Foodborne Illness Outbreaks

Since early 2017, the Public Health Services Division, in the County of San Diego Health and Human Services Agency, has been investigating a local Hepatitis A outbreak. The majority of people who have contracted hepatitis A are homeless and/or illicit drug users, although some cases have been neither.  The outbreak is being spread person-to-person and through contact with a fecally contaminated environment.  No common sources of food, beverage or drugs have been identified that have contributed to this outbreak, though investigation is ongoing.  The Centers for Disease Control and Prevention (CDC) notes that person-to-person transmission through close contact is the primary way people get hepatitis A in the United States.

Vaccination efforts are being implemented in targeted locations by County staff and in collaboration with health care partners. Health providers are asked to inform the Epidemiology Program if they have a patient suspected to have the hepatitis A infection, before the patient leaves the emergency department or provider’s office (see contact number below).

On September 1, 2017, the San Diego County Public Health Officer declared a local public health emergency due to the ongoing hepatitis A virus outbreak in the county. The County Board of Supervisors ratified this declaration on September 6, 2017 and again on September 12, 2017. The declaration shall be ratified every two weeks by the County Board of Supervisors until the declaration is rescinded.

For information and resources, please click on the links below:

The table below will provide a weekly update of total cases, deaths, and hospitalizations.  Following this update is information about hepatitis A to educate the community and help prevent the continual spread of this viral infection.

San Diego County Hepatitis A Outbreak Cases and Deaths as of September 26, 2017*
*Table will be updated weekly each Tuesday

Cases Deaths Hospitalizations
461 17 (4%) 315 (68%)

Please note: Table does not include all reported hepatitis A cases in the county; only those that are local-outbreak-related. Also, data are provisional and subject to change.

The Enterprise News reports that Shino restaurant in Easton is under investigation in connection with a string of Salmonella cases reported in the area.

The Massachusetts Department of Public Health is investigating the Japanese restaurant and sushi bar Shino at 620 Washington St., in Easton.

“The DPH is investigating a cluster of salmonella cases associated with a restaurant in Easton,” DPH Media Relations Coordinator Anne Scales told The Enterprise in a statement. “The Easton Health Department is assisting with the investigation.”

Restaurant owner Allen Yee confirmed that officials from the DPH have visited the restaurant twice in recent days to carry out inspections.

“They’ve been here twice already,” Yee said. “Both times they inspected the restaurant, they didn’t find any major problems.”

State and local officials declined to release the name of the restaurant under investigation, though they confirmed the restaurant has remained open to customers since the investigation began on Monday.

“We do not advertise the names of restaurants under investigation unless there is reason to believe there is an on-going health threat,” Scales said in an email. “We really do not have enough information at this point to believe that there is an ongoing health threat where the public would need to be notified.”

In a statement, Easton Director of Health and Community Services Kristin Kennedy said the investigation remains in its preliminary stages.

Salmonella is a bacteria that causes an infectious disease of the bowel in humans, according to the mass.gov website.

Symptoms – which include stomach cramps, diarrhea, fever and nausea – typically begin 12 to 72 hours after the bacteria are consumed and last for several days.

According to news reports, two people were hospitalized as a result of a Salmonella outbreak at a Duluth nursing facility last month, according to the Minnesota Department of Health.

All told, 15 people became ill in mid-August at Bayshore Residence and Rehabilitation, said Doug Schultz, a health department spokesman, but only five — all residents — tested positive for Salmonella.

The 15 included four staff members and 11 residents, two of whom were hospitalized, Schultz said.

The health department contacted the facility after it noted a “cluster” of cases, Schultz said. Based on what inspectors found, it appeared that the disease was not foodborne but was transmitted via “contaminated hands of staff or residents.”

Earlier this week, Bayshore administrator David Uselman said facility personnel did a thorough examination of the facility’s kitchen and concluded that the bacteria had been brought in from the outside.

Cleaning the environment was recommended, Schultz said, along with making sure staff are properly trained on hand-washing and then pass along that training to residents.

Salmonella, which is the name for the illness and the bacteria that causes it, sickens about a million people in the United States every year, according to the U.S. Centers for Disease Control and Prevention. It leads to 19,000 hospitalizations and 380 deaths annually. Most people infected with salmonella develop diarrhea, fever and abdominal cramps 12 to 72 hours after infection.

Bayshore Residence and Rehabilitation, at 1601 St. Louis Ave. on Park Point, is licensed by the state to provide 139 nursing home beds.

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.

The Minnesota Department of Health (MDH) is working with Hennepin County Public Health, the City of Maple Grove and other partners to investigate two cases of Legionnaires’ disease in residents at the SilverCreek on Main facility in Maple Grove. The facility provides memory care, assisted living and independent living services.

