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Foodborne Illness Outbreaks

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2013 Salmonella Outbreak at North Carolina Holiday Inn

A.        Initial Public Health Response  

Active and enhanced passive surveillance were performed to determine the extent of the outbreak.  A news release was issued by the Cumberland County Health Department on May 14th.  All NC local health departments were notified through the NC Health Alert Network (www.nchan.org) on May 14th, and an Epi-X notification to all US state health departments was released on May 15th.  CCHD established a call line to provide a description of the outbreak to the public and collect information about possible cases.  CCHD and NC DPH staff established daily conference calls to coordinate public health response and communication.  Since several of the initial cases were food workers, CCHD Environmental Health staff immediately organized a training session on food safety for all employees to reinforce elements of the Food Code.  Food employees are defined as “an individual working with unpackaged food, food equipment or utensils, or food-contact surfaces” according to the 2009 FDA Food Code, adopted by reference in the Rules Governing the Food Protection and Sanitation of Food Establishments (15A NCAC 18A 2600).

B.        Case Finding and Hypothesis

A case was defined as: A person presenting with onset of nausea, vomiting, abdominal cramps and/or diarrhea, within three days of food or beverage consumption at the Holiday Inn Bordeaux and Conference Center on or after 1 May 2013 OR (secondary case) a person who developed these symptoms after being in close contact with a case as defined above.

  • Confirmed Case: A clinically compatible case with laboratory confirmed salmonellosis matching PFGE outbreak strain
  • Probable Case: A clinically compatible case with no positive laboratory result but epidemiologically linked to the outbreak
  • Exclusion Criteria: A clinically compatible case with Salmonella culture of a PFGE pattern different from the outbreak strain

C.        Clinical Laboratory Investigation

Stool specimens were requested of all case-patients.  Stool culture, Salmonella serotyping and PFGE analysis were conducted on each specimen.  Stool cultures were performed at the North Carolina State Laboratory of Public Health (NC SLPH), and the state laboratories in South Carolina and Louisiana where some cases were residents.  Serotyping and PFGE were performed at state laboratories of public health.  All testing was accomplished in accordance with standard protocol (http://www.cdc.gov/pulsenet/PDF/ecoli-shigella-Salmonella-pfge-protocol-508c.pdf).

D.        Environmental Investigation

Four environmental health staff from Cumberland County Health Department began an on-site investigation upon notification of a possible foodborne outbreak on May 13, 2013.  The Holiday Inn Bordeaux has a first floor and a second floor kitchen.  The first floor kitchen services the All American Grill, a sports bar restaurant serving American food from 5pm – 11pm daily.  The first floor kitchen also services the Café Bordeaux breakfast buffet.  The second floor kitchen services banquet events and the Café Bordeaux lunch buffet.  Salads for the lunch buffet are stored in the first floor kitchen.  During the investigation, CCHD environmental health staff was accompanied by the Holiday Inn Bordeaux kitchen manager and the assistant general manager. Food sources, storage, and preparation were assessed.  Food, refrigerator, freezer, and water temperatures were monitored.  Hand washing stations and supplies were inspected.  Food products were not sampled.  Subsequent to the initial site visit, multiple repeat visits were made to the facility during the course of the investigation to ensure compliance with outbreak control measures (see Environmental Results below).  On May 28, 2013, the North Carolina Department of Agriculture collected twenty environmental samples from various components of a faulty dishwasher that was being stored in the facility basement after being disconnected due to improper water temperatures.

E.         Results

            Case Patients

One hundred case-patients were identified: 25 confirmed; and 75 probable. Twenty-nine (29%) of the 100 case-patients were staff and 71 (71%) were patrons of the hotel and/or hotel restaurants. One staff person likely became ill as a result of secondary transmission.  Of the 29 ill staff, ten (35%) were laboratory confirmed with the outbreak strain, one (3%) tested negative, one (3%) had a final result of unsatisfactory, and 17 (59%) did not submit a stool specimen.  Of the 71 patrons, 15 (21%) tested positive for the outbreak strain, 26 (37%) tested negative, one (1%) had a final result of unsatisfactory, and 29 (41%) did not submit a stool specimen.  Of the 75 probable cases, 27 persons tested negative for Salmonella, 46 persons did not submit a stool specimen, and two had unsatisfactory samples as a final result.

Illness onset dates for the 100 case-patients ranged from May 1, 2013, to May 17, 2013 (Figure 1 – Epidemiologic Curve).  The majority of case-patients were residents of North Carolina (87%); 4/100 (4%) were from Maryland, 2/100 (2%) South Carolina, 2/100 (2%) Alabama, and 1/100 (1%) from Colorado, Illinois, Louisiana, New Jersey, and New York, respectively. All case-patients reported an association with the Holiday Inn Bordeaux.  Fifty-seven percent were female.

