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Foodborne Illness Outbreaks

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Kansas Buffalo Wild Wings Hit with Norovirus

Buffalo-Wild-Wings1The Kansas health department is yet to find the cause and source of a gastrointestinal illness that affected at least 10 people who ate at a Buffalo Wild Wings Inc restaurant, a spokeswoman for the department’s Johnson County office said.

Shares of the popular chicken wings chain fell as much as 7.8 percent to a 15-month low of $138.31 on Wednesday.

The Johnson County Department of Health and Environment said on Tuesday that it was working with state health officials in probing reports of gastrointestinal illnesses that affected the people, who ate at a Buffalo Wild Wings outlet in Overland Park in suburban Kansas City.

Laboratory results are awaited, the department said, adding that there were currently no confirmed cases of norovirus.

“We expect (the test results) in the next couple days,” said Barbara Mitchell, the public information officer at the department. “This time of year, we typically have norovirus in the area,” she said.

Buffalo Wild Wings voluntarily closed the restaurant on Saturday for cleaning and reopened it on Sunday following consultation with the health department, a spokesman said in an email.

Norovirus is the most common cause of food-borne illnesses and acute gastroenteritis in the United States, with 19 million to 21 million cases and 570-800 deaths annually, according to the U.S. Centers for Disease Control and Prevention.

State health officials said last month that they were probing a norovirus outbreak among customers at the New Theatre Restaurant in Overland Park.

“I don’t believe there’s anything that is connected (to the New Theatre outbreak) but we don’t know that as of yet either,” Mitchell said.

CDC and FDA call Chipotle E. coli O26 Outbreaks Over – But:

Ultimately, no food item has been identified as causing the outbreak, and by the same token, no food has been ruled out as a cause. (FDA)

The FDA and the Centers for Disease Control and Prevention (CDC) along with state and local officials are investigating two separate outbreaks of E. coli O26 infections that have been linked to food served at Chipotle Mexican Grill restaurants in several states.

As of January 27, 2016, the CDC reports a total of 55 people infected with the outbreak strain of STEC (Shiga toxin producing E. coli) O26 from a total of 11 states in the larger outbreak: California (3), Delaware (1), Illinois (1), Kentucky (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27). There have been 21 reported hospitalizations. The majority of these cases were reported from Oregon and Washington during October 2015.

In December 2015, the CDC reported five people infected in three states with a different, rare strain of STEC O26: Kansas (1), North Dakota (1), and Oklahoma (3). Interviews were conducted with five ill people, who all reported eating at Chipotle Mexican Grill restaurants. There were no reports of hemolytic uremic syndrome (HUS) and no deaths in either outbreak.

Investigators used whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness in both outbreaks. Whole genome sequencing (WGS) was performed on STEC O26 isolates from 36 ill people from the first outbreak. All 36 isolates were highly related genetically to one another. This provided additional evidence that illnesses outside the Pacific Northwest, were related to the illnesses in Washington and Oregon. WGS was also performed on STEC isolates from four people in the second outbreak. All were highly related to one another, although not to the isolates from the first outbreak.

Chipotle Mexican Grill closed 43 restaurants in Washington and Oregon in early November 2015 in response to the initial outbreak. All these restaurants reopened in November 2015. Chipotle Mexican Grill worked in close consultation and collaboration with health officials throughout the investigation to determine whether it was appropriate to reopen these restaurants. Chipotle reports taking the following actions, among others, prior to opening:

  • Confirming that all microbial testing performed by the company did not yield E. coli (more than 2,500 tests of Chipotle’s food, restaurant surfaces, and equipment all showed no E. coli)
  • Confirming that no employees in these restaurants were sickened from this incident
  • Expanded testing of fresh produce, raw meat, and dairy items prior to restocking restaurants
  • Implementing additional safety procedures, and audits, in all of its 2,000 restaurants to ensure that robust food safety standards are in place
  • Working closely with federal, state, and local government agencies to ensure that robust food safety standards are in place
  • Replacing all ingredients in the closed restaurants
  • Conducted additional deep cleaning and sanitization in all of its closed restaurants (will conduct deep cleaning and sanitization additionally in all restaurants nationwide)

The FDA conducted tracebacks of multiple widely-distributed ingredients. Traceback can be difficult with Mexican-style foods given they are often complex dishes containing multiple ingredients. No product of interest was identified. Even without a definitive item to follow, the FDA traced back to their origins some widely distributed ingredients in an effort to identify a source for the outbreak. Unfortunately, the distribution path did not lead to an ingredient of interest.

