Food Poisoning Lawyer & Attorney : Marler Clark : Food Poison Journal

Counting Friday's sausage recall by Daniele International, Inc., food companies have recalled at least 2,880,000 pounds of meat products since November 2009 due to contamination by E. coli or Salmonella. 

Friday's recall:  (from FSIS press release)

Daniele International Inc., an establishment with operations in Pascoag and Mapleville, R.I., is recalling approximately 1,240,000 pounds of ready-to-eat (RTE) varieties of Italian sausage products, including salami/salame, in commerce and potentially available to customers in retail locations because they may be contaminated with Salmonella, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.

The Daniele Inc. sausage outbreak, due to contamination by Salmonella Montevideo, has caused at least 184 illnesses in residents of 38 states. 

On January 18, 2010, the USDA's food inspection branch (FSIS) announced the recall of 846,000 pounds of ground beef products produced by a California company called Huntington Meat Packing, Inc., due to potential contamination by E. coli O157:H7.

On January 11, 2010, Adams Farm Slaughterhouse, LLC., an Athol, Mass., establishment, recalled approximately 2,574 pounds of beef products that was potentially contaminated with E. coli O157:H7.  The beef was the cause of infection in at least one Massachusetts resident. 

On December 24, 2009 (The Christmas Eve sneak), an Oklahoma company called National Steak and Poultry recalled 248,000 pounds of tenderized beef products due to contamination by E. coli O157:H7.  The outbreak is known to have sickened at least 21 people in 16 states.  Last week, Marler Clark filed the first lawsuit arising from the outbreak on behalf of a Utah resident.

And in November 2009, A New York company called Fairbank Farms recalled 545,699 pounds of ground beef due to E. coli O157:H7 contamination. The outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS). 

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FSIS reported today that Huntington Meat Packing Inc., a Montebello, Calif. establishment, is recalling approximately 864,000 pounds of beef products that may be contaminated with E. coli O157:H7.  Although the recall is Class I--i.e. associated with a very high risk to consumer health--there are no illnesses currently known to be associated with the potentially contaminated meat.  The recalled ground beef was produced between January 5, 2010, and January 15, 2010, and was shipped to distribution centers, restaurants, and hotels within the State of California.

The following products, consisting of all ground beef products produced by the plant from January 5, 2010 to January 15, 2010, are subject to recall:

40 lb. boxes of “Huntington Meats Ground Beef”
40 lb. boxes of “ HUNTINGTON MEAT PKG. INC. BEEF GROUND FOR FURTHER PROCESSING”
40 lb. boxes of “BEEF BURRITO FILLING MIX”
10 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
20 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
10 lb. boxes of “El Rancho MEAT & PROVISION ALL BEEF PATTIES”

Each box bears the establishment number "EST. 17967" inside the USDA mark of inspection on a label.

Interestingly, though, these are not the only products subject to the large recall.  FSIS investigation at Huntington Meat Packing, Inc., must have turned up some serious violations because the company is also recalling meat produced in 2008.  FSIS determined that the 2008 meat was adulterated because the ground beef products produced from February 19, 2008 to May 15, 2008 may have been contaminated with E. coli O157:H7.

As a result, the following products produced from February 19, 2008 to May 15, 2008, are subject to recall:

40 lb. boxes of “Huntington Meats Ground Beef”
40 lb. boxes of “ HUNTINGTON MEAT PKG. INC. BEEF GROUND FOR FURTHER PROCESSING”
40 lb. boxes of “BEEF BURRITO FILLING MIX”
10 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
20 lb. boxes of “IMPERIAL MEAT CO. GROUND BEEF PATTY”
10 lb. boxes of “El Rancho MEAT & PROVISION ALL BEEF PATTIES”

Each box bears the establishment number "EST. 17967" inside the USDA mark of inspection on a label.

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 Today's announcement by USDA-FSIS of another beef recall due to E. coli O157:H7 contamination bodes poorly for this new year.  Adams Farm Slaughterhouse, LLC., an Athol, Mass., establishment, is recalling approximately 2,574 pounds of beef products that may be contaminated with E. coli O157:H7.  The recall occurs in the wake of an epidemiological investigation into the E. coli illness of at least one Massachusetts resident.  The recall also marks the third beef recall in the last three months due to E. coli O157:H7 contamination.