Laboratory Results

Among 54 people who had specimens submitted for testing, 25 (46%) were positive by culture, 27 (50%) were negative, and two (4%) had a final result of unsatisfactory.  Of the 25 positive results, 100% grew Salmonella species on stool culture.  Of these, 25/25 (100%) were serotype Typhimurium and 25/25 (100%) were a PFGE match to pattern JPXX01.0038. While this pattern is seen each year in North Carolina, it is not a common pattern.  The historical incidence rate for this pattern of Salmonella Typhimurium in North Carolina is <0.5 to 2% per year.

The onset dates of persons testing positive for this outbreak strain ranged from May 2, 2013, to May 16, 2013.

North Carolina’s State Laboratory of Public Health is part of a national surveillance system, PulseNet, which is a database of PFGE patterns for all Salmonella specimens submitted to state laboratories across the US.  Other than the previously identified epidemiologically linked patients, there were no reports of the outbreak strain from other state laboratories across the country during the time period of this outbreak.

            Environmental Results

Site visits to the Holiday Inn Bordeaux were conducted daily from May 13 through May 24.  Interviews with managerial   staff and observation of food preparation identified multiple opportunities for Salmonella contamination, including improper water temperatures and the absence of hand washing supplies in some areas.  Other potential food safety issues that were identified included bare hand contact with ready to eat foods, temperature violations, and a dishwasher in one kitchen that was not operating effectively as described by staff members.  Food Code requirements that were reinforced and control measures recommended by environmental health included exclusion of ill employees, elimination of bare hand contact with ready to eat foods, consistent logging of food temperatures, and discontinued use of the faulty dishwasher.

The following points were noted during the first environmental health inspection:

  • A fan obstructing access to the hand wash sink near the dish washing machine.
  • This same sink was out of paper towels.
  • Although the minimum temperature for a hand wash sink is 100˚F, the temperature reading from the water leaving the faucet for this sink was 75˚F.
  • Soap dispensers were empty in the hand wash sink near the kitchen toaster area and in the female bathroom at the Café Bordeaux entrance.
  • The booster for the hot water sanitizing dish washing machine was not in compliance with the minimum temperature of 140˚F as required by the manufacturer’s data plate.  The temperature was reading 124.4˚F.  The booster was being used despite the fact that it had not been functioning properly for the prior three weeks.  Staff had been instructed to run the dishes through the dish washing machine twice since it was not reaching the proper temperature.  In addition, thermo labels indicated that the surface temperature of dishes did not reach 160˚F, as required by the Food Code.  Environmental health staff instructed the kitchen staff to discontinue this practice and use the 3 compartment sink or use a chemical rinse after running dishes through the dish washing machine.

            Conclusions

An outbreak of Salmonella Typhimurium gastroenteritis occurred in North Carolina during May 2013.  One hundred cases were identified and included residents of North Carolina, Alabama, Colorado, Illinois, Louisiana, Maryland, New Jersey, New York, and South Carolina.  All isolates available for PFGE analysis had identical patterns (JPXX01.0038), representing an uncommon but recurring pattern in the national PulseNet database and for the state.  The source of the outbreak was the All American Grill within the Holiday Inn Bordeaux.  However, a specific food item could not be implicated during the investigation.  One likely reason a specific food item was not identified, as the vehicle in this outbreak was cross-contamination of food products or surfaces in the restaurant.  Although sanitizing solutions were tested by inspectors and found to be in compliance, inadequate dish machine temperatures and hand washing could contribute to the cross-contamination.  Furthermore, during the course of this investigation, it was revealed that seven food service employees, as defined by the North Carolina Food Code Manual, continued to work while ill.  Hotel management was notified that food service employees should be excluded from work until they are asymptomatic for at least 24 hours.

Failure to adhere to guidance requiring exclusion of ill food handlers may have played a role in facilitating ongoing contamination in the facility.

Salmonella Typhimurium with the pattern JPXX01.0038 was found to be the cause of this outbreak, and likely caused illness through a variety of mechanisms, including consumption or handling of undercooked food (due to lack of temperature log), consumption of cross contaminated ready to eat foods, and/or contact with contaminated surfaces.

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.

First Lawsuit to be Filed on Behalf of California Woman Sickened By Salmonella Tainted Food from Brent’s Delicatessen & Restaurant

Plaintiff is one of 21 people infected in 2014 Salmonella outbreak following countless health violations against Westlake Village restaurant

Ventura County resident Stephanie Wehr will file a lawsuit against Brent’s Delicatessen & Restaurant over a severe case of salmonella poisoning she suffered after eating at the restaurant’s Westlake Village location. Wehr is represented by Trevor M. Quirk of Quirk Law Firm, LLP in Ventura, CA., and Bill Marler of Marler Clark, a Seattle-based firm specializing in food safety.  See Outbreak Investigation Timeline.See Inspection Reports.