The FDA also conducted investigations of some suppliers, but did not find any evidence that those suppliers were the source of the outbreak. Ultimately, no food item has been identified as causing the outbreak, and by the same token, no food has been ruled out as a cause.

Lettuce Down Under Recalled Over Extra Salmonella

Consumers have been warned against eating a selection of pre-packed lettuce products grown and distributed by the Victorian-based company Tripod Farmers following confirmation of a number of cases of salmonella infection.

The lettuce is sold through both Coles and Woolworths supermarkets and includes brands such as; Coles 4 Leaf Mix, Woolworths salad mix, SupaSalad Supamix and Wash N Toss salad mix.

All these products have best before dates leading up to and including February 14.

The Department of Health and Human Services Senior Medical Advisor Dr Finn Romanes said people with these products should either return them to the place of purchase or discard them.

Dr Romanes said the links between the product and illness in Victorians had been made because of a higher than usual number of cases of the Salmonella anatum strain.

“Normally we only see a handful of cases of this strain each year, but so far this year there have been 28 adult cases of Salmonella anatum – mostly adults – notified to the Department.

“As a result of following up the food histories of a number of people we have discovered a common source – the Tripod Farmers lettuce,” Dr Romanes said.

“Tests of three products from two batches have also tested positive for Salmonella anatum bacterium,” he said.

Tripod Farmers is issuing a national voluntary product recall for these products and there will be ongoing testing and monitoring of all products from the company.

An inspection of the premises has been undertaken and a full and thorough clean-up has been carried out.

Salmonellosis is a form of gastroenteritis caused by the germ (bacterium) Salmonella and can affect anyone.

The severity of symptoms depends on the number of bacteria ingested, age and general health.

The elderly, those with another medical condition (such as a weakened immune system) or are malnourished are more prone to the illness.

Symptoms of salmonellosis usually occur between 6 to 72 hours after the bacteria is ingested. The most common symptoms include: diarrhoea, which may contain blood or mucous; fever; headache; stomach cramps; nausea; vomiting, and dehydration, especially among infants and the elderly.

In rare cases, septicaemia (local infection) may develop as a complication of salmonellosis.

E. coli Cases in Canada Linked to Pork Sausage

Alberta Health Services (AHS) is currently investigating an outbreak of E. coli O157:H7 cases in the Calgary Zone of AHS.

As of Feb. 2, this outbreak includes 14 lab-confirmed cases of E. coli O157:H7.

Though the ongoing investigation has not yet confirmed a single source of illness linked to all 14 outbreak cases, recent testing has linked at least two of the 14 cases with a specific pork sausage product sold to the public by a Calgary-based retailer.

As such, effective immediately, AHS is advising any individual who purchased Paolini’s Sausage & Meats Ltd’s Hungarian Farmer’s Sausage before Feb. 2, 2016, to handle this product as though it is a raw meat product, and to cook it to an internal temperature of 71 C before consuming.

Cooking to this temperature will destroy any potential E. coli bacteria. This product is not ready-to-eat, and appropriate cooking instructions are not provided with the product.

Please note this product may have been sold by retailers other than Paolini’s Sausage & Meats Ltd., both within and outside of the city of Calgary.

AHS Public Health investigates every case of E. coli O157:H7 confirmed in Alberta as part of routine operations.

As the investigation into this outbreak is still ongoing, AHS continues to work with partners to identify any additional potential source(s) of illness associated with the outbreak, and any ongoing risks to the public. If and as the investigation identifies any additional potential risks to the general public, further updates will be provided by AHS.