In November 2009, ground beef from a New York ground beef company called Fairbank Farms was recalled due to E. coli O157:H7 contamination. That outbreak caused resulted in 26 E. coli O157:H7 illnesses, nineteen hospitalizations, and five who developed hemolytic uremic syndrome (HUS).   

And on Christmas Eve 2009, National Steak and Poultry recalled at least 124 tons of mechanically tenderized beef products.  The National Steak and Poultry outbreak caused at least 21 E. coli O157:H7 illness in 16 states, including nine hospitalizations and one case of HUS.   

Together, the recalls and outbreaks linked to beef from Adams Farm, National Steak and Poultry, and Fairbank Farms, has caused at least 48 illnesses in nationally.  At least 776,000 pounds of beef have been recalled in total in the three outbreaks.  

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The CDC again amended its case-count in the Fairbank Farms ground beef E. coli O157:H7 outbreak.  Secondary DNA tests (surely MLVA) have helped the CDC whittle the number of cases down from 28 in 12 states on November 2, to 26 in 11 states on November 3, to 25 in 10 states today.  These changing case-counts got me thinking about an important aspect of every outbreak of foodborne disease:  that the number of "confirmed cases" is rarely, if ever, an accurate count of the number of actual victims in any outbreak situation. 

The reality of these outbreaks (whether E. coli O157, Salmonella, or anything else) is that the number of people who are actually ill, as opposed to the number who have a stool sample that tests positive, is much bigger than the reports would indicate.  In fact, one of the leading studies on the subject suggests that the number of actual victims in a given outbreak, as opposed to merely those with positive stool samples, is as much as 38 times the number of stool sample confirmed individuals. 

There are several primary reasons why this is the case. First, as noted by Mead et al. in the classic epidemiological study on the subject, underreporting of foodborne disease is common. “Surveillance of foodborne illness is complicated by several factors. The first is underreporting. Although foodborne illnesses can be severe or even fatal, milder cases are often not detected through routine surveillance.” See Mead et al., Emerging Infectious Disease, Vol. 5, No. 5, September-October 1999.  It is frequently the case that only the more severe illnesses come to the attention of health department officials. The less severe illnesses in any given outbreak often require less medical treatment, and the possibility that the causative agent will be identified decreases as well.

Many cases of foodborne illness are not reported because the ill person does not seek medical care, the health-care provider does not obtain a specimen for diagnosis, the laboratory does not perform the necessary diagnostic test, or the illness or laboratory findings are not communicated to public health officials. See Mead at 609.

Also, frequently in the setting of cantagious foodborne diseases, there is a significant likelihood of secondary transmission of disease. As stated in the Mead Article, “many pathogens transmitted through food are also spread through water or from person to person, thus obscuring the role of foodborne transmission.” See Mead at 607. In other words, it is common in outbreak situations for people who became infected by contaminated food to thereafter sicken co-workers or family members by unwitting transmission of a small amount of bacteria.

Thus, for many reasons, publicized case-counts in outbreaks are only indicators of how many people were actually affected. Turning back to the Fairbank Farms outbreak and recall, its a little frightening to apply the Mead formula: 38 X 25 = A lot of sick people, and way too many kids laying in hospital beds connected to dialysis machines.
 

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 The CDC did not provide any updated statistics today about the number of people sickened in the ongoing E. coli O157:H7 outbreaks linked to ground beef (still 26 illness in 11 states, with 2 deaths and 3 HUS), but the Food Safety and Inspection Service (FSIS) did update the list of retail stores who may have received contaminated ground beef.  The list is long and comprehensive and, to me at least, suggests that the number of people who may be involved in at least the Fairbank Farms outbreak may continue to grow.  See the FSIS update here.