In 2014, Wehr was one of 21 people who became seriously ill after eating food tainted with Salmonella serotype Montevideo from Brent’s Delicatessen & Restaurant in Westlake Village, which is located in Ventura County. Two of the victims were employees of Brent’s. Eight customers were hospitalized.

Wehr, who purchased and consumed a sandwich and potato salad from Brent’s Deli on August 2, 2014, began feeling ill the following day while at work. For the next several days, she experienced agonizing symptoms, including excruciating abdominal pain, uncontrollable diarrhea, high fever, nausea, and vomiting. She made several trips to see doctors at Kaiser Oxnard and was prescribed medication, but due to nausea and vomiting, she was unable to keep it down. She again contacted Kaiser on the morning of August 5 and was admitted.

By the time she was admitted to the hospital, she was lethargic and short of breath. Her heart rate was an astounding 118, nearly twice the normal resting rate for a healthy adult. Since seeing a doctor the day before, she had lost 10 pounds. Because of severe stomach cramps, her abdomen was too tender to undergo examination. Soon she was admitted to Ventura Community Memorial Hospital where she stayed for five days, and ultimately was diagnosed with Salmonella poisoning.

The County of Ventura Environmental Health Division conducted an on-site inspection at Brent’s Deli on July 9, 2014—more than three weeks before Wehr ate there. Multiple food safety violations were noted including improper sanitation, cooling, and storage issues. The restaurant manager was instructed to correct all violations immediately. A follow-up inspection was conducted on July 22. Major food safety violations were again noted. Specifically, potentially hazardous foods were not properly cooled, that is held at or below 41 degrees. In addition, wiping cloths were not kept in sanitizing solutions between uses and employees were not properly washing their hands before handling food or clean utensils, among other violations.

“Considering that the owners and management of Brent’s Deli had multiple opportunities to fix known health violations, we can only guess they willfully ignored the problems, said Bill Marler, who has been working to help improve food safety standards since representing victims of the Jack In The Box E. coli outbreak in the early 1990s.

“There is no excuse for the negligence of Brent’s Deli and the failure of its owners and management to perform to legal food safety standards,” said Trevor Quirk, who has been a victim advocate for close to a decade. “Brent’s may have a reputation for a family atmosphere, but they knowingly put their customers at risk over easily remedied health violations, like improper hygiene standards.”

During the August 2014 Salmonella outbreak, after continuing reports of sickened customers, the health department once again inspected the restaurant. Multiple violations—including issues noted in previous inspections—were found. During the investigation, no food or environmental samples tested positive with the outbreak strain of Salmonella, but stool samples from two employees did. Previous health department violations noted that employees were not properly washing their hands after using the restroom and before returning to work.

Salmonella is transmitted by food, water, or surfaces that have been contaminated with the feces of an infected animal or person. Symptoms develop 6 to 72 hours after infection. One of the best ways to prevent the spread of Salmonella is to have proper hygiene and hand washing practices in place, especially after using the bathroom and before handling or preparing food.

Quirk Law Firm, LLC was founded in 2006 in Ventura, California with offices in California and Nevada. 100% of the practice is devoted to representing people who have been injured or lost a loved one. Quirk Law Firm represents diverse clients including accident victims, homeowners’ associations, start-up and established businesses, professional skateboarders, professional models, employees, and everyday individuals.

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.

Queseria Bendita Update Listeria Cheese Recall

Queseria Bendita LLC of Yakima, Washington is recalling all lots of Panela, Queso Fresco, Requeson, Cotija fresh soft cheese products and Sour Cream to include ALL Best By Dates because of a potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women.

Panela, Queso Fresco, Requeson, Cotija fresh soft cheese products and Sour Cream were distributed to Hispanic grocery stores in Washington and Oregon and the firm also sold products from its on-site store in Yakima, Washington.

The recalled products are packaged with clear plastic wrapper or plastic tub, and the best by dates are stamp coded next to a label. The products are refrigerated and have the shelf life of up to 90 days. The last date of distribution of recalled products is January 15, 2015.

The products being recalled are identified in the table below:

Product package size container type UPC Best By Date
Panela 1 lb. plastic wrap 6 10074 99341 4 ALL
Queso Fresco 1 lb. plastic wrap 0 94922 10602 5 ALL
Queso Fresco 3 lbs. plastic wrap None ALL
Requeson 1 lb. Tub 0 94922 10603 2 ALL
Sour Cream/Crema Agria 1 lb. Tub 0 94922 10608 7 none
Cotija Cheese 1 lb. plastic wrap none

Up to date, there are a total of three (3) cases of Listeria monocytogenes infections linked to consumption of soft cheese produced by Queseria Bendita, including two hospitalizations and one death.