As always, all Albertans are encouraged to follow these important precautions on a daily basis to reduce risk of E. coli infection:

  • Wash hands with hot, soapy water often, including after you go to the washroom, before you prepare food, after you touch raw meat, and after you change diapers.
  • Cook beef and pork to at least 71 C (160 F).
  • Thoroughly wash all kitchen tools and surfaces that have touched raw meat to avoid cross-contamination.
  • Thoroughly wash vegetables and fruits before eating.
  • Use only pasteurized milk, dairy, and juice products.
  • Ensure water used for drinking or food preparation is from approved sources (including municipal water supply or properly maintained/treated well water).

More with Listeria in Canada from Dole Lettuce

The Public Health Agency of Canada is collaborating with federal and provincial public health partners, the United States Centers for Disease Control and Prevention (CDC), and the United States Food and Drug Administration (FDA) to investigate an outbreak of Listeria monocytogenes infections linked to Dole and PC Organics packaged salad products produced from a US processing facility in Springfield, Ohio.

Currently, there are 11 cases of Listeria monocytogenes in five provinces related to this outbreak: Ontario (7), Quebec (1), New Brunswick (1), Prince Edward Island (1), and Newfoundland and Labrador (1). Individuals became sick between May 2015 and early January 2016. Some of the individuals who became ill have reported eating packaged salads. It is suspected that these salads were produced at the Dole facility in Ohio. The majority of Canadians cases (55%) are female, with an average age of 79 years. All cases have been hospitalized, and three people have died, however it has not been determined if Listeria contributed to the cause of these deaths.

On Friday, January 22, CFIA issued a food recall warning advising Canadians of the recall to Dole and PC Organics packaged salad products under various product names that were distributed in eastern provinces. The Public Health Agency of Canada advises Canadians not to consume packaged salad products that have been processed at the Dole facility in Springfield, Ohio. This includes a variety of Dole and PC Organics brand items. These products can be identified by letter the “A” at the beginning of the manufacturing code found on the package. For a full list of products, please refer to the CFIA recall notice.

Fifteen people infected with the outbreak strain of Listeria have been reported from eight states since July 5, 2015. The number of ill people reported from each state is as follows: Connecticut (1), Indiana (1), Massachusetts (1), Michigan (4), Missouri (1), New Jersey (1), New York (5), and Pennsylvania (1). Whole genome sequencing has been performed on clinical isolates from all ill people and has shown that the isolates are highly related genetically. Listeria specimens were collected from ill people between July 5, 2015 and January 3, 2016. Ill people range in age from 3 years to 83, and the median age is 64. Seventy-three percent of ill people are female. All 15 (100%) ill people were hospitalized, including one person from Michigan who died as a result of listeriosis. One of the illnesses reported was in a pregnant woman.

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.

RAW Meal Link in 9 State 11 Illness Salmonella Outbreak

A total of 11 people infected with the outbreak strain of Salmonella Virchow have been reported from nine states. The number of ill people identified in each state is as follows: Minnesota (2), New Jersey (2), New Mexico (1), Ohio (1), Oklahoma (1), Oregon (1), Tennessee (1), Utah (1), and Wisconsin (1). Illnesses started on dates ranging from December 5, 2015, to January 21, 2016. Ill people range in age from 8 years to 76, with a median age of 35. Fifty-five percent of ill people are male. Among 10 ill people with available information, one reported being hospitalized, and no deaths have been reported.

big-map-2-1-2016

The epidemiologic and laboratory evidence available at this time suggest that RAW Meal Organic Shake & Meal products made by Garden of Life, LLC are a likely source of this outbreak. This investigation is ongoing.

In interviews, ill people answered questions about foods eaten and other exposures in the week before they became ill. Of the 10 ill people who were interviewed, 10 (100%) reported consuming powdered supplements or meal replacements powders in the week before illness onset; all 10 (100%) 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 have the potential to be contaminated with Salmonella Virchow. The recalled products were available for purchase nationwide in many retail stores and online.

On January 31, 2016, the Utah Public Health Laboratory reported it isolated Salmonella from an open container of Garden of Life RAW Meal collected from an ill person’s home. On February 1, 2016, Oregon health officials also reported Salmonella was isolated from an open container of Garden of Life RAW Meal collected from an ill person’s home. DNA “fingerprinting” is being conducted for both samples to determine the PFGE pattern of the Salmonella isolated from this product. Results will be reported when they become available.

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.

Kansas New Theatre Restaurant Linked to 600 with Norovirus

The Kansas Department of Health and Environment is working with the Kansas Department of Agriculture and the Johnson County Department of Health and Environment to investigate an outbreak of norovirus infection in which more than 600 individuals have became ill after attending the New Theatre Restaurant in Overland Park, Kan.

KDHE, JCDHE, KDA and the city of Overland Park went to the New Theatre Restaurant on Friday, Jan. 29, to educate staff about norovirus, oversee cleanup, and observe food safety practices. Following the visit, the New Theatre Restaurant contracted with a private firm that cleaned the entire facility with an EPA-registered disinfectant, which kills norovirus and is safe for food establishments.

So far during KDHE’s investigation, more than 600 individuals have reported illness. A majority of these reports were from people who attended the New Theatre Restaurant between Friday, Jan. 15, and Tuesday, Jan. 19. KDHE has not received any reports of people becoming ill who attended New Theatre after Wednesday, Jan. 27.

Norovirus is very contagious and symptoms include diarrhea, vomiting, nausea and stomach pain. A person develops symptoms 12 to 48 hours after being exposed and most people get better within one to three days. Norovirus is spread person to person (having contact with someone who is infected with norovirus), through contaminated food or water, or by touching contaminated surfaces. Persons who are ill with norovirus symptoms should not prepare food or care for other persons. The best way to prevent transmission of norovirus and other diseases is by proper hand washing.

Wash your hands with soap and water for 20 seconds:
Before, during and after preparing food
Before and after eating food
Before and after caring for someone who is sick
Before and after treating a cut or wound
After using the toilet
After changing diapers or cleaning up a child who has used the toilet
After blowing your nose, coughing or sneezing
After touching an animal, animal feed or animal waste
After handling pet food or pet treats
After touching garbage

KDHE is requesting that all persons, those that became ill and those that did not become ill, who attended performances since Friday, Jan. 15 to fill out the secure, confidential online survey at http://tinyurl.com/newtheatre2016. KDHE is still investigating the source of the illness. Personal information provided to KDHE will be held confidential, and this information is protected by state law. Persons who have already participated in a telephone interview do not need to complete an online survey. For more information about the outbreak, call the KDHE Epidemiology Hotline at 877-427-7317.

Norovirus: Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Norovirus outbreaks. The Norovirus lawyers of Marler Clark have represented thousands of victims of Norovirus 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.

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

FDA Weighs in on Chipolte E. coli Outbreak

The FDA and the Centers for Disease Control and Prevention (CDC) along with state and local officials are investigating two separate outbreaks of E. coli O26 infections that have been linked to food served at Chipotle Mexican Grill restaurants in several states.

As of January 27, 2016, a total of 55 people infected with the outbreak strain of STEC (Shiga toxin producing E. coli) O26 from a total of 11 states in the larger outbreak: California (3), Delaware (1), Illinois (1), Kentucky (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27). There have been 21 reported hospitalizations. The majority of these cases were reported from Oregon and Washington during October 2015.

In December 2015, the CDC reported five people infected in three states with a different, rare strain of STEC O26: Kansas (1), North Dakota (1), and Oklahoma (3). Interviews were conducted with five ill people, who all reported eating at Chipotle Mexican Grill restaurants. There were no reports of hemolytic uremic syndrome (HUS) and no deaths in either outbreak. .

Investigators used whole genome sequencing, an advanced laboratory technique, to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness in both outbreaks. Whole genome sequencing (WGS) was performed on STEC O26 isolates from 36 ill people from the first outbreak. All 36 isolates were highly related genetically to one another. This provided additional evidence that illnesses outside the Pacific Northwest, were related to the illnesses in Washington and Oregon. WGS was also performed on STEC isolates from four people in the second outbreak. All were highly related to one another, although not to the isolates from the first outbreak.