 Here is the short version:  

Shaws in Connecticut, Maine, Massachussetts, Rhode Island, New Hampshire and Vermont

Price Chopper in Connecticut, Pennsylvania, Rhode Island, and Vermont

Acme in Delaware, Maryland, New Jersey, and Pennsylvania

Giant in Pennsylvania

Pathmark in Delaware, New Jersey, New York, and Pennsylvania

Food Lion in North Carolina, South Carolina, Virginia and West Virginia

Trader Joe in Connecticut, Delaware, Maryland, Massachussetts, New Jersey, New York, and North Carolina

BJ in New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Virginia

Martins in Maryland, Pennsylvania, Virginia, and West Virginia

Great American in New York

IGA in Maine, New York, and Vermont

Surefresh in Delaware, Maryland, and Pennsylvania

Grand Union in Connecticut and New York

A&P in New Jersey and New York

Waldbaum in New York

C&S in Vermont

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 The CDC reports today that there are currently only 26 illnesses in 11 states that are linked to the Fairbank Farms E. coli O157:H7 ground beef outbreak and recall.  This represents a reduction in the number of cases attributed to the outbreak by two.  

Here is the outbreak rundown:

On October 31, 2009, FSIS issued a notice about a recall of over 500,000 pounds of beef products from Fairbank Farms that may be contaminated with E. coli O157:H7. Health officials in several states who were investigating a cluster of E. coli O157:H7 illnesses, with isolates that match by “DNA fingerprinting” analyses, found that most ill persons had consumed ground beef, with several purchasing the same or similar product from a common retail chain. At least some of the illnesses appear to be associated with products subject to these recalls. A sample from an opened package of ground beef recovered from a patient's home was tested by the Massachusetts Department of Health and yielded an E. coli O157:H7 isolate that matched the patient isolates by DNA analysis.

The cluster includes 26 persons from 11 states infected with matching strains of E. coli O157:H7. The number of ill persons identified in each state is as follows: California (1), Connecticut (4), Massachusetts (8), Maryland (1), Maine (2), Minnesota (1), New Hampshire (4), New Jersey (1), New York (1), Pennsylvania (2), and Vermont (1). Of these, the genetic association of 13 human isolates and the product isolate have been confirmed by an advanced secondary DNA test; secondary tests are pending on others. Depending on the results of continuing laboratory testing and ongoing case finding, the number of persons determined to be in this cluster may increase or decrease.

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 Tuesday morning, we will be filing lawsuits on behalf of the families of two children sickened in the ongoing, likely developing, outbreaks of E. coli O157:H7 linked to ground beef.  The lawsuits will be filed in Plymouth County Superior Court for the Commonwealth of Massachussetts against Brockton, Mass.-based Crocetti-Oakdale Packing, Inc., doing business as South Shore Meats Inc., and Ashville, NY-based Fairbank Farms, Inc. Both companies recalled meat last week after their products were identified as the source of a national E. coli outbreak.

The medical complications associated with E. coli O157:H7 infection are many.  Most infections are characterized by 7-10 days of diarrhea, frequently bloody, severe abdominal cramps, and a host of other painful symptoms.  Infection by this dangerous pathogen frequently results in hospitalization, and kills with frightening efficiency and regularity.  Those who are acutely susceptible to severe infection whether by age or immuno-compromisation frequently have dangerously severe medical courses.  

Far and away the most frightening medical complication associated with infection by E. coli O157:H7, however, is hemolytic uremic syndrome, or HUS.  The chain of events leading to HUS begins with ingestion of Stx producing E. coli (e.g., E. coli 0157: H7) in contaminated food, beverages or through person to person transmission. These E. coli rapidly multiply in the intestines causing colitis (diarrhea), and tightly bind to cells that line the large intestine. This snug attachment facilitates absorption of the toxin into the circulation where it becomes attached to weak receptors on white blood cells (WBC) thus allowing the toxin to “ride piggyback” to the kidneys where it is transferred to numerous avid (strong) Gb3 receptors that grasp and hold on to the toxin. Organ injury is primarily a function of Gb3 receptor location and density. Receptors are probably heterogeneously distributed in the major body organs, and this may explain why some patients develop injury in other organs (e.g., brain, pancreas).

Once Stx attaches to receptors, it moves into the cell’s cytoplasm where it shuts down the cells’ protein machinery resulting in cellular injury and/or death. This cellular injury activates blood platelets and the coagulation cascade which results in the formation of clots in the very small vessels of the kidney resulting in acute kidney injury and failure. The red blood cells are hemolyized (destroyed) by Stx and/or damaged as they attempt to pass through partially obstructed microvessels. Blood platelets (required for normal blood clotting), are trapped in the tiny blood clots or are damaged and destroyed by the spleen.

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