The recall was the result of the investigation and samples collection by the Food and Drug Administration. The company has currently agreed to cease the production and distribution of all products.

Wonton Sprouts Link in Salmonella Outbreak in Connecticut, Maine, Maryland, Massachusetts, Montana, New Hampshire, New York, Ohio, Pennsylvania, Rhode Island, Vermont and Virginia

Most ill in Massachusetts, New York and Pennsylvania

CDC collaborated with public health officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella Enteritidis infections. Results from this investigation indicated that bean sprouts produced by Wonton Foods, Inc. were the likely source of this outbreak.

Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA “fingerprinting” is performed on Salmonella bacteria isolated from ill persons using a technique called pulsed-field gel electrophoresis, or PFGE. PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. Two PFGE patterns were included this investigation. Both PFGE patterns are rarely reported to the PulseNet database. On average, fewer than 10 types of Salmonella bacteria with these PFGE patterns are reported to PulseNet each year. Whole genome sequencing, a highly discriminatory subtyping method, was also performed on 16 of the clinical isolates, and all 16 were determined to be highly related to one another.

A total of 115 persons infected with the outbreak strains were reported from 12 states. The number of ill people identified in each state was as follows: Connecticut (8), Maine (4), Maryland (6), Massachusetts (36), Montana (1), New Hampshire (6), New York (22), Ohio (3), Pennsylvania (18), Rhode Island (7), Vermont (3), and Virginia (1). The one ill person from Montana traveled to the Eastern United States during the period when likely exposure occurred.

Illness onset dates ranged from September 30, 2014, to December 15, 2014. Ill persons ranged in age from younger than 1 year to 83 years, with a median age of 32 years. Sixty-four percent of ill persons were female. Among 75 persons with available information, 19 (25%) were hospitalized, and no deaths were reported.

This outbreak appears to be over.

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.

Las Vegas Salmonella Outbreak Sickened 300 in 2013

On April 26, 2013, the Southern Nevada Health District (SNHD), Office of Epidemiology (OOE) received reports of gastrointestinal illness from eight independent groups of patrons of Firefly on Paradise or the adjacent affiliated restaurant Dragonfly on Paradise (Firefly) located at 3900 Paradise Road, Las Vegas, NV 89109.  All patrons from these groups ate at the restaurant during April 21-24, 2013.  Ill patrons reported symptoms of diarrhea and/or vomiting after they consumed food from Firefly restaurant, and many sought medical care for their illness.  In response to these illness reports, the SNHD initiated an investigation.

On April 26, 2013, the SNHD performed investigative inspections and closed Firefly and Dragonfly restaurants to minimize ongoing risk of illness.  The SNHD OOE, Environmental Health (EH) and Southern Nevada Public Health Laboratory (SNPHL) have been collaborating on the investigation and response to this outbreak.  The Centers for Disease Control and Prevention (CDC), the United States Department of Agriculture (USDA), and the Nevada State Health Division (NSHD) were also notified of the outbreak investigation.

Epidemiology

A probable case is defined as illness in a person who consumed food served by Firefly restaurant during April 21-26, 2013, experienced diarrhea (defined as ≥ 3 bouts of loose stools) and/or ≥ 1 episodes of vomiting during a 7-day period after eating, and reported the illness to SNHD no later than end of day May 13, 2013 (midnight).  The case definition for confirmed cases was not changed.

Laboratory

SNPHL continued its normal procedures of receiving Salmonella isolates from local laboratories and performing speciation and pulsed field gel electrophoresis (PFGE) testing on them.  SNPHL is sending Salmonella isolates associated with the outbreak to CDC for multiple-locus variable number tandem repeat analysis (MLVA), a method used to perform molecular typing of particular microorganisms to study possible transmission routes and sources of infection.

Environmental Health

After communication with NSHD, USDA’s Food Safety Inspection Service (FSIS) plans to perform a trace-back of a cooked food item identified as having been contaminated with the outbreak species of Salmonella.

Results

The epidemic curve as of May 20, 2013 shows a total of 294 people whose illnesses met the case definition (73 confirmed and 221 probable cases).  All identified ill persons ate at Firefly during April 21 through April 26, 2013.  Illness onset dates occurred within the April 22 to May 1, 2013 time frame.

From various surveillance data sources, we have received reports of illness from restaurant patrons who normally reside in 27 states and two foreign countries (Canada and United Kingdom) who ate at Firefly during their visits to Las Vegas.