Chipotle Mexican Grill closed 43 restaurants in Washington and Oregon in early November 2015 in response to the initial outbreak. All these restaurants reopened in November 2015. Chipotle Mexican Grill worked in close consultation and collaboration with health officials throughout the investigation to determine whether it was appropriate to reopen these restaurants. Chipotle reports taking the following actions, among others, prior to opening:

  • Confirming that all microbial testing performed by the company did not yield E. coli (more than 2,500 tests of Chipotle’s food, restaurant surfaces, and equipment all showed no E. coli)
  • Confirming that no employees in these restaurants were sickened from this incident
  • Expanded testing of fresh produce, raw meat, and dairy items prior to restocking restaurants
  • Implementing additional safety procedures, and audits, in all of its 2,000 restaurants to ensure that robust food safety standards are in place
  • Working closely with federal, state, and local government agencies to ensure that robust food safety standards are in place
  • Replacing all ingredients in the closed restaurants
  • Conducted additional deep cleaning and sanitization in all of its closed restaurants (will conduct deep cleaning and sanitization additionally in all restaurants nationwide)

The FDA conducted tracebacks of multiple widely-distributed ingredients. Traceback can be difficult with Mexican-style foods given they are often complex dishes containing multiple ingredients. No product of interest was identified. Even without a definitive item to follow, the FDA traced back to their origins some widely distributed ingredients in an effort to identify a source for the outbreak. Unfortunately, the distribution path did not lead to an ingredient of interest.

The FDA also conducted investigations of some suppliers, but did not find any evidence that those suppliers were the source of the outbreak. Ultimately, no food item has been identified as causing the outbreak, and by the same token, no food has been ruled out as a cause.

Pistachios Recalled Over Salmonella Risk

Screen Shot 2016-02-01 at 3.14.24 PMBraga Organic Farms announces the voluntary recall of pistachios due to potential contamination with Salmonella, an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella can experience fever, diarrhea (which may be bloody), nausea, vomiting, and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

No illnesses have been reported to date in connection with this recall.

The recalled nuts were distributed in retail stores in California, Oregon and Washington, and it was distributed through online sales nationwide.

The product comes in a clear or green standup bag, with the date code stamped on the bottom of the bag.

The potential for contamination was noted after routine testing by the FDA revealed the presence of Salmonella in a one-pound package of raw pistachio kernels purchased online.

A list of affected products and code dates is listed below; no other Braga Organic Farms products are associated with this voluntary recall.

Product Size UPC BEST BY OR PURCHASE DATE
Raw Pistachio Kernels 8 oz 896547002047 JUN 29 2016, JUL 04 2016, JUL 18 2016, JUL 25 2016, JUL 26 2016
1 lb 810126020215 Purchased 12/28/15 to 1/27/16
2 lbs 896547002306 JUN 28 2016, JUL 13 2016, JUL 27 2016
5 lbs 896547002641 Purchased 12/28/15 to 1/27/16
Trail Mix 8 oz 896547002139 JUN 29 2016, JUL 7 2016, JUL 11 2016, JUL 26 2016
1 lb 810126020451 Purchased 12/28/15 to 1/29/16
2 lbs 896547002320 JUL 01 2016, Purchased 12/28/15 to 1/29/16
5 lbs 896547002603 Purchased 12/28/15 to 1/29/16
25 lbs 896547002492 Purchased 12/28/15 to 1/29/16
Nut Mix 8 oz 896547002177 JUL 06 2016, JUL 07 2016, JUL 11 2016, JUL 18 2016
1 lb 810126020192 Purchased 12/28/15 to 1/27/16
2 lbs 896547002351 JUL 01 2016, Purchased 12/28/15 to 1/27/16
5 lbs 810126020208 Purchased 12/28/15 to 1/27/16
25 lbs 896547002412 Purchased 12/28/15 to 1/27/16

Consumers who have purchased this recalled product should not consume it.

Chipotle E. coli Outbreaks Over at 60 – Last Illness December

CDC, the U.S. Food and Drug Administration, the U.S. Department of Agriculture’s Food Safety and Inspection Service, and public health officials in several states investigated two outbreaks of Shiga toxin-producing Escherichia coli O26 (STEC O26) infections.

Public health investigators used the PulseNet system to identify illnesses that were part of the outbreaks. PulseNet, the national subtyping network of public health and food regulatory agency laboratories, is coordinated by CDC. DNA fingerprinting is performed on E. coli bacteria isolated from ill people by using a technique called pulsed-field gel electrophoresis, or PFGE. PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. Two different, rare DNA fingerprints of STEC O26 were included in these investigations. Investigators also used whole genome sequencing (WGS), an advanced laboratory technique, to get more detailed information about the DNA fingerprints of the two STEC O26 strains that caused illness.

Summaries of the two outbreaks are provided in more detail below.

Initial, Larger Outbreak

big-epi-first-2-1-2016

The initial, larger outbreak was first detected by public health officials in Washington and Oregon through local foodborne disease surveillance. In late October 2015, officials in those states detected an increase in illness and after interviewing ill people, they determined that illness was likely linked to eating at multiple Chipotle Mexican Grill locations.

PFGE results from ill people in Washington and Oregon indicated that people were infected with a rare strain of STEC O26. A search of the PulseNet database identified illnesses in other states, and these ill people were added to the total case count.

A total of 55 people infected with the outbreak strain of STEC O26 were reported from 11 states. The majority of illnesses were reported from Washington and Oregon during October 2015. The number of ill people reported from each state was as follows: California (3), Delaware (1), Illinois (1), Kentucky (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27).

Among people for whom information was available, illnesses started on dates ranging from October 19, 2015 to December 1, 2015. Ill people ranged in age from 1 year to 94, with a median age of 21. Fifty-seven percent of ill people were female. Twenty-one (38%) people reported being hospitalized. There were no reports of hemolytic uremic syndrome and no deaths.

WGS was performed on 36 STEC O26 isolates from ill people in this outbreak, including isolates from ill people in states outside the Pacific Northwest. All 36 isolates were highly related genetically. This provided additional evidence that illnesses outside the Pacific Northwest were related to the earlier illnesses in Oregon and Washington.

Second, Smaller Outbreak

big-epi-second-2-1-2016

In December 2015, a second outbreak of a different, rare strain of STEC O26 was identified. A total of five people infected with this strain of STEC O26 were reported from three states. The number of ill people reported from each state was as follows: Kansas (1), North Dakota (1), and Oklahoma (3).

Among people for whom information was available, illnesses started on dates ranging from November 18, 2015 to November 26, 2015. Ill people ranged in age from 6 years to 25, with a median age of 22. Eighty percent of ill people were female. One (20%) person reported being hospitalized. There were no reports of hemolytic uremic syndrome and no deaths.

WGS was performed on four STEC O26 isolates from ill people in this outbreak. All four isolates were highly related genetically to each other, but they were not related to isolates from ill people in the initial, larger outbreak.

Investigation of the Outbreaks

The epidemiologic evidence collected during these investigations suggested that a common meal item or ingredient served at Chipotle Mexican Grill restaurants was a likely source of both outbreaks. The investigations did not identify a specific food or ingredient linked to illness in either 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 their illness started. In the initial, larger outbreak, 47 (87%) of 54 people interviewed reported eating at a Chipotle Mexican Grill restaurant. This included at least 17 different restaurant locations in 8 states. In the smaller outbreak, five (100%) of five people interviewed reported eating at a Chipotle Mexican Grill restaurant. All three ill people in Oklahoma ate at a single Chipotle location in that state. The ill person in North Dakota traveled to Kansas during the exposure period and ate at the same Chipotle location as the ill person in Kansas.

The data collected during interviews with ill people indicated that most ate a meal at a Chipotle Mexican Grill in the week before illness started, and they ate many of the same items. The Oregon and Washington Departments of Health conducted epidemiologic studies in the initial outbreak that compared foods eaten by ill and well people at Chipotle Mexican Grill. Those studies did not identify any specific food item or ingredient that could explain the outbreak. When a restaurant serves foods with several ingredients that are mixed or cooked together and then used in multiple menu items, it can be more difficult for epidemiologic studies to identify the specific ingredient that is contaminated.

Testing of multiple food items collected from Chipotle restaurant locations did not identify STEC O26.

A review of Chipotle’s distribution records by state and federal regulatory officials was unable to identify a single food item or ingredient that could explain illnesses in either outbreak. Food industries are an important partner in making food safer for everyone. They can help stop outbreaks and lessen their impact by keeping detailed records to allow faster tracing of individual shipments of foods from source to destination.