The first resident’s symptoms began Aug. 22, and the second resident’s symptoms began Sept. 12. Both residents were hospitalized and are recovering.

MDH is working with SilverCreek to identify possible sources for the Legionellabacteria. SilverCreek has retained an expert consultant to begin immediately evaluating and addressing findings. Available evidence indicates the source of the Legionella, the bacteria that causes Legionnaires’ disease, is most likely within the building water system, though an exact source must still be determined. An assessment of the facility’s plumbing system is underway.

In the meantime, MDH is recommending a number of protective measures to minimize the chance for facility residents to be exposed to Legionella bacteria. These recommendations are based on Centers for Disease Control and Prevention guidance. The facility has notified its residents and their families about these recommendations and has started implementing them. The recommendations apply only to residents, people visiting and workers at SilverCreek on Main. City of Maple Grove water meets water quality standards.

Legionnaires’ disease is a type of bacterial pneumonia. Symptoms include fever, fatigue, headache, muscle aches, chills, shortness of breath, loss of appetite and coughing. Legionnaires’ disease is spread by inhaling the fine spray (aerosols) from water sources containing Legionella bacteria. It is not spread from person to person. Minnesota typically sees 50-60 cases in a year. The last major outbreak took place in 2016 in Hopkins.

Most people exposed to Legionella do not develop Legionnaires’ disease. People over the age of 50, smokers or those with certain medical conditions including weakened immune systems, diabetes, chronic lung disease or other chronic health conditions are at an increased risk. If you have concerns about possible exposure, please contact your health care provider.

Baked goods sold at the Meijer in Mount Pleasant could be contaminated with Hepatitis A, state officials warned on Thursday.

A bakery worker from the store at 1015 Pickard St. tested positive for Hepatitis A on Thursday. Anyone who ate items purchased from the bakery between Aug. 23 and Sept. 20 may have been exposed to the virus, according to a press release from the Michigan Department of Health and Human Services.

Affected baked goods will bear the Meijer Bakery label, including individual items such as single doughnuts and rolls from the self-serve case. Anyone who has any affected products in their home should discard them immediately. Freezing does not kill the hepatitis A virus.

Only products from the Mount Pleasant Meijer bakery are affected. There is no danger from bakeries at other Meijer locations or from other departments at the store.

The Health and Human Services Department says no illnesses have been identified from this exposure and the risk is low. However, health officials say anyone who ate baked goods from the Meijer should watch for symptoms of hepatitis A.

Symptoms include sudden onset of abdominal discomfort, dark urine, fever, diarrhea, and yellow skin and eyes. Time from exposure to onset of illness (incubation period) is typically 15 to 50 days.

Hepatitis A illnesses typically last several weeks to several months. Most people will recover with no lasting effects.

The Hepatitis A vaccine may provide protection against the disease if administered within two weeks of exposure. State health officials are urging anyone who ate baked goods from the Meijer to contact a physician to find out whether they qualify for the vaccine.

Meijer is offering the Hepatitis A vaccine for free at the Mount Pleasant store. It also will be available at other pharmacies around the city.

The Central Michigan District Health Department is working with Meijer to provide vaccines to any of their bakery employees and to ensure they are following recommend guidelines.

Anyone who already had Hepatitis A or received two doses of the vaccine don’t need to worry about getting vaccinated again.

The best protection for avoiding a Hepatitis A infection is traditional handwashing precautions and thoroughly cooking foods to their recommended temperatures.

Anyone who develops symptoms of hepatitis A infection should stay home and contact their health care provider.

Anyone with questions or looking for assistance in locating the Hepatitis A vaccine is asked to the call the Central Michigan District Health Department.

Hepatitis A has continued to spread in southeast Michigan with 319 confirmed cases between Aug. 1, 2016 and Sept. 15 — resulting in 14 deaths, state health officials announced Thursday.

The cases in Detroit and Wayne, Oakland, Macomb, Monroe and St. Clair counties represent a 16-fold increase over the same period in 2014-15.

Eighty-one cases were diagnosed last month alone, compared with six reported to the Michigan Department of Health and Human Services in August 2016.

“The southeast Michigan hepatitis A outbreak remains a top priority for public health officials from both the investigation and prevention standpoints,” Dr. Eden Wells, chief medical executive for MDHHS, said in a press release Thursday.

“Hepatitis A is a vaccine-preventable disease and in addition to our investigation of current and new cases, our focus is strongly aimed at increasing vaccination in adults, where hepatitis A vaccination is commonly low.”

