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Genki Sushi Scallops Hepatitis A Outbreak in Hawaii

On August 15, 2016, the Hawaii Department of Health (HDOH) identified raw scallops served at Genki Sushi restaurants on Oahu and Kauai as a likely source of an ongoing hepatitis A outbreak. The product of concern was identified to be Sea Port Bay Scallops (Wild Harvest, Raw Frozen) that originated in the Philippines (states “Product of the Philippines” on the box) and were distributed by Koha Oriental Foods.

As a result, HDOH ordered this product embargoed (not to be sold, purchased, or consumed) throughout the state, and the temporary closure of all Genki Sushi restaurants on Oahu and Kauai.

As of November 30, 2016, HDOH has identified 292 cases of hepatitis A. Seventy-four have required hospitalization. Findings of the investigation suggest that the source of the outbreak is focused on Oahu. Eleven individuals are residents of the islands of Hawaii, Kauai, or Maui, and seven visitors have returned to the mainland or overseas. Onset of illness has ranged between June 12, 2016 and October 9, 2016.

The FDA and CDC are supporting the HDOH in the investigation of hepatitis A virus (HAV) infections linked to scallops supplied by Sea Port Products Corp. On August 17, 2016, the FDA, HDOH, CDC, and state partners informed Sea Port Products Corp. that epidemiological, laboratory, and traceback information indicated that their scallops are the likely source of illnesses. On August 18, 2016, Sea Port Products Corp. initiated a voluntary recall of three lots of frozen Bay Scallops produced on November 23 and 24, 2015. The lot numbers for the recalled scallops are 5885, 5886, and 5887. The products were distributed to California, Hawaii, and Nevada. According to Sea Port Products Corp., the recalled products are not intended for retail sale. The FDA is working with the recalling firm to ensure their recall is effective and that recalled product is removed from the market.

The FDA’s traceback investigation involved working with HDOH to trace the path of food eaten by those made ill back to a common source. The traceback investigation determined that Sea Port Products Corp. imported the scallops that were later supplied to certain Genki Sushi locations in Hawaii, where ill people reported eating.

On August 17, 2016, FDA laboratory analysis of two scallop samples, which were collected on August 11, 2016, were confirmed positive for hepatitis A. These samples were imported by Sea Port Products Corp. and were produced on November 23 and 24, 2015.

The Hepatitis A Virus

Exposure to hepatitis A virus (“HAV”) can cause an acute infection of the liver that is typically mild and resolves on its own.[1] The symptoms and duration of illness vary a great deal, with many persons showing no symptoms at all.[2] Fever and jaundice are two of the symptoms most commonly associated with HAV infection.[3]

Throughout history, hepatitis infections have plagued humans. The “earliest accounts of contagious jaundice are found in ancient China.”[4] According to the CDC:

The first descriptions of hepatitis (epidemic jaundice) are generally attributed to Hippocrates.  Outbreaks of jaundice, probably hepatitis A, were reported in the 17th and 18th centuries, particularly in association with military campaigns.  Hepatitis A (formerly called infectious hepatitis) was first differentiated epidemiologically from hepatitis B, which has a long incubation period, in the 1940s.  Development of serologic tests allowed definitive diagnosis of hepatitis B.  In the 1970s, identification of the virus, and development of serologic tests helped differentiate hepatitis A from other types of non-B hepatitis.[5]

Until 2004, HAV was the most frequently reported type of hepatitis in the United States. In the pre-vaccine era, the primary methods used for preventing HAV infections were hygienic measures and passive protection with immune globulin (IG). Hepatitis A vaccines were licensed in 1995 and 1999. These vaccines provide long-term protection against HAV infection.[6]

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States.[7] This virus is one of five human hepatitis viruses that primarily infect the human liver and cause human illness.[8] Unlike hepatitis B and C, hepatitis A does not develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions.[9] Nonetheless, infection with the hepatitis A virus (HAV) can lead to acute liver failure and death.[10]

Where does Hepatitis A Come From?

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person.[11] Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.[12] Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler.[13] The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins.[14]

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A.[15] In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states.[16] Six years later, in 2003, fresh green onions were identified as the source of a HAV outbreak traced to consumption of food at a Pennsylvania restaurant.[17] Other fruits and vegetables, such as blueberries and lettuce, have also been associated with HAV outbreaks in the U.S. as well as in other developed countries.[18] HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces.[19] The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of household bleach in tap water.[20] HAV can still be spread from cooked food if it is contaminated after cooking.[21]

Although ingestion of contaminated food is a common means of spread for HAV, it may also be spread by household contact among families or roommates, sexual contact, or by direct inoculation from persons sharing illicit drugs.[22] Children are often asymptomatic, or have unrecognized infections, and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children.[23]

What are the Symptoms of Hepatitis A?

Hepatitis A may cause no symptoms at all when it is contracted, especially in children.[24] Asymptomatic individuals will only know they were infected (and have become immune, given that you can only get hepatitis A once) by getting a blood test later in life.[25] Approximately 10 to 12 days after exposure, HAV is present in blood and is excreted via the biliary system into the feces.[26] Although the virus is present in the blood, its concentration is much higher in feces.[27] HAV excretion begins to decline at the onset of clinical illness, and decreases significantly by 7 to 10 days after onset of symptoms.[28] Most infected persons no longer excrete virus in the feces by the third week of illness. Children may excrete HAV longer than adults.[29]

Seventy percent of HAV infections in children younger than six years of age are asymptomatic; in older children and adults, infection tends to be symptomatic with more than 70% of those infected developing jaundice.[30] Symptoms typically begin about 28 days after contracting HAV, but can begin as early as 15 days or as late as 50 days after exposure.[31] The symptoms include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise.[32]

After a few days of typical symptoms, jaundice (also termed “icterus”) sets in.[33] Jaundice is a yellowing of the skin, eyes, and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood.[34] The urine will also turn dark with bile and the stool light or clay-colored from lack of bile.[35] When jaundice sets in, initial symptoms such as fever and headache begin to subside.[36]

In general, symptoms usually last less than two months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.[37] It is not unusual, however, for blood tests to remain abnormal for six months or more.[38] The jaundice so commonly associated with HAV can also linger for a prolonged period in some infected persons, sometimes as long as eight months or more.[39] Additionally, pruritus, or severe “itchiness” of the skin, can persist for several months after the onset of symptoms. These conditions are frequently accompanied by diarrhea, anorexia, and fatigue.[40]

Relapse is possible with hepatitis A, typically within three months of the initial onset of symptoms.[41] Although relapse is more common in children, it does occur with some regularity in adults.[42] The vast majority of persons who are infected with hepatitis A fully recover, and do not develop chronic hepatitis.[43] Persons do not carry HAV long-term as with hepatitis B and C.[44]

Fulminant Hepatitis A

Fulminant hepatitis A, or acute liver failure, is a rare but devastating complication of HAV infection.[45] As many as 50% of individuals with acute liver failure may die or require emergency liver transplantation.[46] Elderly patients and patients with chronic liver disease are at higher risk for fulminant hepatitis A.[47] In parallel with a declining incidence of acute HAV infection in the general population, however, the incidence of fulminant HAV appears to be decreasing.[48]

HAV infects the liver’s parenchymal cells (internal liver cells).[49] Once a cell has been penetrated by the viral particles, the hepatitis A releases its own toxins that cause, in essence, a hostile takeover of the host’s cellular system.[50] The cell then produces new viral components that are released into the bile capillaries or tubes that run between the liver’s parenchymal cells.[51] This process results in the death of liver cells, called hepatic necrosis.[52]

The fulminant form of hepatitis occurs when this necrotic process kills so many liver cells—upwards of three-quarters of the liver’s total cell count—that the liver can no longer perform its job.[53] Aside from the loss of liver function, fulminant hepatic failure can lead to encephalopathy and cerebral edema.[54] Encephalopathy is a brain disorder that causes central nervous system depression and abnormal neuromuscular function.[55] Cerebral edema is a swelling of the brain that can result in dangerous intracranial pressure.[56] Intracranial hypertensions leading to a brain stem death and sepsis with multiple organ failure are the leading causes of death in individuals with fulminant hepatic failure.[57]

Incidence of Hepatitis A Infection

Hepatitis A is much more common in countries with underdeveloped sanitation systems and, thus, is a risk in most of the world.[58] An increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe.[59] Nevertheless, infections continue to occur in the United States, where approximately one-third of the population has been previously infected with HAV.[60]

Each year, approximately 30,000 to 50,000 cases of hepatitis A occur in the United States.[61] Historically, acute hepatitis A rates have varied cyclically, with nationwide increases every 10 to 15 years.[62] The national rate of HAV infections has declined steadily since the last peak in 1995.[63] Although the national incidence—1.0 case per 100,000 population—of hepatitis A was the lowest ever recorded in 2007, it is estimated that asymptomatic infections and underreporting kept the documented incidence-rate lower than it actually is. In fact, it is estimated that there were 25,000 new infections in 2007.[64]

In 2007, the CDC reported a total of 2,979 acute symptomatic cases of HAV.[65] Of these, information about food and water exposure was known for 1,047 cases, leading to an estimate that 6.5% of all infections were caused by exposure to contaminated water or food.[66] In 2,500 of the cases, no known risk factor was identified.[67]

Hepatitis A outbreaks associated with shellfish, worldwide, from 1956 to 2016. Adapted and expanded from Richards et al., 1985, Portnoy et al., 1975, and Fiore et al., 2004. Outbreaks that were poorly investigated or had fewer than 30 cases were omitted.  Italics indicate the seafood was locally sourced with respect to the cases.

Hepatitis A outbreaks associated with shellfish, worldwide, from 1956 to 2016
Year # Cases Implicated food Location of cases Source of implicated food Suspected cause of contamination Reference
1956 629 Oysters Sweden Havstenssund Harbor, Sweden Oysters stored in polluted water Roos, 1956[68]; Pintó et al., 2009[69]; Portnoy et al., 1975[70]
1961 80

 

Oysters Mississippi, Alabama Pascagoula River, Mississippi Polluted harvesting areas Mason and McLean, 1962*[71]
1961 459 Clams New Jersey Raritan Bay, New Jersey Polluted harvesting areas Dougherty and Altman, 1962*[72]
1964 123 Clams Connecticut Multiple US sources, primarily Rhode Island Unknown Ruddy et al., 1969[73]
1973 281 Oysters Texas, Georgia, Louisiana Louisiana Stormwater runoff; investigated possible illegal harvesting Mackowiak et al., 1976[74]; Portnoy et al., 1975[75]
1980 312 Oysters Singapore Philippines Suspect contaminated harvesting waters Lee et al., 2011[76]; Goh, 1981[77]
1981 132 Cockles, whelks, mussels, prawns Southeast England United Kingdom Sewage discharge near harvesting beds, insufficient processing O’Mahoney et al., 1983[78]
1982 225 Oysters Hondo City, Japan Ariake Bay, Japan Unknown Fujiyama et al., 1985[79]
1984 75 Mussels and clams Livorno, Italy Livorno, Italy; Venice, Italy Sewage discharge near harvesting beds, improper handling at point of sale Mele et al., 1989[80]
1988 61 Oysters Alabama, Georgia, Florida, Tennessee, Hawaii Florida Untreated sewage from residents and boats, possible illegal harvesting Descenclos et al., 1991[81]
1988 292,301 Clams Shanghai, China Qi-Dong, China Untreated sewage Halliday et al., 1991[82]
1992 800 Raw shellfish Western France Loire-Atlantique and Morbihan, France Unknown Apaire-Marchais et al., 1995[83]
1996, 1997 5673,

5382

Mussels and clams Puglia, Italy Italy Unknown Chironna et al., 2002[84]
1997 444

 

Oysters New South Wales, Australia Wallis Lake, Australia Untreated sewage; stormwater runoff Conaty et al., 2000[85]
1999 184 Coquina clams Valencia, Spain Peru Unknown Sanchez et al., 2002[86]; Bosch et al., 2001[87]
1999 32 Raw shellfish Bretagne, France Bay of Pampiol, France Unknown, harvesting sites near a busy tourist port Costa-Mattioli et al., 2000[88]
2004 882 Mussels and clams Campania, Italy Primarily Campania, also other areas of Italy, Turkey Illegal storage of shellfish in contaminated seawater at point of purchase Pontrelli et al., 2008[89]
2005 39 Oysters Alabama, Florida, South Carolina, Tennessee Louisiana Untreated sewage, possibly from recreational and other boats Bialek et al., 2007[90]; Shieh et al., 2007[91]
2007 111 Oysters Côtes d’Armor, France Côtes d’Armor, France Suspect contaminated water in tanks used on a shellfish farm, nearby untreated sewage Guillois-Bécel et al., 2009[92]
2008 100 Coquina clams Spain Peru Unknown Pintó et al., 2009[93]; Polo et al., 2010[94]
2013 117 Suspect raw foods, especially seafood Taiwan Unknown Unknown Lung and Kay, 2013[95]
2014 30 Raw bivalves: oysters, clams Taiwan Unknown Unknown Taiwan CDC, 2014[96]
2016 292 Scallops Hawaii Philippines Unknown CDC, 2016[97]; HI DOH, 2016[98]

 

Estimates of the annual costs (direct and indirect) of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.[99] Nationwide, adults who become ill miss an average of 27 workdays per illness, and 11 to 22 percent of those infected are hospitalized.[100] All of these costs are entirely preventable given the effectiveness of a vaccination in providing immunity from infection.[101]

References (more…)

Egyptian Strawberry Hepatitis A Outbreak

Beginning in September 2016, several states, CDC, and the FDA investigated a multistate outbreak of foodborne hepatitis A. Epidemiologic and traceback evidence indicate that frozen strawberries imported from Egypt are the likely source of this outbreak. Although no discovery has been done to date to confirm how the Egyptian strawberries made it to consumers, we have learned that Tropical Smoothie had a bulk purchasing agreement with Patagonia. Patagonia bought from VLM Canada.  It is also our understanding that VLM Canada bought from ICAPP and that VLM USA was the importer.  It appears that the strawberries entered the US in Norfolk into VLM USA’s possession and then were transferred to Preferred Freezers Storage, Inc. in Chesapeake into Patagonia’s possession.  From there, ITI picked up the berries and delivered them to either Sysco Hampton Roads or Sysco VA.  Sysco delivered them to Tropical Smoothie franchisees.

Nearly all ill people interviewed reported drinking smoothies containing strawberries at Tropical Smoothie Café locations prior to August 8, in a limited geographical area, including Maryland, North Carolina, Virginia, and West Virginia, but there have been a small number of cases outside of that geographic area with no Tropical Smoothie Café exposure.

In total, 134 people with hepatitis A have been reported from nine states: Arkansas (1), California (1), Maryland (12), New York (3), North Carolina (1), Oregon (1), Virginia (107), West Virginia (7), and Wisconsin (1). Of these cases, 129 people reported eating a smoothie containing strawberries from Tropical Smoothie Café and 5 cases reported having no exposure to Tropical Smoothie Café. There have been no cases reporting illness from this same exposure since September 23, 2016. The latest illness onset date among these cases was October 1, 2016. The investigation into these cases is ongoing. Of the 134 cases, 52 ill people have been hospitalized and no deaths have been reported.

FDA traceback information indicated that the frozen strawberries served in the Tropical Smoothie Café locations were from the International Company for Agricultural Production & Processing (ICAPP), imported from Egypt. On August 8, 2016, Tropical Smoothie Café reported that they removed the Egyptian frozen strawberries from their restaurants in Maryland, North Carolina, Virginia, and West Virginia and switched to another supplier out of an abundance of caution. Information available at this time does not indicate an ongoing risk of hepatitis A virus infection at Tropical Smoothie Cafes.

On October 30, 2016, the International Company for Agricultural Production & Processing (ICAPP) recalled all of its frozen strawberries that were imported into the U.S. since January 1, 2016. The recalled products were distributed for sale to and use in food service establishments nationwide. The FDA reports that hepatitis A virus contamination was found in four samples of ICAPP frozen strawberries.

What is Hepatitis A?

Exposure to hepatitis A virus (“HAV”) can cause an acute infection of the liver that is typically mild and resolves on its own.[1] The symptoms and duration of illness vary a great deal, with many persons showing no symptoms at all.[2] Fever and jaundice are two of the symptoms most commonly associated with HAV infection.[3]

Throughout history, hepatitis infections have plagued humans. The “earliest accounts of contagious jaundice are found in ancient China.”[4] According to the CDC:

The first descriptions of hepatitis (epidemic jaundice) are generally attributed to Hippocrates.  Outbreaks of jaundice, probably hepatitis A, were reported in the 17th and 18th centuries, particularly in association with military campaigns.  Hepatitis A (formerly called infectious hepatitis) was first differentiated epidemiologically from hepatitis B, which has a long incubation period, in the 1940s.  Development of serologic tests allowed definitive diagnosis of hepatitis B.  In the 1970s, identification of the virus, and development of serologic tests helped differentiate hepatitis A from other types of non-B hepatitis.[5]

Until 2004, HAV was the most frequently reported type of hepatitis in the United States. In the pre-vaccine era, the primary methods used for preventing HAV infections were hygienic measures and passive protection with immune globulin (IG). Hepatitis A vaccines were licensed in 1995 and 1999. These vaccines provide long-term protection against HAV infection.[6]

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States.[7] This virus is one of five human hepatitis viruses that primarily infect the human liver and cause human illness.[8] Unlike hepatitis B and C, hepatitis A does not develop into chronic hepatitis or cirrhosis, which are both potentially fatal conditions.[9] Nonetheless, infection with the hepatitis A virus (HAV) can lead to acute liver failure and death.[10]

Where does Hepatitis A Come From?

Hepatitis A is a communicable (or contagious) disease that often spreads from person to person.[11] Person-to-person transmission occurs via the “fecal-oral route,” while all other exposure is generally attributable to contaminated food or water.[12] Food-related outbreaks are usually associated with contamination of food during preparation by a HAV-infected food handler.[13] The food handler is generally not ill because the peak time of infectivity—that is, when the most virus is present in the stool of an infected individual—occurs two weeks before illness begins.[14]

Fresh produce contaminated during cultivation, harvesting, processing, and distribution has also been a source of hepatitis A.[15] In 1997, frozen strawberries were the source of a hepatitis A outbreak in five states.[16] Six years later, in 2003, fresh green onions were identified as the sourse of a HAV outbreak traced to consumption of food at a Pennsylvania restaurant.[17] Other fruits and vegetables, such as blueberries and lettuce, have also been associated with HAV outbreaks in the U.S. as well as in other developed countries.[18] HAV is relatively stable and can survive for several hours on fingertips and hands and up to two months on dry surfaces.[19] The virus can be inactivated by heating to 185°F (85°C) or higher for one minute, or disinfecting surfaces with a 1:100 dilution of household bleach in tap water.[20] HAV can still be spread from cooked food if it is contaminated after cooking.[21]

Although ingestion of contaminated food is a common means of spread for HAV, it may also be spread by household contact among families or roommates, sexual contact, or by direct inoculation from persons sharing illicit drugs.[22] Children are often asymptomatic, or have unrecognized infections, and can pass the virus through ordinary play, unknown to their parents, who may later become infected from contact with their children.[23]

What are the Symptoms of Hepatitis A?

Hepatitis A may cause no symptoms at all when it is contracted, especially in children.[24] Asymptomatic individuals will only know they were infected (and have become immune, given that you can only get hepatitis A once) by getting a blood test later in life.[25] Approximately 10 to 12 days after exposure, HAV is present in blood and is excreted via the biliary system into the feces.[26] Although the virus is present in the blood, its concentration is much higher in feces.[27] HAV excretion begins to decline at the onset of clinical illness, and decreases significantly by 7 to 10 days after onset of symptoms.[28] Most infected persons no longer excrete virus in the feces by the third week of illness. Children may excrete HAV longer than adults.[29]

Seventy percent of HAV infections in children younger than six years of age are asymptomatic; in older children and adults, infection tends to be symptomatic with more than 70% of those infected developing jaundice.[30] Symptoms typically begin about 28 days after contracting HAV, but can begin as early as 15 days or as late as 50 days after exposure.[31] The symptoms include muscle aches, headache, anorexia (loss of appetite), abdominal discomfort, fever, and malaise.[32]

After a few days of typical symptoms, jaundice (also termed “icterus”) sets in.[33] Jaundice is a yellowing of the skin, eyes, and mucous membranes that occurs because bile flows poorly through the liver and backs up into the blood.[34] The urine will also turn dark with bile and the stool light or clay-colored from lack of bile.[35] When jaundice sets in, initial symptoms such as fever and headache begin to subside.[36]

In general, symptoms usually last less than two months, although 10% to 15% of symptomatic persons have prolonged or relapsing disease for up to 6 months.[37] It is not unusual, however, for blood tests to remain abnormal for six months or more.[38] The jaundice so commonly associated with HAV can also linger for a prolonged period in some infected persons, sometimes as long as eight months or more.[39] Additionally, pruritus, or severe “itchiness” of the skin, can persist for several months after the onset of symptoms. These conditions are frequently accompanied by diarrhea, anorexia, and fatigue.[40]

Relapse is possible with hepatitis A, typically within three months of the initial onset of symptoms.[41] Although relapse is more common in children, it does occur with some regularity in adults.[42] The vast majority of persons who are infected with hepatitis A fully recover, and do not develop chronic hepatitis.[43] Persons do not carry HAV long-term as with hepatitis B and C.[44]

Fulminant Hepatitis A

Fulminant hepatitis A, or acute liver failure, is a rare but devastating complication of HAV infection.[45] As many as 50% of individuals with acute liver failure may die or require emergency liver transplantation.[46] Elderly patients and patients with chronic liver disease are at higher risk for fulminant hepatitis A.[47] In parallel with a declining incidence of acute HAV infection in the general population, however, the incidence of fulminant HAV appears to be decreasing.[48]

HAV infects the liver’s parenchymal cells (internal liver cells).[49] Once a cell has been penetrated by the viral particles, the hepatitis A releases its own toxins that cause, in essence, a hostile takeover of the host’s cellular system.[50] The cell then produces new viral components that are released into the bile capillaries or tubes that run between the liver’s parenchymal cells.[51] This process results in the death of liver cells, called hepatic necrosis.[52]

The fulminant form of hepatitis occurs when this necrotic process kills so many liver cells—upwards of three-quarters of the liver’s total cell count—that the liver can no longer perform its job.[53] Aside from the loss of liver function, fulminant hepatic failure can lead to encephalopathy and cerebral edema.[54] Encephalopathy is a brain disorder that causes central nervous system depression and abnormal neuromuscular function.[55] Cerebral edema is a swelling of the brain that can result in dangerous intracranial pressure.[56] Intracranial hypertensions leading to a brain stem death and sepsis with multiple organ failure are the leading causes of death in individuals with fulminant hepatic failure.[57]

Incidence of Hepatitis A Infection

Hepatitis A is much more common in countries with underdeveloped sanitation systems and, thus, is a risk in most of the world.[58] An increased transmission rate is seen in all countries other than the United States, Canada, Japan, Australia, New Zealand, and the countries of Western Europe.[59] Nevertheless, infections continue to occur in the United States, where approximately one-third of the population has been previously infected with HAV.[60]

Each year, approximately 30,000 to 50,000 cases of hepatitis A occur in the United States.[61] Historically, acute hepatitis A rates have varied cyclically, with nationwide increases every 10 to 15 years.[62] The national rate of HAV infections has declined steadily since the last peak in 1995.[63] Although the national incidence—1.0 case per 100,000 population—of hepatitis A was the lowest ever recorded in 2007, it is estimated that asymptomatic infections and underreporting kept the documented incidence-rate lower than it actually is. In fact, it is estimated that there were 25,000 new infections in 2007.[64]

In 2007, the CDC reported a total of 2,979 acute symptomatic cases of HAV.[65] Of these, information about food and water exposure was known for 1,047 cases, leading to an estimate that 6.5% of all infections were caused by exposure to contaminated water or food.[66] In 2,500 of the cases, no known risk factor was identified.[67]

Hepatitis A outbreaks associated with fresh, frozen, and minimally processed produce, worldwide, from 1983 to 2016. Adapted and expanded from Sivapalasingam et al., 2004 and Fiore, 2004. Italics indicate instances where the food was locally sourced with respect to the cases. The implicated foods were raw unless listed otherwise.

Hepatitis A outbreaks associated with fresh, frozen, and minimally processed produce, worldwide, from 1983 to 2016
Year # Cases Implicated food Location of cases Source of implicated food Suspected cause of contamination Reference
1983 24 Raspberries (frozen) Scotland Scotland Infected pickers or packers Reid et al., 1987[68]
1987 5 Raspberries (frozen) Scotland Tayside, Scotland Infected pickers Ramsay and Upton, 1989[69]
1988 202 Iceberg lettuce Kentucky Unknown, suspected to be from Mexico Believed to have occurred prior to distribution, since multiple restaurants involved Rosenblum et al., 1990[70]
1990 35

 

Strawberries (frozen) Montana, Georgia California Suspect an infected picker at farm Sivapalasingam et al., 2004;[71] Niu et al., 1992[72]
1996 30 Salad ingredients Finland Imported salad ingredients Unknown Pebody et al., 1998[73]
1997 256 Strawberries (frozen) Michigan, Maine, Wisconsin, Arizona, Louisiana, Tennessee Grown in Mexico,

processed and frozen at a single California facility a year before consumption

Inconclusive due to time between harvest and consumption, suspect barehanded contact with berries at harvesting, coupled with few latrines and handwashing facilities on site Hutin et al., 1999[74]
1998 43 Green onions Ohio One of two Mexican farms or a farm in California Believed to be contaminated before arrival at restaurant Dentinger et al., 2001[75]
2000 31 Green onions or tomatoes Kentucky, Florida Green onions: California or Mexico

Tomatoes: Unknown

 

Unknown Wheeler et al., 2005[76]; Datta et al., 2001[77]; Fiore, 2004[78]
2002 81 Blueberries New Zealand New Zealand, one orchard Inadequate bathroom facilities in fields, workers had barehanded contact with product, polluted groundwater from nearby latrines a possibility Calder et al., 2003[79]
2003 601 Green onions Pennsylvania,

Tennessee, Georgia, North Carolina

Mexico, two farms Contaminated during or before packing at farm CDC, 2003[80]; Wheeler et al., 2005[81]
2009 562 Tomatoes (semidried) Australia Unknown; imported and domestic product involved Product suspected to be imported due to concurrent outbreaks elsewhere at the time, source of contamination unknown Donnan et al., 2012[82]
2009 13 Tomatoes

(semidried)

Netherlands Unknown; imported product suspected Identical strain to the 2009 Australian outbreak Petrignani et al., 2010[83]
2010 59 Tomatoes

(semidried)

France Likely Turkey, single batch of product Unable to determine when and where contamination occurred. Virus was slightly different from one in the 2009 Australian and Dutch outbreaks. Gallot et al., 2011[84]
2012 9 Pomegranate seeds (frozen) Canada Egypt Suspect product contamination before export. Some history of travel to endemic areas among workers at Canadian processing facility, but less likely as only one product was associated with illness. CDC 2013[85]; Swinkels et al., 2014[86]
2013 103 Strawberries (frozen)

Other frozen berries may have been involved

Denmark, Finland, Norway, Sweden Suspected Egypt and Morocco based on virus strain and import history Unknown, some cases matched the strain of the larger 2013 European outbreak (see below) Nordic Outbreak Investigation Team, 2013[87]
2013 1589 Berries (frozen) Italy (90% of cases), Austria, Bulgaria, Denmark, England, Finland, France, Germany, Ireland, the Netherlands, Norway, Poland, Sweden Multiple food items containing frozen mixed berries (cakes, smoothies); Bulgarian blackberries and Polish redcurrants were the most common ingredients in the implicated lots Unknown, no single source found. Some cases also related to travel to Italy. Severi et al., 2015[88]; EFSA 2014[89]; Chiapponi et al., 2014[90]; Rizzo et al., 2013[91]; Guzman-Herrador et al., 2014[92]; Fitzgerald et al., 2014[93]

 

2013 165 Pomegranate arils (frozen) Arizona, California, Colorado, Hawaii, New Hampshire, New Jersey, New Mexico, Nevada, Utah, Wisconsin Turkey Unknown Collier et al., 2014[94]; CDC 2013[95]
2016 143 Strawberries (frozen) Arkansas, California, Maryland, New York, North Carolina, Oregon, Virginia, West Virginia, Wisconsin Egypt Unknown CDC 2016[96]

Estimates of the annual costs (direct and indirect) of hepatitis A in the United States have ranged from $300 million to $488.8 million in 1997 dollars.[97] In one study conducted in Spokane, Washington, the combined direct and indirect costs for each case of hepatitis A from all sources ranged from $2,892 to $3,837.[98] In a 2007 Ohio study, each case of HAV infection attributable to contaminated food was estimated to cost at least $10,000, including medical and other non-economic costs.[99] Nationwide, adults who become ill miss an average of 27 workdays per illness, and 11 to 22 percent of those infected are hospitalized.[100] All of these costs are entirely preventable given the effectiveness of a vaccination in providing immunity from infection.[101]

(more…)

Salmonella cases linked to hazelnuts sold at Schmidt Farm roadside stand

hazelRecent cases of salmonellosis, a foodborne illness caused by exposure to Salmonella bacteria, have been linked to hazelnuts sold at a farm stand in McMinnville, and state agencies are recommending that people who bought the nuts discard them immediately.

Officials at the Oregon Health Authority Public Health Division and the Oregon Department of Agriculture announced today that laboratory and epidemiologic analyses traced the salmonellosis cases to hazelnuts sold by Schmidt Farm and Nursery along Oregon Route 18.

“People who have hazelnuts from the farm stand at Schmidt Farm and Nursery should toss them out right away,” said Paul Cieslak, MD, medical director of the Public Health Division’s Acute and Communicable Disease Prevention Section.

Five people became ill with a specific strain of Salmonella Typhimurium between Oct. 15 and Dec. 13. When interviewed by public health officials, three of the individuals recalled buying hazelnuts from the Schmidt Farm and Nursery stand in McMinnville. The fourth ate hazelnuts from an unlabeled bag of partially shelled nuts. A fifth case was linked to the other four cases after having tested positive for the same strain of Salmonella. Tests performed on nuts purchased at the farm also identified the same strain of Salmonella. All five cases were in adults. None of the individuals were hospitalized and all have recovered.

According to the Oregon Department of Agriculture, Schmidt Farm and Nursery sells only a small portion of its hazelnuts at the farm stand. Schmidt Farm and Nursery distributes the bulk of its hazelnuts through wholesalers.

“Wholesalers have steps in place that kill any Salmonella on the hazelnuts they handle before the nuts reach consumers,” said Stephanie Page, the agriculture department’s director of food safety and animal services. “To date, we have no indication there were any issues with this part of the process. The concern in this case is with hazelnuts bought at the farm stand.”

Raw or undercooked poultry, meats and eggs are the most common sources of Salmonella, but other foods such as hazelnuts can become contaminated. Contamination of other foods on a farm typically occurs when product is exposed to feces from an animal carrying Salmonella or to its environment. It also can happen when an uncontaminated product has direct or indirect exposure to product containing Salmonella. In homes, foods can be contaminated when raw or undercooked meat, poultry or eggs come into contact with other foods.

Most people who get salmonellosis become sick in one to five days after exposure. Salmonellosis can cause diarrhea, fever, and abdominal cramps that can last up to seven days. Most people recover without treatment, but in some cases the diarrhea is so severe that hospital care is needed. Though rare, the most severe cases of Salmonella can lead to death if not treated.

People can take steps to prevent Salmonella at home, including washing their hands before cooking and after being around animals; keeping food preparation surfaces clean; washing raw fruits and vegetables before eating; keeping raw vegetables away from raw meat, poultry or eggs; always cooking meat and poultry to the proper temperature; and drinking only pasteurized milk and juices.

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.

Carbon E. coli Outbreak: 69 confirmed cases and 37 probable cases, 16 of the 40 food handlers tested positive for E. coli, was it Cilantro?

Carbon-thumb-640xauto-954656Introduction. On June 28, 2016, the Chicago Department of Public Health (CDPH) received five reports of Shiga Toxin-producing Escherichia Coli (STEC)1 through routine surveillance. By June 29, routine interviews conducted by the CDPH Communicable Disease (CD) Program revealed that three of the five cases reported consuming food items from Carbon (Restaurant A) within 2-3 days before illness onset. That evening, three separate hospitals reported an increase in the number of patients that presented to the ED with complaints of diarrhea and had preliminary positive STEC diagnostic laboratory tests. By July 1, seven cases reported eating at Restaurant A prior to their illness onset.

Carbon Final Outbreak Summary – City of Chicago Dept. of Public Health

Restaurant. Restaurant A has two Chicago locations, one on the south side and another on the west side of the city. The restaurant is open 7 days a week and serves Mexican-style foods. Both locations serve the same menu and use the same food suppliers. The majority of food preparation is performed out of the south side location; most food for the west side location is transported after preparation at the south side kitchen. Catering is also available. Overall, approximately 40% of food orders are placed by phone or through online ordering websites (i.e. GrubHub, Eat24, etc.) for delivery or pickup. Catering and other delivery orders are prepared in the same kitchen and by the same staff as dine-in orders at both locations. Staff members at each location reported regularly consuming restaurant food.

Epidemiological investigation. Case finding was conducted through public messaging and disease surveillance. On June 30, 2016, CDPH issued a health alert to all Chicago hospitals to notify them of the outbreak, to request prompt reporting of STEC cases, and to discourage use of antibiotics and encourage aggressive hydration if suspecting a diagnosis of STEC. Concurrently, the Illinois Department of Public Health (IDPH) issued an alert via the Food borne Outbreak Network to state health departments to notify them of any STEC cases with travel to Chicago and mention of Restaurant A.

A standard questionnaire was created to collect information about signs and symptoms of illness, food consumption and other potential exposures occurring in the seven days prior to the case’s onset of illness, and meal companions. A case-control study was conducted to determine risk factors for infection with STEC. Case definitions were in accordance with the Centers for Disease Control and Prevention (CDC) and Council of State and Territorial Epidemiologists standards2. A confirmed case was defined as isolation of E. coli O157:H7 (STEC) from a clinical specimen in a person with illness onset between June 3-July 23, 2016, with either reported exposure to Restaurant A or a pulsed-field gel electrophoresis (PFGE) pattern indistinguishable from one of 14 patterns associated with the outbreak. Confirmed cases with reported Restaurant A exposure and onset dates that preceded others within their household were considered confirmed primary cases. A probable case was defined as a person with clinically compatible illness (bloody diarrhea or ~3 days of diarrhea with ~3 stools in a 24-hour period) in the absence of laboratory confirmation, and exposure to Restaurant A or shared household with a primary case. Secondary cases were defined as household contacts of primary confirmed or probable cases, with onset of diarrhea one to eight days after the primary case’s symptom onset date. Case-control analysis was limited to primary confirmed cases and well controls. To identify controls, CD Program staff asked confirmed cases about their meal companions and obtained a list of individuals who placed orders through the online delivery service GrubHub. Controls were frequency matched 4:1 to cases by meal date (June 17th-June 30th) and restaurant location.

Contingency tables were arranged to evaluate the bivariate relationships between case status and individual food items, and odds ratios (OR) with 95% confidence intervals {95% Cl) were estimated for each. Chi-Square tests were performed to identify statistically significant associations, except when expected cell counts were less than or equal to 5, in which case Fisher’s Exact test was used. P-values <0.05 were considered statistically significant. The independent effects of variables found to be significantly associated with disease in the bivariate analyses were further evaluated using multivariable logistic regression, adjusted for age and gender. All statistical analyses were carried out with SAS version 9.3 (SAS Institute, Cary, NC).

Environmental investigation. On July 1, 2016, the Food Protection Division (FPD) conducted an environmental inspection of Restaurant A and collected the following: food samples, initial information about restaurant employees and food preparation, and copies of invoices for food items. Food items collected included steak, chicken, cilantro, elote (corn), elote mix, cheese, sour cream, grilled corn & pineapple salsa, salsa fresca, tequila lime sauce, red and green salsas. CD Program staff performed in depth interviews of the owners of the restaurant and employees. Because employees at both locations often functioned in multiple roles, all on-site restaurant employees were considered food handlers for the purposes of this outbreak investigation. Food handlers were asked to submit stool specimens to screen for STEC.

Laboratory investigation. Clinical culture or polymerase chain reaction tests were performed by hospital and commercial laboratories and results were reported to the CD program. Specimens from cases, food handlers, and food were sent to the Illinois Department of Public Health Division of Laboratories for culture, and for serotyping and PFGE analysis of STEC isolates. PFGE patterns were uploaded to the national Pulse Net database and compared by the Centers of Disease Control (CDC). Sixteen isolates selected to represent all outbreak-associated PFGE patterns and a variety of source patients (primary and secondary cases as well as food handlers), restaurant locations, and meal dates were sent to CDC for characterization by multiple locus variable number of tandem repeats analysis (MLVA).

Epidemiologic findings. Sixty-nine confirmed and 37 probable cases were identified as part of this outbreak. Among the confirmed, 55 met the primary case definition, four were secondary cases, and ten of the confirmed cases matched the outbreak PFGE pattern but their association with the restaurant was not identified (five denied eating at the restaurant and five were unable to locate). One additional case, identified after the restaurant closure and reopening, was unable to be classified due to multiple

Restaurant A meal dates and a PFGE pattern that was similar but not identical to other outbreak patterns. Illness onset dates of the 55 confirmed primary cases ranged from June 19-July 3.

Median age was 29 years (range, 3 to 69 years); 29 (53%) of the cases were female. Median incubation period was 3 days (range 12 hours-5 days). Twenty-one primary and one secondary case were hospitalized. No cases developed hemolytic uremic syndrome, and none died. Among the 55 confirmed primary cases, 50 (91%) ate at the south side location (meal date range 6/17 to 6/30) and 5 (9%) ate at the west side location (meal date range 6/19 to 6/26).

Multiple food items were associated with illness on bivariate analysis (Table 1) including consumption of cilantro (odds ratio [OR] 3.5, 95% Cl: 1.5-8.1), salsa fresca (OR 3.1, 95% Cl: 1.6-6.1), chicken taco (OR 3.1, 95% Cl: 1.6-6.0), and lettuce (OR 2.01, 95% Cl: 1.1-3.8). Multivariable analysis using logistic regression (Table 2) revealed that consumption of cilantro (adjusted OR [aOR] 4.64, 95% Cl: 1.87-12.011.6), salsa fresca (aOR 2.85, 95% Cl: 1.31-6.05.4), and lettuce (aOR 2.57, 95% Cl: 1.23-5.26) remained independently associated with illness after adjusting for age and gender. The observed epidemiologic association with chicken tacos may reflect collinearity between chicken tacos and cilantro, meaning that an association was identified because the chicken tacos are prepared and served with raw cilantro. All cases who reported eating a chicken taco also reported eating cilantro. Other chicken-containing items (e.g., chicken burritos, chicken salad bowls) were not associated with illness. Because salsa fresca was known to contain raw cilantro, an additional multivariable logistic regression analysis was performed including a combined variable indicating consumption of either cilantro or salsa fresca. In this model, consumption of cilantro or salsa fresca was associated with an adjusted odds ratio of 6.9 [Cl: 2.0-24.0]

Lettuce was associated with illness in both multivariable models but was consumed by only 44% of cases. In comparison, cilantro was consumed by 87% of cases, and either cilantro or salsa fresca were consumed by 95% of cases.

Environmental findings and food handler interviews. Meats, salsas, and marinades were fully or partially prepared at the south side location and transported daily to the west side location. Most fresh produce items, including cilantro and lettuce, were received by each location in separate deliveries and chopped and prepared on-site. Several critical violations were identified during the sanitarians’ inspection of Restaurant A on July 1, including improper temperatures for several food items (i.e. red & green salsas, tequila lime sauce, raw fish, guacamole, and cheese), and improper hand hygiene practices among food handlers. Because of concern for a potential ongoing public health threat associated with food served by Restaurant A, CDPH recommended that the restaurant voluntarily cease operations and withdraw from a large outdoor food festival until more information about the source of the contamination was known. The owner agreed, and Restaurant A voluntarily closed both locations. CD staff subsequently interviewed and tested forty food handlers from both locations. According to the restaurant owner, there was no cross-over of food handlers at the two locations. Among the forty food handlers interviewed none reported any history of gastrointestinal illness in the two weeks preceding or during the outbreak period, though absenteeism was reported for one. Nearly all food handlers had stool tests performed within one week after the restaurant closure.

Laboratory findings. Specimens from 69 cases and 16/40 (40%) food handlers yielded STEC isolates. From primary case isolates, 10 PFGE patterns were identified. An additional four similar patterns were identified among food handler isolates. The 16 isolates analyzed by MLVA displayed four unique MLVA patterns. One predominant MLVA pattern was shared by 10 isolates. Food handler and case isolates displayed a variety of MLVA patterns, with some food handlers sharing MVLA patterns indistinguishable from restaurant patrons despite differing PFGE patterns. There were no distinct pattern groupings according to restaurant location. None of the 12 food items cultured were positive for STEC.

Food product traceback. In collaboration with CDPH, FPO and IDPH department of Food, Drugs and Dairy, invoices collected from the restaurant for the outbreak period meal dates were reviewed. Cilantro was purchased from a distributor serving multiple other restaurants throughout Illinois. The distributor repackaged cilantro from multiple sources, including suppliers in Mexico and Illinois. Of the five laboratory-confirmed cases who denied Restaurant A exposure, none reported cilantro consumption, although cooperation with re-interview was limited. In the absence of confirmed cases reporting consumption of implicated food items from another restaurant, it was not possible to perform further traceback to assess for a common source of contamination. No other restaurants serviced by the distributor were linked to the outbreak.

Re-inspection and reopening. FPO performed re-inspections at both locations, during which instruction and guidance were provided on hand hygiene and it was ensured that food preparation and storage areas were adequately sanitized. Only food workers who had two consecutive negative tests for STEC were permitted to work at the reopened locations, which delayed reopening of the south side location. After passing FPO re-inspections, the south and west side restaurants re-opened on July 9 and 29, respectively.

An additional case of STEC was subsequently identified with a meal date of July 11, 2016 at the reopened west side location, prompting imposed restriction of all food handlers who had been involved with preparation of the case’s meal. All of these food handlers and the case’s meal companions were tested for STEC, with negative results. The case had also eaten food from the restaurant on June 21 with a household member, prior to the restaurant’s closing; neither reported symptoms of illness at that time. PFGE analysis revealed an additional pattern not previously identified in this outbreak, but which appeared related to other outbreak patterns. Because of the multiple meal dates, negative test results of all meal companions and involved food handlers, and absence of additional reported restaurant-associated cases after the re-opening, we could not definitively determine if the case was primary, secondary or unrelated. Food handlers were permitted to return to work after repeated negative test results. No additional complaints were received in association with the restaurant in the two months following this case’s illness onset

Conclusion. This was a large restaurant-associated outbreak of Shiga toxin-producing E. coli O157:H7 infections. Closure of the restaurant during the early stage of the investigation prevented additional cases of illness from occurring. Cilantro was the most likely food-vehicle causing this outbreak, based on the strong statistical association of raw cilantro consumption with illness, and the high percentage of cases explained by cilantro consumption. The large number of PFGE patterns associated with the outbreak was suggestive of a heavily contaminated food item rather than introduction from a point source such as an ill food worker at the restaurant. However, STEC was not isolated from cilantro or cilantro-containing food items collected from the restaurant or the restaurant’s distributor. Inability to isolate STEC from food samples may have been hindered by imperfect sensitivity of testing, imperfect representativeness of food samples, or turnover of produce items through the distribution chain leading to items no longer being contaminated at the time of collection. Additionally, cross-contamination during food preparation and transmission by food handlers who were found to have STEC infection likely contributed to the outbreak.

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Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli lawyers have litigated E. coli and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera

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

E. coli O157:H7 Illnesses in Tennessee Tied to Recall

007-2016-labelSnapp’s Ferry Packing Company, an Afton, Tenn. establishment, is recalling approximately 410 pounds of beef product that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The ground beef item was produced on Nov. 20, 2015. The following product is subject to recall: [View Label]

  • 5-lb. packages of “Ground Beef,” with a packaging date of Nov. 20, 2015.

The product subject to recall bears establishment number “Est. 9085” inside the USDA mark of inspection. The item was distributed to restaurants in the Knoxville, Tenn. area. None of this product was sold at retail.

The problem was discovered on Jan. 19, 2016, when a positive result for E. coli O157:H7 from FSIS testing was traced back to the establishment as a result of an ongoing illness investigation in Tennessee. FSIS is continuing to work with our public health partners at the Tennessee Department of Health and Knox County Health Department on this investigation and will provide updated information as it becomes available.

E. coli O157:H7 is a potentially deadly bacterium that can cause dehydration, bloody diarrhea and abdominal cramps 2–8 days (3–4 days, on average) after exposure the organism. While most people recover within a week, some develop a type of kidney failure called hemolytic uremic syndrome (HUS). This condition can occur among persons of any age but is most common in children under 5-years old and older adults. It is marked by easy bruising, pallor, and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

What is Clostridium perfringens?

Clostridium perfringens are bacteria that produce toxins harmful to humans. Clostridium perfringens and its toxins are found everywhere in the environment, but human infection is most likely to come from eating food with Clostridium perfringens in it. Food poisoning from Clostridium perfringens fairly common, but is typically not too severe, and is often mistaken for the 24-hour flu.

The majority of outbreaks are associated with undercooked meats, often in large quantities of food prepared for a large group of people and left to sit out for long periods of time. Because of this, it is sometimes referred to as the “food service germ.” Meat products such as stews, casseroles, and gravy are the most common sources of illness from C. perfringens. Most outbreaks come from food whose temperature is poorly controlled. If food is kept between 70 and 140 F, it is likely to grow Clostridium perfringens bacteria.

People generally experience symptoms of Clostridium perfringens infection 6 to 24 hours after consuming the bacteria or toxins. Clostridium perfringens toxins cause abdominal pain and stomach cramps, followed by diarrhea. Nausea is also a common symptom. Fever and vomiting are not normally symptoms of poisoning by Clostridium perfringens toxins.

Illness from Clostridium perferingens generally lasts around 24 hours, and is rarely fatal.

The Type C strain of Clostridium perfringens can cause a more serious condition called Pig-bel Syndrome. This syndrome can cause death of intestinal cells and can often be fatal.

To prevent infection by Clostridium perfringens, follow the these tips:

  • Cook foods containing meat thoroughly
  • If keeping foods out, make sure they maintain a temperature of 140 F (60 C)
  • When storing food in the refrigerator, divide it into pieces with a thickness of three inches or less so that it cools faster
  • Reheat foods to at least 165 F (74 C)

References

Clostridium perfringens.” Illinois Department of Public Health. Available at http://www.idph.state.il.us/Bioterrorism/factsheets/clostridium.htm.
Rohrs, Barbara. “Clostridium perfringens.” Ohio State University Extension Family and Consumer Sciences. Available at http://ohioline.osu.edu/hyg-fact/5000/5568.html.

Wisconsin Dairy Bull Calves Likely Link in Salmonella Outbreak

Portrait of the cute baby bull calfCDC is working with Wisconsin health, agriculture, and laboratory agencies, several other states, and the U.S. Department of Agriculture Animal and Plant Health Inspection Service (USDA-APHIS) to investigate a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections.

Epidemiologic, traceback, and laboratory findings have identified dairy bull calves from livestock markets in Wisconsin as the likely source of infections. Dairy bull calves are young, male cattle that have not been castrated and may be raised for meat. Dairy bull calves in this outbreak have also been purchased for use with 4-H projects.

In interviews, ill people answered questions about any contact with animals and foods eaten in the week before becoming ill. Of the 19 people interviewed, 15 (79%) reported contact with dairy bull calves or other cattle. Some of the ill people interviewed reported that they became sick after their dairy bull calves became ill or died.

One ill person’s dairy calves were tested for the presence of Salmonella bacteria. This laboratory testing identified Salmonella Heidelberg in the calves. Further testing using WGS showed that isolates from ill people are closely related genetically to isolates from these calves. This close genetic relationship means that the human infections in this outbreak are likely linked to ill calves.

Traceback information available at this time indicates that most calves in this outbreak originated in Wisconsin. Wisconsin health and agriculture officials continue to work with other states to identify herds that may be affected.

big-map-11-25-16Public health investigators used the PulseNet system to identify illnesses that may have been part of this outbreak. 

Twenty-one people infected with an outbreak strain of Salmonella Heidelberg have been reported from eight states. A list of states and the number of cases in each can be found on the Case Count Map page.

Among 19 people with available information, illnesses started on dates ranging from January 11, 2016 to October 24, 2016. Ill people range in age from less than 1 year to 72, with a median age of 21. Sixty-two percent of ill people are female. Among 19 ill people with available information, 8 (42%) reported being hospitalized, and no deaths have been reported.

WGS showed that isolates from ill people are closely related genetically to one another. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Calling All New Sea Hawaii Victims: Settlement reached in 2013 Bronx Hepatitis A Lawsuit

Successful class action lawsuit seeks beneficiaries of $200,000 settlement

A settlement has been reached in the class action lawsuit against New Hawaii Sea Restaurant, formerly of the Bronx, New York. Approximately 3,000 people received Hepatitis A vaccinations after being exposed to the illness by the restaurant in September 2013 and all are included in the class-action lawsuit.

The deadline for applying to receive a portion of the $200,000 settlement is December 16th, 2016.  Those interested in benefiting from the class action settlement should visit www.NewHawaiiHepA.com for more information.

According to the settlement, potential class members who may benefit by this settlement include anyone who ate or drank food from the New Hawaii Sea Restaurant from September 7-19, 2013, or were exposed to someone who did, and obtained a blood test and immune globulin (IG) or Hepatitis A vaccination shot within 30 days of eating at the restaurant. Those who actually developed Hepatitis A infections after eating at the restaurant are not included in this settlement.

Bill Marler of Marler Clark LLP, an expert on Hepatitis outbreaks, is available for comment on the outcome of the case. Marler is the nation’s premiere legal expert on foodborne illness and has represented victims of various foodborne illnesses. If you would like to speak with Mr. Marler, please contact Colleen McMahon (colleen@quinnbrein.com), Samantha Jones (sam@quinnbrein.com), or call (206) 842-8922.

Marler Clark, LLC has been an advocate for victims of foodborne illnesses for decades, and have represented thousands of victims of Hepatitis A and other foodborne illnesses.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Marler Clark attorneys have litigated Hepatitis A cases stemming from outbreaks traced to a variety of foods. The firm has brought lawsuits against companies such as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you would like more information regarding the New Sea Hawaii outbreak and settlement, or would like to schedule an interview with an expert from Marler Clark, please contact Colleen McMahon (colleen@quinnbrein.com), Samantha Jones (Sam@quinnbrein.com) or call (206) 842-8922.

99 Sick After Alabama Wedding

The Alabama Department of Public Health has determined that the Salmonella outbreak last week in Colbert County that reportedly sickened at least 99 patients and hospitalized 22 is most likely linked to a meal prepared for a private event. Eighteen of the hospitalized persons have been discharged home and the remaining hospitalized patients are recovering. Approximately 150 persons attended the private event.

The investigation is ongoing, but preliminary reports indicate the state health department laboratory has identified Salmonella enteriditis (a common foodborne germ) in food specimens of cooked chicken as well as green beans.

Dr. Karen Landers, Assistant State Health Officer, Bureau of Communicable Disease, states that chicken was likely the primary source of the germ as raw chicken can be contaminated with Salmonella. Chicken has to be cooked to an internal temperature of 165 degrees Fahrenheit to kill the germ. Finding Salmonella in the green beans during this investigation was probably from cross contamination such as using the same serving utensils for the beans and the chicken.

Dr. Scott Harris, Assistant State Health Officer for Public Health Area 2, where the catering business was located, states that he issued an emergency order to suspend the caterer’s permit last week pending further investigation. The caterer, Indelible Catering of Moulton, is no longer preparing food for the public.

Salmonella outbreaks reported by the CDC in 2016 were linked to contaminated eggs, poultry, meat, unpasteurized milk and juice, cheese, contaminated raw fruits and vegetables (alfalfa sprouts, melons), spices and nuts.

Food safety practices can reduce the risk of foodborne outbreaks. Some measures to reduce illness include keeping food properly refrigerated before cooking, washing hands with soap and warm water before handling foods, and cleaning surfaces before preparing foods on them.

Follow these practices when preparing foods:

  • Separate cooked foods from ready-to-eat foods.
  • Do not use utensils on cooked foods that were previously used on raw foods and do not place cooked foods on plates where raw foods once were unless the plates have been cleaned thoroughly.
  • Cook foods to a safe internal temperature. Use a meat thermometer to make sure foods are cooked to a safe temperature.
  • Chill foods promptly after serving and when transporting from one place to another. Safe temperatures for food preparation are available on many websites including foodsafety.gov.

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.

Salmonella Prompts World-Wide Recall of Hawaii “Kahuku Ogo”, “Robusta Ogo” and “Kahuku Sea Asparagus”

Marine Agrifuture, LLC. of Kahuku, HI, is recalling its “Kahuku Ogo”, “Robusta Ogo” and  “Kahuku Sea Asparagus” because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often 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.

The recalled “Kahuku Ogo”, “Robusta Ogo”, and  “Kahuku Sea Asparagus” were distributed mainly in Hawaii to Seafood and Produce Distributors through direct delivery, but also to some customers in CA, WA, NV, and Tokyo Japan, and retailed at local Farmers Markets in Hawaii.

The Ogo products come in a plastic bag of various weights from 0.5 LB to 35 LB, which were sold from November 2, 2016 and prior, and the Sea Asparagus in 4 Ounce, 1 LB clear plastic clamshell or in a 5 LB of plastic bag marked with a tracking number stamped on the lids or bags, which were sold from November 8, 2016 and prior. The corresponding UPC number for 4 OZ, 1 LB, and 5 LB of sea asparagus are 897680001010, 897680001027, and 897680001041 respectively.

Fourteen cases of Salmonella on Oahu have been reported to date in connection with this problem. The potential for contamination was noted after special tests by the Hawaii Department of Health revealed the presence of Salmonella in saltwater in the farm production and processing areas.

Production of the product has been suspended while FDA and the company continue their investigation as to what caused the problem.

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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.