Laboratory

As of May 20, 2013, the following laboratory activities have occurred.  In addition to 14 specimens initially collected and tested by SNHD, of which 12 were positive for the outbreak strain of Salmonella, local microbiology laboratories have submitted to the SNPHL 83 Salmonella isolates obtained from Clark County residents.  Among them, serotyping and PFGE analyses have been completed on 74 of these samples, with the remaining nine samples still pending serotyping and PFGE analyses.  Of the 74 samples, 61 had PFGE patterns matching the outbreak strain and were from specimens collected from persons whose illnesses met the case definition.  These 61 PFGE patterns were sent to CDC’s PulseNet program to determine if they are related to other common source outbreaks in the U.S.  To date, PulseNet results have identified no concurrent U.S. cases of salmonellosis matching the outbreak strain other than those linked to the Firefly restaurant.

SNPHL has sent 6 Salmonella isolates to CDC for testing by the National Antimicrobial Resistance Monitoring System (NARMS) program.  Results are pending.  SNPHL has sent 49 Salmonella isolates to CDC for MLVA.  Results are pending.

Of the 21 food items that were analyzed and are shown in the table below, one item, cooked chorizo (a type of sausage), tested positive for Salmonella.  Culture and PFGE-pattern results of the Salmonella isolate obtained from the cooked chorizo matched those of the outbreak strain. There are no plans to test the remaining 14 food items that were collected on April 26, 2013.

Environmental Health

EH staff contacted Firefly restaurant management to gather more information about the handling of the chorizo product.  The chorizo came into the restaurant raw and was subsequently cooked by Firefly restaurant staff.  All chorizo items collected from Firefly by EH and tested were already cooked by restaurant staff.  No raw chorizo was collected by EH in the initial inspection.

Initially, we attempted to trace back some food products that either arrived raw to the restaurant or were served uncooked to patrons to try to identify how a food could have become contaminated at its source or during delivery, storage or preparation.  However, in light of the laboratory result that the outbreak strain of Salmonella was isolated from the cooked chorizo, trace-back efforts have been redirected at the chorizo products due to a small possibility that raw chorizo was contaminated prior to arriving at Firefly.

Discussion

As of May 20, 2013 at least 290 patrons and four employees who consumed food and/or drinks at Firefly restaurant during April 21-26, 2013 have been identified to be confirmed or probable cases of Salmonella infection.  No illness has been reported among staff or patrons of the other Firefly restaurants located in Clark County (Firefly Westside and Firefly on Eastern).  The rate of cases being reported to SNHD has declined significantly with no evidence of any disease transmission after the closure of the restaurant on April 26, 2013.  It is possible that the number of cases will change slightly over the next weeks as the last laboratory results arrive that either identify new confirmed cases, or eliminate probable cases from our count should they fail to have PFGE patterns matching the outbreak strain.

No concurrent cases of salmonellosis having a PFGE pattern matching the outbreak strain have been identified in the U.S. other than those linked to the Firefly on Paradise restaurant.

It is likely that the outbreak was due to local cross-contamination in the restaurant’s kitchen and not from a contaminated commercial food.

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.

Most Current Update on Listeria Caramel Apple Outbreak and Recall

The Outbreak:  On December 18, 2014, the Minnesota Department of Health reported four Listeria monocytogenes illnesses.  The Minnesota cases purchased caramel apples from Cub Foods, Kwik Trip, and Mike’s Discount Foods, which carried Carnival brand and Kitchen Cravings brand caramel apples. These apples were produced by H. Brooks and supplied indirectly by Bidart Brothers.

On January 10, 2015, the CDC reported a total of 32 people infected with the outbreak strains of Listeria monocytogenes had been reported from 11 states: Arizona (4), California (2), Minnesota (4), Missouri (5), Nevada (1), New Mexico (6), North Carolina (1), Texas (4), Utah (1), Washington (1), and Wisconsin (3).  The Public Health Agency of Canada (PHAC) has identified 2 cases of listeriosis in Canada with the same pulsed-field gel electrophoresis (PFGE) patterns as seen in the U.S. outbreak.

  • Thirty-one ill people have been hospitalized, and seven deaths have been reported. Listeriosis contributed to at least three of these deaths.
  • Ten illnesses were pregnancy-related (occurred in a pregnant woman or her newborn infant), with one illness resulting in a fetal loss.
  • Three invasive illnesses (meningitis) were among otherwise healthy children aged 5–15 years.

The First Lawsuit:  On December 22, 2014, we filed a wrongful death lawsuit against Safeway Inc, in the Superior Court of Santa Cruz on behalf of James Raymond Frey, 87, and the estate of his deceased wife, Shirlee Jean Frey, 81, who died tragically on December 2, 2014 after consuming a Listeria-tainted caramel apple purchased at the Safeway in Felton, California. The case number is CISCV180721.   The complaint was amended on December 29, 2014 to add in two additional parties – Happy Apple and Bidart Brothers.