Health officials have doubled down on efforts to fight the outbreak through increased awareness. The highly contagious viral liver disease can sometimes cause liver failure and death, but is easily prevented by getting vaccinated.

The state agency said no common source of the outbreak, such as contaminated food or water, has been identified. Transmission appears to be person-to-person, mostly through illicit drug use, sexual activity and other close contact.

MDHHS sent a letter to 5,069 Medicaid-enrolled health care providers across southeast Michigan earlier this month with information about the outbreak and the need for people to get vaccinated.

They said many vaccination campaigns are in place across the region, with some focusing on high-risk populations at jails, substance use treatment centers and homeless centers.

DHHS also has been in discussions with the Michigan Department of Corrections about implementing a vaccination campaign in the Detroit Receiving Center and Detroit Detention Center, they said.
Local health departments also are partnering with community organizations to provide hepatitis A vaccine to at-risk individuals, officials said. More than half of those diagnosed have a history of substance abuse, and 15 percent are homeless or living in shelters, according to DHHS.

Individuals with hepatitis A are infectious for two weeks before symptoms appear. The symptoms include jaundice (yellowing of the skin), fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine and light-colored stools.

People most at risk are those living with someone who has hepatitis A, having sexual contact with someone who has hepatitis A, or sharing injection or non-injection illegal drugs with someone who has hepatitis A. The virus also can be transmitted through contaminated food or water.

As of September 13, 2017 (1:30pm EDT), CDC has been notified of 988 laboratory-confirmed cases of cyclosporiasis in persons who became ill in 2017. This number includes persons who reported international travel as well as persons who did not report travel. The reports have come from 40 states.

At least 553 (56%) of these persons did not report international travel (i.e., likely were infected in the United States) and became ill on or after May 1, 2017 (a date after which cases tend to increase each year). These 553 persons were from the following 36 states: Arizona (1), California (10), Colorado (6), Connecticut (23), Florida (68), Georgia (10), Illinois (17), Indiana (4), Iowa (14), Kansas (2), Louisiana (7), Maryland (12), Massachusetts (13), Michigan (3), Minnesota (11), Mississippi (1), Missouri (13), Montana (2), Nebraska (5), New Hampshire (4), New Jersey (19), New Mexico (1), New York (excluding NYC) (15), New York City (30), North Carolina (45), Ohio (16), Pennsylvania (2), Rhode Island (2), South Carolina (7), South Dakota (4), Tennessee (3), Texas (163), Utah (1), Virginia (7), Washington (1), West Virginia (2), and Wisconsin (9).

At this time, no specific vehicle of interest has been identified, and investigations to identify a potential source (or sources) of infection are ongoing. It is too early to say whether cases of Cyclospora infection in different states are related to each other or to the same food item(s).

Previous U.S. outbreaks of cyclosporiasis have been linked to various types of imported fresh produce (e.g., basil, cilantro, mesclun lettuce, raspberries, snow peas). Consumers should continue to enjoy the health benefits of eating fresh fruits and vegetables as part of a well-balanced diet.

More information about Cyclospora can be found on CDC’s Cyclospora pages.

Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.

Advice for consumers about prevention and recognition of cyclosporiasis can be found here.

Troy Neumann of WKBT reports several recent cases of E. coli are concerning some residents of the La Crosse area.

The La Crosse County Health Department is currently investigating eight reported cases of E. coli in the county. The strain found in our area is known to cause diarrhea, potentially hospitalizing young children.

The Health Department says good hygiene is one of the best and easiest things you can do to prevent an E. coli infection.

“Good hand washing after using the bathroom, good hand washing after changing diapers, good hand washing before preparing food, and good hand washing after coming in from outside are all those hand hygiene things that we would recommend that people do,” said La Crosse County Health Department Health Education Manager Paula Silha.

The La Crosse County Health Department is still investigating eight reports of E. coli in the La Crosse area.

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.

Public Health Announces Hepatitis A Outbreak in LA County  – Hepatitis A vaccine is the best protection

The Los Angeles County Department of Public Health (Public Health) has declared a local outbreak of hepatitis A (HAV) in Los Angeles County because the most recent new cases appear to be locally acquired.Hepatitis A outbreaks are currently ongoing in San Diego and Santa Cruz counties. The large majority of cases have occurred in persons who are homeless and/or use illicit drugs (injection and non-injection), with several cases also occurring among people who provide services to the homeless.

Public Health has confirmed 10 total cases of hepatitis A among high-risk individuals (those that are homeless or in institutions that serve the homeless) in Los Angeles County. Of the confirmed cases, four had been in San Diego and one had been in Santa Cruz during their exposure period. Three secondary cases occurred in a health care facility in Los Angeles County. The two most recent cases appear to have acquired their infection locally within Los Angeles County.

