small batches products sold at the Farm Stand “on and off for a few years.” She did not maintain a Processed Food Registration or a Cannery License with CDPH as required to manufacture these types of foods for retail sales.

Rose Schwinn described the process used to make the pesto sauce. Raw garlic cloves and salt were ground in the food processor. Fresh basil leaves and olive oil were added and then mixed with pine nuts and parmesan cheese. The ingredients were processed in small batches and added to one large pot due to limited size of the food processor. The product could sit for up to one hour at room temperature before it was filled into the jars.

New jars were cleaned by placing them in her household dishwasher on the hot cycle with dish detergent and bleach. The jars were then filled with water and place in the microwave until boiling. The lids were maintained in hot water until use. The ingredients were mixed together without a heat step to form a sauce and then filled into hot mason jars. Lids were applied and the jars were placed into a stove top water bath canning unit. The water in the canning unit was brought to a boil and the product was heated. A thermometer was not used. The jars were allowed to cool, the seal around the lid checked, and the product was labeled for distribution. The label did not include a complete ingredient statement, lot code, best by date, or a “Perishable Keep Refrigerated” statement.  CDPH FDB described the manufacturing process to be conducted under “insanitary conditions at a home residence.”

The CDPH Food and Drug Laboratory Branch (FDLB) collected an unopened jar of VRGF Basil Pine Nut Pesto from Rose Schwinn. The sample was tested for pH, water activity, and Elisa screening for C. botulinum.  Test results showed for sample #062080514, the pH was 5.3 and water activity was 0.965. Non-refrigerated foods that are packed in hermetically sealed jars with a pH above 4.6 and water activity above 0.85 are at risk for supporting C. botulinum toxin formation and must be manufactured in accordance with an approved scheduled process, controls and in California pursuant to a Cannery License.  Clearly, VRGF Basil Pine Nut Pesto did not meet the minimum requirements for food safety. Investigators determined that VRGF Basil Pine Nut Pesto placed “consumers of the product at risk for C. botulinum toxin illness.”

State public health laboratories in Ohio and California tested several samples of the pesto.  The Ohio Department of Health Bureau of Public Health Laboratories tested an unopened jar collected from Katy as well as leftover chicken pasta with pesto found in Arielle’s apartment. The left over pasta meal was positive for Clostridium botulinum toxin type B.  The unopened jar of pesto sauce tested negative for Clostridium botulinum toxins. Of the two jars that had been dropped off in Colorado, one jar had been consumed with no ill effects. The second jar had a swollen lid and was shipped to Ohio for C. botulinum testing. This jar also tested negative for C. botulinum toxins.  CDPH FDLB also tested an unopened jar of pesto collected from John Napierski.  This jar showed low levels of C. botulinum toxin B by Luminex system testing and “borderline” testing results by Elisa but definitive testing by the mouse bioassay was negative.

References (more…)

RAW Meal Organic Shake & Meal Salmonella Outbreak is Over

big-map-4-21-16A total of 33 people infected with the outbreak strain of Salmonella Virchow were reported from 23 states. Among people for whom information was available, illnesses started on dates ranging from December 5, 2015 to March 18, 2016. Ill people ranged in age from less than 1 year to 84, with a median age of 35. Fifty-three percent of ill people were female. Among 27 ill people with available information, 6 (22%) were hospitalized, and no deaths were reported.

Epidemiologic and laboratory evidence indicated that RAW Meal Organic Shake & Meal products made by Garden of Life, LLC were the likely source of this outbreak.

State and local public health officials interviewed ill people to obtain information about foods they might have eaten and other exposures in the week before they became ill. Of the 30 ill people who were interviewed, 28 (93%) reported consuming powdered supplements or meal replacement powders in the week before illness onset; 27 of these 28 (96%) ill people specifically reported consuming RAW Meal products made by Garden of Life, LLC.

On January 29, 2016, Garden of Life, LLC voluntarily recalled a limited quantity of its RAW Meal Organic Shake & Meal products available in chocolate, original, vanilla, and vanilla chai because they had the potential to be contaminated with Salmonella Virchow. The recalled products were available for purchase nationwide in many retail stores and online.

The Utah Public Health Laboratory and Oklahoma Public Health Laboratory isolated the outbreak strain of Salmonella Virchow from open containers of Garden of Life RAW Meal collected from ill people’s homes in Utah and Oklahoma.  Both products that were tested were from lots covered under the recalls announced by Garden of Life, LLC.

FDA sampling confirmed the presence of the outbreak strain of Salmonella Virchow in Organic Moringa Leaf powder used in RAW Meal Organic Shake & Meal Replacement products. On February 12, 2016, Garden of Life, LLC issued an expanded recall of its RAW Meal Organic Shake & Meal products available in chocolate, original, vanilla, and vanilla chai to include additional lots that contained the contaminated Organic Moringa Leaf powder.

This outbreak investigation is over. However, the recalled products have a long shelf life and may still be in people’s homes. Consumers unaware of the recalls could continue to eat the products and get sick.

Costco Berries with Hepatitis Again – 12 Sick in Canada

20160415a_1460738325415_eng_thumb_The Public Health Agency of Canada is collaborating with federal and provincial public health partners to investigate an outbreak of Hepatitis A infections in three provinces linked to the frozen fruit product: Nature’s Touch Organic Berry Cherry Blend. The Canadian Food Inspection Agency (CFIA) has issued a food recall warning advising Canadians of the recall of the frozen fruit product that has been distributed in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

The Public Health Agency of Canada advises Canadians not to consume the frozen fruit product Nature’s Touch Organic Berry Cherry Blend sold exclusively at Costco warehouse locations in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

The overall risk to Canadians is low. Hepatitis A is a disease that can cause inflammation of the liver. Hepatitis A can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. You can get the Hepatitis A virus by eating contaminated food or water or through contact with an infected person’s stool. Adequate vaccination can protect against the Hepatitis A virus.

Currently, there are 12 cases of Hepatitis A in three provinces related to this outbreak: Ontario (9), Quebec (2), and Newfoundland and Labrador (1). Individuals became sick in February and March of this year. Some of the individuals who became ill have reported eating the recalled product. The majority of cases (58%) are male, with an average age of 37 years. Three cases have been hospitalized.

Hmmm,  where have I heard this before – http://www.cdc.gov/hepatitis/Outbreaks/2013/A1b-03-31/index.html

Shigella Reported in Dubuque County Iowa

The Dubuque County Health Department, the Dubuque County Board of Health, and the Iowa Department of Public Health (IDPH) are investigating an outbreak of Shigellosis cases. Shigellosis is a disease caused by the bacterium, Shigella, which causes watery and sometimes bloody diarrhea. Symptoms of Shigellosis usually begin one to three days after infection and include diarrhea, fever, nausea, vomiting, and abdominal cramps.Shigella is spread:

Person-to-Person. Any infected person can infect others by failing to properly wash their hands before

handling food or coming into close contact with another person. Infections in households, pre-schools, child care facilities, and elderly and developmentally disabled living facilities are commonly spread in this manner.

Shigellosis is an extremely contagious disease. Because of this, measures should be taken to prevent its spread. These measures include:

Thoroughly wash hands with soap and running warm water for no less than 15 seconds. This should be done after using the toilet, changing diapers, or before eating or preparing any food.

Infants and children should have their hands washed as above after a diaper change, after using the toilet, or before eating.

Infected people should stay away from school, child care, food preparation or work while they have diarrhea. Food handlers, health care workers, and those working in child care who have shigellosis should have two consecutive negative stool cultures before returning to work or child care. Children who have had shigellosis and are returning to child care should have one negative stool culture.

Contact the Dubuque County Infection Control Specialists at the VNA (563-556-6200) or IDPH 515-242- 5935) for questions about clearing persons for work or child care.

Shigellosis typically goes away without treatment after four to seven days; however, if the infection is severe or the infected person has a poor immune system, antibiotic treatment may be needed. In some cases, the diarrhea associated with shigellosis can be dangerously dehydrating, especially in the very young and very old. In that event, see a doctor immediately. If you have symptoms of shigellosis, or have had contact with someone diagnosed with the infection, you should contact your health care provider.