The Recalls:  On December 24, 2014, Happy Apple Company of Washington, Missouri, voluntarily recalled Happy Apples brand caramel apples with a best use by date between August 25 and November 23, 2014. On December 31, 2014, Happy Apple Company expanded the recall to include Kroger brand caramel apples produced by Happy Apple Company with a best use by date between September 15 and November 18, 2014.

On December 27, 2014, California Snack Foods voluntarily recalled Karm’l Dapple brand caramel apples with a best use by date between August 15 and November 28, 2014.

On December 29, 2014, Merb’s Candies of St. Louis, Missouri issued a voluntary recall of Merb’s Candies Bionic Apples and Double Dipped Apples that would have been available from September 8 through November 25, 2014.

On January 6, 2015, Bidart Bros. of Bakersfield, California voluntarily recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility. The recall includes all Granny Smith and Gala apples shipped from its Shafter, California packing facility in 2014. CDC recommends that consumers not eat any of the recalled Granny Smith and Gala apples produced by Bidart Bros. and that retailers not sell or serve them.

The Genetic Connection:  On January 9, 2015, according to Bidart Bros., the United States Food and Drug Administration (FDA) announced the results of findings from additional tests performed on samples collected from Bidart Bros. apple processing plant near Bakersfield, California. Test results confirm two strains of Listeria monocytogenes were found at the apple processing facility and are believed to be the same strains associated with the outbreak. Those same strains were also found in Bidart Bros. apples collected from a retailer by the FDA.

The Bacteria:  Listeria monocytogenes is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women. Approximately 2,500 cases of listeriosis are estimated to occur in the U.S. each year. About 200 in every 1,000 cases result in death.

The Firm:  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.

A 2014 Shigella Outbreak at a Trendy California Restaurant

In August 2014 staff at the Health Care Agency of Orange County (HCAOC) investigated an outbreak of Shigella among customers of True Food Kitchen, a restaurant located in Newport Beach, California. A total of 7 restaurant patrons and one restaurant employee were laboratory confirmed with Shigella.  All reported eating at the restaurant between August 21 and August 25. According to Denise Fennessy, director of Environmental Health at HCAOC, spread of the bacteria was believed to be person-to-person since none of the ill patrons ate the same dish. All employees were required to submit stool specimens for testing for Shigella before they could return to work. The restaurant was closed on August 28 for what county inspectors labeled as an “imminent health risk”. During the two day closure, True Food was required to discard all ready-to-eat foods and open beverage bottles.  Unsealed linens and ice were also disposed.[1]

True Food Kitchen in Newport Beach has a history of poor food safety practices.  The restaurant was inspected 4 times in 2013; once in response to an illness complaint.  Each time serious food handling practices were observed and required correction.  An inspection conducted on June 9, 2014 showed a lack of sanitary conditions including evidence of “vermin activity,” improper food storage and inadequate hygiene.  Even after the August 2014 outbreak, the restaurant continued to perform poorly on inspection.  On December 2, 2014 a county inspector identified vegetables held at improper temperatures. Employees were directed to discard sweet potato cubes that had been held on the cook’s line in ambient air for 5 hours.  Roasted onion slices were held at 65oF instead of the required 165oF.

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


[1] Luna, N. (2014, September 17). Illness investigation of True Food Kitchen in Newport continues.  Orange County Register. Retrieved January 5, 2015, from http://www.ocregister.com/articles/true-635362-food-restaurant.html

The 2010 El Gran Burrito Salmonella Newport Outbreak

On Sunday, July 10, 2011 the Mount Sinai Hospital Emergency Department notified the City of Chicago Department of Public Health (CDPH) of a possible foodborne illness outbreak.  Over the weekend at least 15 people had been seen at the hospital for gastrointestinal symptoms.  Five patients were admitted.  Laboratory analysis of stool specimens collected from two patients were positive for Salmonella.  At least four ill persons reported eating at El Gran Burrito located at 1207 South Pulaski Road in Chicago in the 72 hours before symptom onset.

Ill customers had dined at the El Gran Burrito restaurant between July 6 and July 11.  On Monday, July 11 CDPH staff informed Dr. Corland Lohff, state epidemiologist at the Illinois Department of Public Health (IDPH), of the ill patients and the suspected source, El Gran Burrito.  CDPH staff began to interview ill persons about symptoms and possible exposures to a foodborne pathogen using a standardize questionnaire.  Patient answers clearly implicated food prepared and sold at the El Gran Burrito restaurant located on South Pulaski Road.

Illness complaints among El Gran Burrito customers prompted CDPH restaurant inspectors to make an on-site visit to the restaurant on Monday, July 11.  The restaurant “passed” inspection although food and non-food contact surfaces were in obvious need of cleaning.  By July 12 more patient data were gathered and evidence connecting illnesses to the El Gran Burrito mounted. Leftover foods and environmental swabs were collected for laboratory analysis.  CDPH staff met with employees to discuss food safety procedures, proper temperature controls, and good hygienic practices.  El Gran Burrito voluntarily closed on July 12 for thorough cleaning and sanitizing.

Patient stool specimens were serotype as Salmonella serotype Newport.  Genetic testing of isolates obtained from stool cultures was conducted by pulsed field gel electrophoresis (PFGE).  Molecular tests results solidified evidence of an outbreak of salmonellosis among customers of El Gran Burrito.  Ill El Gran Burrito patrons shared a common genetic strain of Salmonella Newport identified as JJPX01.0166/JJPA6.0146.  The IDPH assigned identification number IL2011-122 to the outbreak.

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.

One Large and Nasty Salmonella Outbreak Linked to Eggs

Beginning in July, 2010, the Centers for Disease Control and Prevention (CDC) identified a nationwide sustained increase in the number of Salmonella Enteritidis isolates with PFGE pattern JEGX01.0004 on PulseNet.[1]   As of December, 2010, the CDC counted 3,578 illnesses, while noting that there might still be more as yet uncounted.  CDC reports that during the timeframe of the outbreak, approximately 1,639 total illnesses of the implicated PFGE pattern would be expected to occur.  Thus CDC concluded that “there are approximately 1,939 reported illnesses that are likely to be associated with this outbreak.”

In addition to the general outbreak investigation, a number of epidemiologic investigations were conducted by public health officials in 11 states.  These various investigations revealed that beginning in April, 2010 there were 29 restaurants or event clusters where more than one ill person with the outbreak strain had eaten. The CDC reported that:

Data from these investigations suggest that shell eggs were a likely source of infections in many of these restaurants or event clusters. Wright County Egg, in Galt, Iowa, was an egg supplier in 15 of these 29 restaurants or event clusters.

Beyond the epidemiological link to Wright County Egg, public health officials have uncovered startlingly substandard conditions at Wright County Egg’s production facilities.   CDC summarized those findings as follows:

FDA has now completed its on-site investigations of both Iowa farms and an evaluation of the investigational data, including review of sampling results and records. FDA’s inspectional observations, in addition to sample results, indicate substantial potential for Salmonella to have persisted in the environment and to have contaminated eggs.

The CDC’s summary, however, falls well short of capturing the deplorable conditions at Wright County Egg that caused this outbreak, and led to a national outcry for better oversight of egg production facilities.   The FDA form 483, which contains observations of its inspection, included the following:

  • Chicken manure located in the manure pits below the egg laying operations was observed to be approximately 4 feet high to 8 feet high at the following locations: Layer 1 – House 1; Layer 3 – Houses 2, 7, 17, and 18.  The outside access doors to the manure pits at these locations had been pushed out by the weight of the manure, leaving open access to wildlife or domesticated animals.
  • Un-baited, unsealed holes appearing to be rodent burrows located along the second floor baseboards were observed inside Layer 1 – Houses 1-9 and 11-13; Layer 2 – Houses 7 and 11; Layer 3 – Houses 1, 3, 4, 5, and 6; Layer 4 – House 3.
  • Dark liquid which appeared to be manure was observed seeping through the concrete foundation to the outside of the laying houses at the following locations: Layer 1 – Houses 1, 2, 3, 4, 5, 8, 11, 12, and 14; and Layer 3 – Houses 1, 8, 13, and 17.
  • Standing water approximately 3 inches deep was observed at the southeast corner of the manure pit located inside Layer 1 – House 13.
  • Un-caged birds (chickens having escaped) were observed in the egg laying operations in contact with the egg laying birds at Layer 3 – Houses 9 and 16.  The un-caged birds were using the manure, which was approximately 8 feet high, to access the egg laying area.
  • Layer 3 – House 11, the house entrance door to access both House 11 and 12 was blocked with excessive amounts of manure in the manure pits.
  • There were between 2 to 5 live mice observed inside the egg laying Houses 1, 2, 3, 5, 7, 9, 10, 11, and 14.
  • Live and dead flies too numerous to count were observed at the following locations inside the egg laying houses: Layer 1 – Houses 3, 4, 6, 8, 9, 11, and 12; Layer 2 – Houses 7 and 11; Layer 3 – Houses 3, 4, 4, 5, 7, 8, 15, 16, 17, and 18.  The live flies were on and around egg belts, feed, shell eggs and walkways in the different sections of each egg laying area.  In addition, live and dead maggots too numerous to count were observed on the manure pit floor located in Layer 2 – House 7.
  • [failure to] document washing and disinfecting of your dead hen truck and manure equipment prior to moving from farm to farm.
  • [failure to] maintain records documenting the washing and disinfection of the trailers used for the movement of pullets to laying houses.
  • Birds were observed roosting and flying, chicks heard chirping in the storage and milking facilities.  In addition, nesting material was observed in the feed mill closed mixing system, ingredient storage and truck filling areas.
  • Outdoor whole kernel corn grain bins 4 and 6 observed to have the topside doors/lids open to the environment and pigeons were observed entering and leaving these openings.  Birds were also observed sitting/flying around and over the openings.

In addition, FDA investigators found Salmonella in numerous environmental samples collected at the facility, including:

  • On 8/13/2010, an environmental sample was collected from Layer 2, house 7 manure swab from row 1 – left side.
  • On 8/16/2010, an environmental sample was collected from Layer 2, house 11 at manure scraper blade from row 3 – right side.
  • On 8/13/2010, an environmental sample was collected from Layer 4, house 3 at walkway 1 – right side and walkway 3 – right side.
  • On 8/14/2010, a sample of meat and bone meal was collected from ingredient bin 7 located at your feed mill.
  • On 8/17/2010, a sample of finished feed “Developer” pullet feed was collected from the feed mill.
  • On 8/16/2010, an environmental sample was collected from the roof level covered ingredient bin chute 8; Second Floor ingredient bin cover 19 (ingredient bin 19 holds ground corn) located at your feed mill.

In addition to the FDA investigation, a Congressional investigation uncovered further evidence of Wright County Egg’s indifference to the conditions at its facility and risk of illness to consumers.  Records presented at the Congressional hearings included environmental sample reports from the defendant’s facility in and around Galt Iowa from between 2008 and 2010 that indicated that Wright County Egg received 426 positive results for Salmonella, including 73 samples that were potentially positive for Salmonella enteritidis.  The testing included 66 positive samples for Salmonella on May 27, 2010 alone.

In short, the Wright County Egg facility was a major Salmonella epidemic waiting to happen.   Our clients were among those sickened when the outbreak did, in fact, come to fruition.

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.


[1]   Pulsenet is the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

Outbreak of Salmonella Montevideo at Deli in 2014

2014 Outbreak of Salmonella Montevideo, Brent’s Deli Westlake Village

(Thanks to Trevor Quirk for bringing me in)

In July 2014 public health investigators in California learned of an increase of case patients diagnosed with Salmonella serotype Montevideo.  The California Department of Public Health (CDPH) Microbial Disease Laboratory (MDL) conducted pulsed field gel electrophoresis (PFGE) on isolates cultured from patient specimens. Seven patients were infected with an indistinguishable genetic strain identified as JIXX01.0645, an uncommon genetic strain.  Patients resided in Ventura and Los Angeles counties.  Information gathered in interviews conducted by local health investigators revealed that just prior to onset of symptoms; all seven patients had eaten at Brent’s Deli, a restaurant located in Westlake Village, California.  Health officials initiated active surveillance of patients diagnosed with Salmonella Montevideo strain JIXX01.0645. In total 19 patients infected with strain JIXX01.0645 were identified. Two additional patients were infected with strain JIXX01.1565, considered to be a clonal derivative of the main outbreak strain. Two of the 21 patients were employees of Brent’s Deli. Eight patients were hospitalized. Dates of illness onset ranged from April 30, 2014 to August 15, 2014.  See Outbreak Investigation Timeline.

On July 9, 2014 environmental health staff at the County of Ventura Environmental Health Division conducted an on-site inspection at Brent’s Deli. Multiple food safety violations were noted including improper sanitation, cooling and storage issues. The restaurant manager was instructed to correct all violations immediately. A follow-up inspection was conducted on July 22. Major food safety violations were again noted. Specifically, potentially hazardous foods were not held at or below 41 degrees and were not properly cooled. Wiping cloths were not stored in a sanitizing solution between uses. The inspector observed an employee not properly washing hands before handling food or clean utensils. A refrigerator was not operating properly. Plumbing fixtures were leaking and in disrepair. Floor surfaces were damaged preventing adequate cleaning. These items were corrected by the next inspection conducted on July 29. Due to continuing reports of ill customers, Ventura County Environmental Health staff conducted another inspection on August 11. Violations included inadequate hot holding temperatures for corned beef and improper thawing.  On August 12 the restaurant was closed and a third party company was hired to oversee cleaning. Stool specimens were collected from employees who were also required to attend training classes on proper food safety practices.  Food and environmental samples were collected for testing.  Tests showed that two employees were positive for Salmonella Montevideo, strain JIXX01.0645. None of the environmental samples was positive for Salmonella. None of the food samples was positive for Salmonella. The restaurant was allowed to reopen on August 13.  Inspections continued to occur between August 14 and August 19. An inspection was conducted during the week of September 12 and no violations were noted.  The outbreak investigation was closed on October 1, 2014 after no reports of illnesses had been received since August 16, 2014.  See Inspection Reports.

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.