“Public Health has been proactively preparing for an outbreak for some time and is working diligently to prevent spread in local communities. Our priorities are to keep all our residents both safe and well informed of the situation,” said Jeffrey Gunzenhauser, MD, MPH, Interim Health Officer, Los Angeles County. “Vaccination is the best protection against Hepatitis A. With this in mind, our outreach teams and clinics are offering free vaccine to persons who are homeless, active drug users, and those who provide services and support to those individuals.”

A person can get hepatitis A if they come into contact with an infected person’s feces through contaminated food or objects. The hepatitis A virus can spread when a person does not properly wash their hands after going to the bathroom or changing diapers. Other modes of transmission include certain sexual practices, sharing equipment related to illicit drug use, and consumption of food or water contaminated with the virus. People who are homeless are at higher risk because they face challenges to maintaining good hygiene.

Physicians are required to report HAV cases to Public Health. HAV causes acute liver disease, which may be severe. It is transmitted by contact with feces from a person who is infected – often through contact with food or water or during sex or other close contact. Signs and symptoms of acute HAV include fever, malaise, dark urine, lack of appetite, nausea, and stomach pain, followed by jaundice. Symptoms generally last for less than 2 months although some persons may have prolonged or more severe illness. Infection can be prevented in close contacts of patients by vaccination or administration of immune globulin within 2-weeks following exposure. If you experience these symptoms, contact your physician.

Although Hepatitis A is very contagious, you can take the following steps to prevent Hepatitis A:

  • Get vaccinated for Hepatitis A
  • Don’t have sex with someone who has Hepatitis A infection
  • Use your own towels, toothbrushes and eating utensils
  • Don’t share food, drinks, or smokes with other people
  • Wash hands with soap and water after using the bathroom, changing diapers, and before preparing, serving or eating food.

Public Health continues surveillance for cases and is working closely with healthcare providers and organizations that serve the homeless population to protect the health of patients/clients, staff and the community. Public Health is providing education and vaccination to the homeless and those who work with them, and working with other organizations that provide services for the homeless population to reach this community. Hepatitis A vaccination is available at Public Health clinics or from your health care provider. County residents may call the LA County Information line at 2-1- 1 from any landline or cell phone within the county for referrals to providers offering vaccines at no-cost or a reduced cost. For patients without access to HAV vaccine, Public Health will have vaccine available at its Public Health Centers located throughout the County.

CDC and Texas Health Officials Warn About Illness Linked to Raw Milk from Texas Dairy – Raw milk contained rare but dangerous germ, consumers should get antibiotics

People who consumed raw milk or raw milk products from one Texas dairy should contact their health care provider immediately, warn health investigators from the Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS). Raw milk from the K-Bar Dairy in Paradise, Texas (northwest of Fort Worth), tested positive for a rare but potentially serious bacteria known as Brucella RB51.

CDC advises that people who consumed raw milk or milk products from the K-Bar Dairy between June 1 and Aug. 7, 2017, should get antibiotic treatment to avoid the risk of lifelong, chronic infections. Initially, people with brucellosis experience fever, sweats, aches and fatigue. If not treated, Brucella RB51 infection can result in long-term complications, like arthritis; heart problems; enlargement of the spleen or liver; and, in rare cases, nervous system problems, like meningitis RB51 can cause severe illness in people with weakened immune systems and miscarriages in pregnant women.

“It’s very important for people who drank raw milk from this dairy to seek treatment to prevent infection with Brucella RB51,” said William Bower, M.D., team lead for the CDC group that investigates brucellosis. “Even if people don’t have any symptoms now, they can develop a chronic infection that can impact their health for years to come.”

Milk from K-Bar dairy is known to have caused Brucella infection in one Texas resident. One illness in a Texas woman has been linked to the dairy. Purchase records and illness reports indicate additional people in Texas and some as far away as California and North Dakota may need antibiotics to prevent or treat infection. In Texas, raw milk is only allowed to be sold on site at the dairy. According to Texas DHSH, K-Bar dairy has been operating in compliance with state dairy laws and rules and is cooperating fully with the investigation.

CDC and Texas health officials have been trying to reach people in more than 800 households known to have purchased K-Bar raw milk. Texas is following up with 170; CDC tried to contact the remaining 672 households but many did not provide contact information. Of the 485 households with contact information, CDC successfully reached 236 households. Among the 236 households, 83 percent of people were exposed to RB51 by drinking the milk.

Officials Worried People Not Aware of Risk

Due to incomplete contact information, CDC staff have been unable to reach about 200 households in which someone bought K-Bar milk. People who sampled the milk at the dairy or got the milk from friends or family also may not be aware of their risk.

So far, CDC and Texas health officials have received reports about people who drank K-Bar milk or have symptoms consistent with brucellosis caused by RB51 in Alabama, Arkansas, California, Ohio, North Dakota, Tennessee and Texas.

Those Exposed Need Antibiotics

CDC recommends that anyone who drank raw milk or consumed milk products from K-Bar dairy between June 1 and Aug. 7, 2017, see their doctor for antibiotics to prevent infection. Because Brucella can cause complications during pregnancy, including miscarriage, it is especially important for pregnant women who may have been exposed to seek medical care. RB51 is resistant to some antibiotics that would normally be used to prevent or treat brucellosis, so people who drank the milk should tell their doctor that they may have been exposed to RB51 and refer their healthcare provider to the CDC website (link below).

People who have consumed the milk should also check themselves for fever for four weeks after they last drank the milk and watch for other brucellosis symptoms for six months. These symptoms include but are not limited to: muscle pain, lasting fatigue, arthritis, depression, and swelling of the testicles.

Doctors can find more information about testing patients for RB51 and which antibiotics to use to prevent infection on the CDC website at: https://www.cdc.gov/brucellosis/clinicians/rb51-raw-milk.html.

About RB51

RB51 is a weakened strain of Brucella used to vaccinate young female cattle against infection with more serious strains of Brucella. Vaccinating cows with the RB51 vaccine helps prevent abortions in cows and reduces the risk of people coming into contact with cows infected with more severe strains of Brucella. However, in rare cases, vaccinated cows can shed RB51 in their milk.

Testing of milk from the individual cows in the dairy herd revealed two cows that were infected with Brucella RB51, supporting the conclusion that these cows are a source of RB51 contamination of the dairy’s raw milk. Testing is ongoing by Texas officials to assure that the remaining cows in the herd do not pose an ongoing risk of RB51contamination of the dairy’s raw milk. The only way to avoid this potential exposure is to drink milk that has been pasteurized to kill the germs.

Brucella is rare in the United States, largely due to our vaccination practices in cattle to prevent brucellosis. There are about 120 reported cases in people each year. Most cases of brucellosis in the U.S. occur in people who traveled to countries where Brucella is more common and drank contaminated cow, sheep or goat milk or had contact with infected animals. Among cases in the U.S. who acquired brucellosis here, infections occur from contact with feral swine or, more rarely, dogs, or because of accidental exposure in lab settings.

Raw Milk: a Risk for Infections

Raw milk and raw milk products are those that have not undergone a process called pasteurization that kills disease-causing germs. CDC recommends that people only drink milk that has been pasteurized to kill germs. Even healthy animals may carry germs that can contaminate milk. There is no substitute for pasteurization to assure that milk is safe to drink.

The risk of getting sick from drinking raw milk is greater for infants and young children, the elderly, pregnant women, and people with weakened immune systems, such as people with cancer, an organ transplant, or HIV/AIDS. However, healthy people of any age can get very sick if they drink raw milk contaminated with harmful germs.

More info on raw milk: https://www.cdc.gov/foodsafety/rawmilk/raw-milk-index.html and www.realrawmilkfacts.com

The CDC is providing updated information on three of the four separate multistate outbreaks of Salmonella infections linked to imported Maradol papayas from Mexico. Each outbreak is linked to papayas imported from a different farm in Mexico. CDC is concerned that Maradol papayas from other farms in Mexico might be contaminated with Salmonella and are making people sick.

Updates:

  • Among all four outbreaks, there are a total of 235 people sick from 26 states.
  • There are 78 hospitalizations, including two deaths (one from New York and one from California).
  • 69% of sick people are Hispanic.
  • CDC recommends that consumers not eat, restaurants not serve, and retailers not sell recalled Maradol papayas from Carica de Campeche, Rancho El Ganadero, El Zapotanito, or Productores y Exportadores de Carica Papaya de Tecomán y Costa Alegre farms in Mexico.
  • Several companies have recalled papayas from these farms: Grande Produce recalledCaribena brand Maradol papayas. Agroson’s LLC recalled certain Cavi brand Maradol papayas. Freshtex Produce, LLC recalled Valery Brand Maradol papayas. Bravo Produce, Inc. recalled Maradol papayas packed by Frutas Selectas de Tijuana, S. de RL de CV.
  • If you aren’t sure if the papaya you bought is a recalled Maradol papaya, ask the place where you bought it. When in doubt, throw it out.
  • The investigation is ongoing and CDC will provide updates when more information is available.

Individual outbreak announcements: