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

While details on the full magnitude of the nationwide Wright County Egg recall and related Salmonella enteritidis outbreak continue to unfold, the conversation on prevention has begun.  One such preventative measure being discussed involves vaccinations.

In an article published in today's Washington Post by Associated Press writer Michael Crumb, he writes:

Low-cost vaccines that may have helped prevent the kind of salmonella outbreak that has led to the recall of more than a half-billion eggs haven't been given to half of the nation's egg-laying hens.

The vaccines aren't required in the U.S., although in Great Britain, officials say vaccinations have given them the safest egg supply in Europe. A survey conducted by the European food safety agency in 2009 found that about 1 percent of British flocks had salmonella compared to about 60 to 70 percent of flocks elsewhere in Europe, said Amanda Cryer, spokeswoman for the British Egg Information Service.

The vaccine works by protecting the hens from contracting the bacteria in the first place, thereby stopping the spread among the flock.

Of course, vaccines are only one part of a possible solution.  As Mr. Crumb's article points out, vaccines may help prevent the spread of this nasty bug, but they will do nothing to prevent the less-than-stellar animal handling and food manufacturing practices that encourage the spread of these foodborne bugs in the first place.

Doug Grian-Sherman, senior scientist at the Union of Concerned Scientists, said the vaccine deserves additional study, but it would likely have only have limited effectiveness against a bacteria like salmonella, which has many different strains.

"It's only going to be a Band-Aid on a much bigger problem," he said.

It would be more effective to give the FDA additional authority to stop repeat offenders and pull contaminated products off shelves and to move away from big production facilities that ship across the nation and can quickly spread disease, Grian-Sherman said.

"The way we produce a lot of our food and meat and eggs in particular, has gotten to a scale where it's very difficult to prevent these problems," he said. "That needs to change and we need to think about producing food on a scale that is better for the communities and safer for consumers."

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CDC announced this afternoon that it is investigating two multistate outbreaks of Salmonella infections, each involving a different Salmonella serotype: Hartford and Baildon. Both of these Salmonella serotypes are rare, and ill persons in both outbreaks have a similar age and geographic distribution.

An analysis indicates that eating at a Mexican-style fast food restaurant chain, Restaurant Chain A, is associated with some illnesses. Among persons eating at Restaurant Chain A, no specific food item or ingredient was found to be associated with illness for either outbreak.

An extensive traceback effort was initiated to determine if a common source or supplier could be identified to help focus the epidemiologic investigations. No common food source was identified in either traceback.

Salmonella Hartford Outbreak Investigation

As of August 1, 2010, a total of 75 individuals infected with a matching strain of Salmonella Hartford have been reported from 15 states since April 1, 2010. The number of ill people identified in each state with this strain is as follows: CO (1), GA (1), IL (5), IN (11), KY (23), MA (2), MI (3), MT (1), NC (1), NH (1), NY (1), OH (19), PA (1), SC (1) and WI (4). Among those for whom information is available about when symptoms started, illnesses began between April 30, 2010 and July 18, 2010. Case-patients range in age from <1 to 80 years old, and the median age is 39 years. Fifty-seven percent of patients are female. Among the 47 patients with available hospitalization information, 15 (32 %) were hospitalized. No deaths have been reported.

Salmonella Baildon Outbreak Investigation

As of August 1, 2010, a total of 80 individuals infected with a matching strain of Salmonella Baildon have been reported from 15 states since May 1, 2010. The number of ill people identified in each state with this strain is as follows: CT (1), GA (1), IA (1), IL (20), IN (4), KY (5), MA (1), MI (4), MN (5), NJ (6), NY (2), OH (6), OR (1), WA (1) and WI (22). Among those for whom information is available about when symptoms started, illnesses began between May 11, 2010 and July 19, 2010. Case-patients range in age from 1 to 82 years old, and the median age is 47 years. Seventy-four percent of patients are female. Among the 68 patients with available hospitalization information, 27 (40 %) were hospitalized. No deaths have been reported.

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Health officials in Cook County, Illinois are currently investigating 7 culture-confirmed Salmonella infections in folks who visited the Skokie Country Club in Glencoe.  The source of the bacteria is not currently known, and the country club has closed its kitchen since Thursday while the investigation continues.

The severity of those 7 victims is not presently known, although the symptoms of a Salmonella infection can vary.  Mild infections frequently include symptoms such as diarrhea, abdominal cramps, fever, nausea, and vomiting, while severe infections can lead to bloody diarrhea, typhoid fever, bacteremia, and Reiter's syndrome.

 

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As the investigation continues into the cause of the 80 (and counting) Salmonella Hvittingfoss illnesses associated with Illinois Subway restaurants, the question arises of the possible role each Subway restaurant could have played in furthering the spread of the bacteria. 

With that in mind, a recent article by Nicole Norfleet caught my attention for its insight into the way that outbreaks such as Subway's can be made exponentially worse by poor food safety practices at the restaurant.

Her report details a study by Ben Chapman, an assistant professor and food safety specialist who used video cameras in eight restaurant kitchens to monitor worker food safety habits.  He found that a typical kitchen worker cross-contaminates food with potentially dangerous pathogens about once per hour.  "Among the risky behaviors cited were workers using aprons and other garments to dry hands, as well as using the same utensils and surfaces to prepare both raw and cooked foods, according to a review by a North Carolina State University researcher."  The article continues:

Joan McGlockton, a food policy representative for the National Restaurant Association, said that while the study is disconcerting, the association doesn't feel it is representative of the entire restaurant industry.

"We apply strong emphasis on employee training in areas of food safety to ensure that proper practices in hygiene, food handling and sanitation are in place in every food service outlet," she said in an e-mail.

Americans experience about 76 million foodborne illnesses a year. While most of these cases are mild and don't have long-term symptoms, foodborne illnesses cause about 5,000 deaths annually, according to the Centers for Disease Control and Prevention. From 1998 to 2004, the latest figures available, more than 50 percent of foodborne disease outbreaks reported to the CDC were associated with restaurants or delicatessens.

Cross-contamination happens when pathogens, such as salmonella and E. coli, are transferred from raw food or contaminated source to already prepared food. For example, when a cook uses the same knife to first cut raw chicken and then to slice a sandwich.

Chapman says the risky behaviors were most prevalent during busy periods. For example, some employees didn't attempt to wash their hands during lunch and breakfast rushes. Multiple workers using the same tools caused many of the cross-contaminations, according to the review published in the June issue of the Journal of Food Protection.

There was also some good news: Chapman found that posting information about food safety in kitchens and break rooms that gives employees examples of the consequences of poor food handling significantly reduced risky behaviors.

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Statistics about thesalmonella montevideo and senftenberg outbreak linked to salami and pepper were recently updated.  According to the CDC, 272 people were sickened by Salmonella montevideo from since July 2009 after consuming salami that was manufactured using salmonella-contaminated red and black pepper.  The salami was manufactured and sold by a Rhode Island company called Daniele Inc.  The pepper (both black and red), which has long been known to have been the original source of contamination, was imported and sold by two companies:  Wholesome Spice Company and Mincing Oversease Spice Company.

Originally, Rhode Island health officials discovered that it was the pepper, rather than the meat itself, that was originally contaminated.  The CDC states:

Testing by the Rhode Island Department of Public Health found the outbreak strain of Salmonella Montevideo in samples of black and red pepper intended for use in the production of Italian-style meats at Daniele International Inc. Since then, several recalls have been issued.

Interestingly, Salmonella senftenberg illnesses that occurred as a result of consuming the contaminated product are not counted in the CDC's official case count.  Why I do not know.  Packages from consumer households tested positive for both Salmonella Montevideo and Senftenberg, which seems to be the smoking gun.  Possibly the DNA fingerprint of the senftenberg strains are different, making it more difficult to include them as part of the outbreak. 

Another concern is that the contaminated pepper is still out there.  The CDC believes that it might be, and may pose an ongoing health risk to consumers.  The most recent confirmed illness in the outbreak occurred on April 14, 2010, long after the peak of illness in the outbreak, which was November 2009.  With regard to the ongoing threat to public health, the CDC states:

The numbers of new cases have declined substantially since the peak in November 2009, but some of the recalled products have long shelf-lives and could cause illness if consumed. Consumers should avoid eating recalled products.

The outbreak has spawned multiple lawsuits. 

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In the Oregon Salmonella outbreak linked to Dos Amigos mexican restaurant, Douglas County Health officials now say they have confirmed 17 cases.  The illnesses are said to have taken place from April 9 through April 17.

KVAL.com reported today on the Salmonella outbreak:

Dawnelle Marshall from the Public Health Division of the Douglas County Health Department said they still don't know what caused the outbreak, but they are interviewing people that ate there during that time, to see if they can figure out where the problem started.

"We've not been able to pinpoint the source, whether that is a food item, whether there is cross-contamination. We have not been able to do that, but we do have sampling that is pending, and those results should be in later this week," said Marshall.

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Today' a foodpoisoning outbreak was announced in Durham, NC at a restaurant called "Bullock's Barbecue."  Though lab tests have not yet confirmed the organism responsible for sickening at least 15 people, health officials suspect that Salmonella is to blame. 

In 2002, a large Salmonella outbreak was associated with eating at the Western Sizzlin' Restaurant in Spruce Pine, North Carolina. Hamburger steak with gravy, fried chicken, and ham all tested positive for the presence of Salmonella Heidelberg. Two employees were found to be infected with the same strain of Salmonella Heidelberg. Both had eaten food that had been prepared at the restaurant so it was not clear if they were the source of the outbreak or if they were victims, like the patrons.

In May 2005, patrons of the Old South Restaurant in Camden, South Carolina, became ill with Salmonella Enteriditis after eating at the restaurant from May 19 - 21. The Old South Restaurant was a family-owned, buffet-style restaurant. Salmonella contamination was documented in the roasted turkey. The convection oven had malfunctioned, and therefore the turkey did not reach an internal temperature high enough to kill Salmonella.

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NBC 17 just reported on a possible Salmonella outbreak linked to a well-known Durham, NC area barbeque restaurant called "Bullock's Barbeque."  At least 15 customers became sick.  The Durham County Health department says all the illnesses were reported after April 20 from people who had dined at the restaurant.  "County inspectors suspect Salmonella may be to blame, but are waiting for lab work to confirm that theory."

After officials began receiving reports of people becoming sick after eating there, the kitchen was the first thing health inspectors checked.

"We have gone to the restaurant and looked at their production process from beginning to end and have no problem with that," Harris said.

Heath officials say owner Tommy Bullock has cooperated fully as officials try to figure out how the pathogen was spread.

"We will be interviewing the employees of the restaurant to determine if any of them have been sick," Harris said.

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Today, the Hawaii Department of Health announced a Salmonella paratyphi b outbreak linked to ahi tuna.  Interestingly, the ten illnesses in Hawaii appear to be linked to 13 other illnesses nationally, and possibly even linked to an outbreak of illnesses linked to the same product two years ago.  (We reported on this phase of the outbreak in February 2008).  Was it a frozen product that was held at the manufacturer or distributor's facilities for two years, and finally released now?  Or is there a persistent source of the paratyphi b strain at the manufacturer's facilities?

The paratyphi b strain of salmonella is different from those that we see most frequently in foodpoisoning outbreaks.  There are well over 2,000 individual strains of salmonella, but not all of them cause typhoid fever.  Paratyphi b, however, does cause typhoid fever. 

Typhoid fever is the most serious form of enteric fever, with humans being the sole reservoir of the bacteria. Based on a recent survey, the global number of typhoid cases in 2000 exceeded 21,000,000, with more than 200,000 deaths [1]. Enteric fever, that is typhoid and paratyphoid fevers, is the common name for infections caused by Salmonella enterica serotypes typhi and paratyphi. Of the three types of S. paratyphi (A, B, and C), B is the most common.

http://casesjournal.com/content/1/1/403.  Salmonella typhi and paratyphi are also more likely than other salmonella serotypes to cause enteric fever, as well as the chronic carrier state.

Typhoid fever, or enteric fever, differs from the typical salmonella gastrointestinal illness in that typhoid fever does not always cause severe gastrointestinal symptoms. 

The syndrome of enteric fever is characterized by prolonged sustained fever, relative bradycardia, hepatosplenomegaly, rose spots, and leucopenia and neutropenia [3]. After an incubation period of 5 to 21 days (generally 7 to 14 days), fever and malaise develop, often associated with cough. A small proportion of patients may have diarrhea during the incubation period. The fever tends to rise in stepwise fashion over the first few days to a week and then becomes sustained, usually at 39.4 to 40°C (103 to 104°F) or higher. After 2 weeks of illness, the severe complications of intestinal hemorrhage or perforation may be observed. The illness usually resolves by the end of the fourth week in an untreated patient. Relapse may occur in untreated as well as treated patients, but the illness is milder than the original episode. Rarely, some of the following complications may occur: pancreatitis, cholecystitis, infective endocarditis, pneumonia, hepatic or splenic abscess, orchitis, or focal infection at virtually any site [6].

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From today's Hawaii Department of Health press release:

The Hawai‘i State Department of Health (DOH) has confirmed 10 cases of
illness occurring on O‘ahu caused by Salmonella Paratyphi B infection related to eating previously frozen internationally imported raw ahi. The individuals, who became ill, reported eating raw ahi (often prepared as poke) purchased or served at various locations on O‘ahu.

As of April 12, 2010, there were 13 laboratory confirmed cases with the same S. Paratyphi B pattern in five other states: California (7), Maryland (2), Pennsylvania (2), Massachusetts (1), and New York (1). DOH is working with the U.S. Centers for Disease Control and Prevention (CDC) and the other states to identify if those cases were also exposed to raw ahi. DOH has informed the U.S. Food and Drug Administration (USFDA) and requested an investigation of international sources of frozen raw ahi.

“The Department of Health is concerned about these cases that are similar to a cluster of cases we investigated two years ago,” Health Director Dr. Chiyome Fukino said. “With the help of the USFDA, we hope to identify the source so we can prevent any further illness."

Between October 2007 and February 2008, DOH identified a total of 35 confirmed cases of Salmonella Paratyphi B infection on O‘ahu. An exhaustive investigation by the department identified raw imported frozen ahi used in ahi poke as the probable source of illness. At that time, confirmation of additional cases in Colorado and California related to the consumption of raw fish prompted an investigation by the USFDA, but a definitive source for the implicated ahi could not be identified.
 

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KITV in Honolulu reported today that ten people have been infected and sickened by Salmonella in Hawaii recently, and all report having recently consumed imported ahi tuna.

At least 10 people have fallen ill with salmonella infections after eating imported ahi tuna, Hawaii Department of Health officials said on Thursday.

The people who became sick said they had eaten raw ahi, usually served as poke, at different places on Oahu, DOH officials said.

There have been 13 other cases of the same type of salmonella partyphi B in other states on the mainland, officials said.

"The Department of Health is concerned about these cases that are similar to a cluster of cases we investigated two years ago," Health Director Dr. Chiyome Fukino said. "With the help of the U.S. (Food and Drug Administration), we hope to identify the source so we can prevent any further illness."

From October 2007 to February 2008, DOH officials found 35 cases of the same pattern of salmonella.

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This morning, Phyllis Entis of eFoodAlert.com posted an interesting article on the Montefiore Cheese Salmonella recall that has occurred in Austrialia, Tazmania, and New Zealand.  Ms. Entis's issue with the conduct of the recall seems to be delays in product testing that revealed the contamination, and dissemination of that critical information to the food-consuming public.  The article, titled Montefiore Cheese Plays Recall Hopscotch With Salmonella, asks:

It took more than three weeks for Montefiore to complete its Salmonella tests, in an era when Salmonella tests can be completed easily within 48 hours.  What took so long?  And why, with rapid testing so readily available, would Montefiore not follow a test-and-hold policy - an approach that would have vastly reduced the risk of contaminated products entering the food supply.

Another example, according to the article, of slow and inefficient action that lead to an outbreak occurred in Canada in 2008.  Ms. Entis states:

I would refer Montefiore's management to the 2008 experience of Canada's Maple Leaf Foods. That company initially recalled just two batches – produced two weeks apart – of ready-to-eat deli meat, after those batches were found to contain Listeria monocytogenes. The recall quickly expanded to include additional production dates and deli meat varieties. Ultimately, the entire production facility was shut down for extensive cleaning and sanitation, and several months worth of ready-to-eat meats were recalled. Fifty-seven illnesses were linked to the contaminated deli meats. Twenty-two people died.

Though insightful and always worth emphasizing, this is not new stuff.  Timely testing and reporting are critical to ensuring the safety of our food supply, and when contamination does occur, ensuring that people don't get sick.  As I have reported before,  

 whether it appears in a statute or not, recalling companies have an obligation not only to announce the recall but also to act aggressively in (a) identifying what retailers or other companies may have received the contaminated product (b) identifying what consumers may have purchased the contaminated product and (c) using all means necessary to make the important details of the recall (e.g. what products are included) known to retailers and consumers alike.

See Transparency in food recalls:  important on both sides of the Atlantic.

Ms. Entis ultimately concludes, as we both have before, "A bit more transparency would be helpful here."  I still agree wholeheartedly.  Consumer health and safety demands it.

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The CDC updated its statement on the large Salmonella outbreak linked to now-recalled salami and red and black pepper.  According to the CDC's April 1 statement, the outbreak has sickened 252 people in 44 states and the District of Columbia.  The outbreak strain of Salmonella is Montevideo, but Salmonella Senftenberg has also been found in recalled product.  It is presently unknown, at least publicly, how many Salmonella Senftenberg illnesses are linked to the outbreak. 

The first level of companies (i.e. those that manufactured the recalled products) involved in this outbreak and recall are Daniele Inc., a Rhode Island specialty foods maker, and Wholesome Spice and Seasoning Company and Mincing Overseas Spice Company.  The recalled products include well over one million pounds of salami and both black and crushed red pepper.  The outbreak happened because Daniele used Salmonella-contaminated pepper (both red and black) in the manufacture of its salami products.  Both the red and black pepper have tested positive for the outbreak strain of Salmonella. 

As is relatively common in a situation where a base ingredient like pepper is contaminated, it is not just recalled Daniele Inc salami products that are potentially contaminated and should be avoided.  The outbreak has resulted in a "rolling recall," where other Wholesome Spice and Mincing Overseas customers have received contaminated product, and have also initiated product recalls.  See the FDA's complete list of recalled pepper products.  Notably, companies continue to recall products on a fairly regular basis, but there has been no public statement whether additional illnesses are linked to pepper contained in anything other than Daniele's salami products. 

We have filed two lawsuits on behalf of people sickened in the outbreak, including Lee Hanks and Raymond Ciriimele.  Notably, however, these victim suits are not the only lawsuits that have been filed as a result of the outbreak and recall.  Daniele Inc has also sued Wholesome Spice Company and Mincing Overseas for substantial business losses incurred as a result of selling Daniele contaminated product. 

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The FDA announed recently yet another secondary recall in the larger salmonella outbreak/recall linked to pepper manufactured and sold by Mincing Overseas Spice Company and Wholesome Spice. 

As the result of a recall of Black Pepper by Mincing Overseas Spice Company, Binell Bros. of Dearborn, MI is recalling ground black pepper because it has the potential to be contaminated with Salmonella. The pepper is packaged in clear, plastic bags weighing between ¼ lb and 10 lbs, and was sold on-site between December 11, 2009 and February 2, 2010. The bags are labeled with stickers identifying the distributor, Binell Bros. Cutlery, but no product code. The product was sold in Michigan only.

The original recalls by Wholesome and Mincing occurred as a result of red and black pepper's implication in a large Salmonella outbreak that has sickened at least 252 people nationally.  Many other companies have also recalled pepper, or productions containing pepper, in this large outbreak/recall.

Interestingly, Daniele Inc., the company who manufactured and sold the retail product that made people sick in the outbreak (largely because the implicated salami contained, or was coated with, the contaminated pepper), has sued Mincing Overseas Spice Company for losses incurred as a result of the outbreak and result recall.  According to Katie Mulvaney of the Providence Rhode Island Journal,

The company accuses the spice manufacturers of negligence and breach of contract. According to the suit, the company was forced to recall 1.2 million pounds of its meat and refund $1.5 million to customers.

"The hallmarks of success in the specialty food industry are quality and reputation," the suit says.

Founded in 1945, Daniele produced cured meat products, including salami, prosciutto and pancetta that it sold to delis and supermarkets in the United States, Latin American and countries in Asia.

Daniele in 2009 purchased 50,000 pounds of pepper from Wholesome Spice and 40,000 pounds from Mincing, the suit says.

Beginning in July, public health officials nationwide observed a spike in people reporting poisoning symptoms resembling salmonella. During the six-month outbreak, the United States Centers for Disease Control identified at least 252 people in 44 states who were infected, the suit says.

Based on the CDC findings, Daniele recalled ready-to-eat pepper coated salami and other pepper-coated products in January. The Rhode Island Department of Health and other health officials linked the outbreak to black pepper used by Daniele. The U.S. Food and Drug Administration found that the contaminated black pepper and crushed red pepper had been produced by Wholesome and Mincing. The companies recalled the pepper.

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The outbreak linked to salami and pepper, and the recall linked to hydrolyzed vegetable protein (HVP), have sparked additional food recalls.  First, the pepper.  The FDA's recall notice posted today (it is dated March 25th--from a consumer health standpoint, shouldn't these notices be going up a little closer in time to the day they occurred) states as follows:

As a result of a nationwide recall of Black Pepper by Mincing Overseas Spice Company and by Dutch Valley Food Distributors, Perfect Candy & Packaging Co is joining in this product recall due to the possibility of contamination 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.

Perfect Candy & Packaging Co. has issued a voluntary recall for the following product with an H.D.W. Foods Inc. label.

Whole Black Peppercorns, 2.0 oz Bags UPC# 080869654293

And the HVP recall notice (again, dated March 25 but posted today--I check multiple times a day) states:

Modern Products, Inc. is initiating a recall of products manufactured with HVP (Hydrolyzed Vegetable Protein) supplied by Basic Food Flavors of Las Vegas, Nevada, because the ingredient has the potential to be contaminated with Salmonella.

"Consumption of products containing Salmonella 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."

To date, no illnesses have been associated with any Modern Products seasonings. In addition, random samples covering all HVP batches of concern were sent to an independent laboratory for testing and all results came back negative, but to be safe, FDA's recommendation to recall product is being followed. 

The CDC's outbreak summary indicates that , from July 2009 through February 2010, at least 252 people were infected by Salmonella as a result of consuming Daniele, Inc. salami products that were manufactured using contaminated pepper from Wholesome Spice Company and Mincing Overseas Spice Company.  See summary and other commentary on outbreak.

The original HVP recall occurred last month and was initiated by Basic Food Flavors, a Las Vegas, Nevada company.  HVP is a flavor enhancer used in a wide variety of processed food products, such as soups, sauces, chilis, stews, hot dogs, gravies, seasoned snack foods, dips, and dressings. The FDA recently announced that, during its investigation at the Las Vegas facilities of Basic Food Flavors, it found Salmonella Tenessee (the serotype involved in the recall) in the companies production equipment. “This situation clearly underscores the need for new food safety legislation to equip FDA with the tools we need to prevent contamination," said Dr. Jeff Farrar, associate commissioner for food protection, FDA’s Office of Foods.

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The FDA announced Tuesday that, as a result of a recall of using salmonella-contaminated black pepper from Mincing Overseas Spice Company  in its products, Blue Line Foodservice Distribution of Farmington Hills, MI is voluntarily recalling Little Caesars Spice Paks. The Spice Paks are small white packets, approximately 1.5'' X 2.5'' that contain black pepper and other spices. The packets do not have lot codes or UPC codes. Before they were removed from the stores, they were available upon request to consumers at many Little Caesars stores in the US, Canada and Mexico. The Spice Paks are not used in making any Little Caesars food products.

So the rolling recall linked to pepper that was the source of a recent, major national outbreak continues.  To recap, the CDC counts 252 people nationally who have been sickened with Salmonella Montevideo after eating salami manufactured by Daniele, Inc. a Rhode Island company.  Daniele used pepper from Mincing Overseas Spice Company, and Wholesome Spice Company, in the production of its salami products.  Mincing and Overseas have both recalled pepper in the wake of the large outbreak. 

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Yesterday, yet another company announced a recall of products containing black pepper sold by Mincing Overseas Spice Company.  The company that announced yesterday's recall is John B. Sanfilippo and Sons, from Elgin, Illinois.  The FDA's recall notice states as follows:

As a follow up to the voluntary recall of black pepper from Mincing Overseas Spice Company announced on March 5, 2010, John B. Sanfilippo & Son, Inc. (Nasdaq: JBSS) (the "Company") announced today that it is voluntarily recalling various snack mix and cashew products, which have been flavored with seasoning containing the recalled black pepper and which are listed below, as a precautionary measure because the product may be contaminated with Salmonella

Does Mincing Overseas Spice Company have problems with traceability?  See Delays in Pepper Recalls Threaten Public Health.  Will punitive damages be assessed against Mincing in lawsuits against it in the pepper outbreak?  After all, pepper has been known to have been the source of the large national Salmonella outbreak associated with Daniele Inc. salami since late January.  How many people have needlessly become ill as a result of consuming pepper products that should have been taken out of distribution weeks, if not months, ago?

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From July 2009 through February 2010, at least 252 people were infected by Salmonella as a result of consuming Daniele, Inc. salami products that were manufactured using contaminated pepper.  The salami actually contained two kinds of pepper, red and black, both of which may have been contaminated.  Daniele purchased the contaminated pepper from two different companies:  Mincing Overseas Spice Company and Wholesome Spice Co, who have since initiated recalls of their contaminated products.  Ever since, multiple food companies from across the country have inititated their own recalls because they contained pepper from Mincing and Wholesome spice companies.  And just this week, two more companies, CH Guenther and Sons and Spice Barn, Inc., have recalled their pepper products as a result of Mincing's outbreak/recall.

A recall can be a very effective tool to prevent a dangerous product from injuring or killing somebody.  But the effectiveness of the recall process depends on the speedy and free flow of information, and particularly in the context of a raw food item subject to further processing, also the ability to effectively track where the dangerous products are ("traceability"). 

If companies are just now recalling pepper products sold by Mincing and/or Wholesome spice companies, there is a big problem.  Here are a few thoughts on what the problem might be:

1.  Maybe Mincing and Wholesome spice companies thought their obligations ended after recalling their contaminated product.  Not so.  Whether it appears in a statute or not, recalling companies have an obligation not only to announce the recall but also to act aggressively in (a) identifying what retailers or other companies may have received the contaminated product (b) identifying what consumers may have purchased the contaminated product and (c) using all means necessary to make the important details of the recall (e.g. what products are included) known to retailers and consumers alike.

2.  Another possibility that we frequently see in recall situations is that the recalling company has simply taken too narrow of an approach to the scope of its recall.  In other words, its initial recall efforts did not include all contaminated products.  There is no solution to this problem that perfectly balances a business's economic interests with public safety.  Clearly, a company cannot recall all of its products because to do so may mean corporate death.  But in the name of public health, it absolutely has to take a broad approach to to assessing what products are potentially implicated by the problem.  Thus, it is critical that food companies are able to accurately track which of its products are potentially implicated in a contamination problem.

What has happened to prompt these pepper recalls now, a month and a half after pepper was first suspected to be the source of infection in the major national outbreak linked to Daniele salami, is not yet publicly known.  But the fact that these recalls are happening so late in the game is absolutely unacceptable.  True, a late recall is better than no recall at all, but if a company is discharging the obligations described above and is serious about its efforts to protect the health of its customers, then information leading to such recalls has to be disseminated much faster. 

There was certainly a failure, probably many, somewhere along the line in this large outbreak and recall.  The questions that now remain unanswered are (1) how many more companies still have contaminated pepper products from Daniele, Overseas, and Wholesome spice companies in the marketplace, and (2) how many more people will fall ill as a result of the brutally slow flow of information critical to the protection of public health?

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On March 13, Spice Industrial Group, Inc., of Industry, California, recalled white sesame seeds sold under the Lian How brand name and supplied by Specialty Commodities Corp.  The affected products were distributed from november 6 to December 11, 2009.  The sesame seeds were recalled because of potential contamination by Salmonella bacteria,  which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

If the words Lian How and Salmonella are familiar at all, in conjunction, it's because the Lian How brand was implicated in a large spring 2009 outbreak/recall due to Salmonella contamination, and linked to black and white pepper products.  The company at the epicenter of the 2009 recall was Union International Food; and the outbreak linked to its contaminated pepper products ultimately sickened more than 87 people in Western states between December 2008 and April 2009; the majority of the illnesses were in California. Public health officials traced the outbreak to white pepper manufactured by Union International and sold under the brand names Uncle Chen and Lian How. Ultimately the company recalled more than 50 products, including spices, oils, and sauces, due to potential contamination with Salmonella.
 

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Over the last several years, there have been multiple outbreaks linked to, and recalls of, various kinds of spices. From white pepper, to red pepper, to black pepper and beyond, spices are a potentially ideal vehicle for the transmission of foodborne disease. More and more people are becoming ill from contaminated spices, and more and more recalls are occurring. So is this problem merely an emerging threat? Or is it a problem that food producers must confront here and now, finding ways to better ensure the safety of the consumers they profit from.

Spice outbreaks in recent history:

1. Veggie Booty

In May 2007, the Centers for Disease Control and Prevention (CDC) began a multi-state investigation in response to an increase in laboratory reports, first posted on PulseNet on April 2, 2007, of Salmonella Wandsworth. Salmonella Wandsworth is a very rare serotype that was never before implicated in a U.S. outbreak. As of September 6, 2007, there were 69 reported cases of Salmonella Wandsworth in 23 states and 14 cases of Salmonella Typhimurium in six states who became ill after consuming Veggie Booty, a puffed vegetable snack food with a raw, dried vegetable coating. A total of 61 bags of Veggie Booty were ultimately tested in twelve states. Salmonella was isolated from thirteen of them. Eleven of the thirteen bags were positive for the outbreak strain of Salmonella Wandsworth, and one bag was positive for Salmonella Typhimurium and Enterobacter sakazakii. One bag also tested positive for Salmonella Kentucky, and Salmonella Haifa and Saintpaul were isolated from other bags.

2. Union International

The Union International Food outbreak sickened more than 79 people in Western states between December 2008 and April 2009; the majority of the illnesses were in California. Public health officials traced the outbreak to white pepper manufactured by Union International and sold under the brand names Uncle Chen and Lian How. Ultimately the company recalled more than 50 products, including spices, oils, and sauces, due to potential contamination with Salmonella.

3. Wholesome Spice Company and Overseas Spice

This outbreak and recall is, of course, still going on.  According to the CDC just days ago, 238 individuals infected with the outbreak strain of Salmonella Montevideo, which displays either of two closely related pulsed-field gel electrophoresis (PFGE) patterns, have been reported from 44 states and District of Columbia since July 1, 2009.  Epidemiological investigation showed that these 238 sick people all ate Daniele Inc salami products contaminated by salmonella.  Daniele used salmonella-contaminated pepper in the production of the various kinds of recalled salami. 

4. Today’s recall of Johnny’s brand French dip au jus powder?

Will the Johnny’s recall, announced today out of Tacoma, Washington, be another recall or outbreak to add to this list? The ingredient list for the recalled prodcut states that it contains: 'MSG, Wheat, Soy & Milk; Hydrolyzed vegetable protein (corn, soy, wheat), yeast extract, salt, rice flour, monosodium glutamate, partially hydrogenated vegetable oil (soy & cottonseed), caramel color, whey solids, non-fat milk solids, mono & diglycerides."  Only time will tell, hopefully, what happened at Johnny's to prompt today's recall.  Spices?  Certainly possible.

The historical trend:

These kinds of events naturally prompt the question why are we suddenly seeing outbreaks and recalls linked to pepper and other spices. Is this truly a new phenomenon; a new species of failure by food importers and producers? 
 

The combination of Google and about 5 spare minutes will show you that spice problems are, by no means, a new phenomenon. As stated in a 2006 Journal of Food Protection article (“Journal article”): "We reviewed spice recalls that took place in the United States from fiscal years 1970 to 2003. During the study period, the FDA monitored 21 recalls involving 12 spice types contaminated with bacterial pathogens."  See Journal of Food Protection, Vol. 69, No. 1, 2006, Pages 233–237(Recalls of Spices Due to Bacterial Contamination Monitored by the U.S. Food and Drug Administration: The Predominance of Salmonellae). See article at: http://www.cdc.gov/enterics/publications/381_vij.pdf.

Indeed, as the name of the Journal article suggests, the problem of spice contamination has long been known. And not only that, it has long been known to be predominantly one of Salmonella contamination specifically.

Defining the problem:

Lest we delude ourselves into believing that the risk is not that great, it is clear that spice outbreaks are on the rise. The Journal article further states that “Although five of these recalls transpired during the preceding 30 years (one each in 1971, 1983, 1989, 1995, and 1996), the remaining 16 (76%) occurred during fiscal years 2001 to 2004.” And the other outbreaks described above (i.e. Veggie Booty, Union International, Wholesome/Overseas, and possibly Johnny’s) are too recent to have been included in the Journal article’s study.

But to add even further concern, it is evident that counting recalls and outbreaks may only partially define the problem. The Journal article further notes that, of the 105,440 spice brands imported at the time into the US, 258 were coded as "refusals" and were thus prevented access to US markets:

178 (69%) were refused because the manufacturer had a history of shipping Salmonella-contaminated spices. In 131 (74%) of these 178 refusals, the importer chose not to challenge the refusal; in 44 (25%) instances, Salmonella was shown to be present by laboratory analysis. In the remaining three (1%) instances, the spices were refused because of the presence of mold or filth.

Thus, upon inspection, there were an additional 258 refusals of spice products during the one year period analyzed, thereby preventing those contaminated spices from being included in the Journal article’s analysis. Admittedly, some were refused entry only because of past problems associated with the exporter, and some due to contamination by mold or other filth, but 44 were refused entry because they were, in fact, contaminated.

Where do all these contaminated spices come from? Again, the Journal article:

The country of origin of the spice was known for 15 recalls: 12 involved imported spices (India [three recalls], Spain [three recalls], Turkey [two recalls], and one recall each from Egypt, Jamaica, Mexico, and Taiwan), and the remaining three involved domestically produced spices (two recalls due to Salmonella and one recall due to L. monocytogenes).

Further:

Overall, there were 6,112 unique spice manufacturers in the 129 nations from which the United States imported spices; the three countries with the leading numbers of spice manufacturers were India (629 manufacturers), China (547), and Mexico (441). During fiscal year 2003, there were 9,911 unique spice consignees in the United States who purchased imported spices. Approximately 85% of the spices imported in fiscal year 2003 were produced in China, and the next four leading spice exporters to the United States—Honduras, Mexico, Lebanon, and Peru—contributed an additional 13%.

Further defining the problem:

As we know from past experience with food products, certain items are more susceptible to contamination, or to causing higher rates of infection and illness, due to their very nature. For instance, ground beef is a risky food because of the oftentimes preventable contamination that is so rampant in the production process. And lettuce and other leafy greens are susceptible to contamination because they are grown in an environment particularly capable of causing the contamination. 

Spices have numerous “performance characteristics” that make them a ready vehicle for contamination and illness. First, they are generally a dried product that have a long shelf-life . . . even for those of us who do not have spices still on our shelves for the 1990s. Second, they are ubiquitous and widely-sold; everybody has them, and everybody eats them, from the very healthy to the young and old, and all people in between. Third, the Salmonella bacteria, which is far and away the most prevalent contaminant of spices, is a hearty bug capable of surviving for long periods in a dry environment (e.g. a container of spices). As the Journal article notes, in a 1993 spice outbreak in Germany, testing 8 months after the contaminated product was identified produced positive results for viable Salmonella bacteria.

And the threats from a public health and surveillance standpoint? Long shelf-life frustrates the efforts of investigating health authorities to detect outbreaks and stop them.  Also, again, everybody eats these spices, which works to the detriment of public health in investigating spice outbreaks because investigators are not necessarily able to hone in on the suspect product as easily. Even though everybody buys them and uses them, people may use many different brands on their shelves and would not be able to retrospectively identify which particular brand they used days, weeks, or months ago.  And finally, spices are often a post-cooking flavoring ingredient, and thus there is often no kill step.

So what are we to do?

Certainly, the solution does not lie in not using the product. Very few, even among those who truly know the scope of the problem, will stop using spices altogether. And nor does the solution lie in preventing US food companies from using imported spices. These solutions are both totally unrealistic, forcing the bottom line conclusion that the food companies themselves must act as a buffer against the purchase, manufacture, and distribution of contaminated spices.

With respect to spices, the buck stops with the industry. It is time for the process of irradiation to gain a stronger foothold in the United States with respect to all products, and most definitely with respect to those food products that carry the greatest risk.

But irradiation is not the only answer. The Journal article describes others as well:

A number of methods exist to reduce or eliminate pathogens from spices (e.g., the use ethylene oxide, heat treatment, or irradiation [UV, infrared, or gamma]). Ethylene oxide is highly diffusive; is simple to use; does not significantly alter either the aromatic or flavor components of spices (unlike heat treatment, which can destroy the aromatic and flavor components of spices as well as their color (12)); and is effective in destroying microorganisms (18). However, the effect of ethylene oxide on spores is not as great as it is for vegetative cells (12). The FDA has established a maximum tolerance of 50 ppm for residues of ethylene oxide in ground spices (2). On the other hand, at least one study has suggested that irradiation represents the most effective and safe method of treatment of spices, and it is a process that yields no toxic by-products (17). For the microbial disinfection of spices, the FDA has established that, when irradiation is used, the maximum dose should not exceed 30 kilogray (3 Mrad) (3).

And yet another solution is good old fashioned hard work by food companies. Do your job better by instituting and following rigorous standards in the import, production, distribution, and sale of your products. This involves knowing your suppliers, and their track-record with respect to food safety; don’t simply look at cost as the sole conclusive factor in deciding who to buy spice products from. Also, take all necessary precautions to avoid contaminating your production environment. This was certainly a factor in the Union International outbreak, and possibly one in the Daniele salami outbreak linked to black and red pepper. And finally, as is the case in any outbreak of foodborne illness, act quickly and proactively in informing the public and investigating health authorities about the probability and scope of a contamination problem with your products. Media exposure, and the resulting business loss, that occurs in the wake of outbreaks and recalls is only worse when more people get sick; and hiding the ball is certainly a good way to make more people sick.
 

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This evening, Wholesome Spice and Seasoning Company, a Brooklyn, NY, spice wholesaler, recalled "all lots of 25 lb boxes of Crushed Red Pepper sold between 4/6/09 and 1/20/10."  See FDA Recall Notice.  The reason for the recall is, of course, that the recalled red pepper is contaminated with Salmonella, thus explaining (partially, fully?) a national Salmonella outbreak that has sickened, to date, at least 238 people from 44 states and the District of Columbia.

Of course, the recall notice hedges a little bit, stating in bold that "It cannot be determined at this time if this product has been related to any illnesses to date."  Whether this is an acceptable qualification of Wholesome's recall remains to be seen.  After all, health authorities and the companies involved have long suspected that pepper was the source of contamination in the outbreak, and we know that at least 238 people are sick nationally with salmonella and an exposure to Wholesome's now recalled product.  Logic would suggest that there really isn't much reason to hedge. 

But, as has been the case throughout the evolution of this outbreak, there are still important questions to be answered.  Are other products implicated?  Not just other Daniele products, but food products from other companies to whom Wholesome may have sold the contaminated pepper.  Wholesome needs to reveal exactly where the contaminated pepper is now, and who bought it, so that public health authorities, not just the companies involved, can determine whether there is any ongoing threat to public health.   

Another question borne of legitimate concerns about the sheer size of this outbreak.  Did the manufacturing environment at Daniele become contaminated too, so that other products than only those containing red pepper may also be contaminated?  

Finally, how many people are really ill as a result of consuming the contaminated products?  There are many reasons why an infected person may not test positive for the outbreak bacteria.  The person may not have received medical attention; he may have seen his doctor and not had a stool test done; a stool test may have been done but returned falsely negative; or the doctor may have prescribed antibiotics before testing the stool sample, thereby basically eliminating the efficacy of the procedure.  In any case, it is a virtual certainty that, in any outbreak situation, more people than just the ones counted in the CDC's official list have actually been sickened. 

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We have known for some time now that Daniele Inc.'s recalled salami products, and pepper sold by Overseas Spice Company and Wholesome Spice, were contaminated with more than one strain of Salmonella.  We have also known for some time that the strains involved, or at least two of them, are Montevideo and Senftenberg.  But who knew that some of the recalled, contaminated Salami products were contaminated with BOTH strains of Salmonella? 

Lee Hanks, our client from Missouri who filed the second suit nationally linked to this outbreak, found out the hard way.  Two of the salamis in a variety pack (hot calabrese and hot capocollo) that he purchased from a Missouri Costco store tested positive for both strains of the bacteria.  One wonders what discovery will show regarding the extent of contamination of the recalled salami products, and the black pepper used to make it. 

 

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Today Marler Clark filed a lawsuit on behalf of Raymond Cirimele, another victim of the Salmonella outbreak linked to salami manufactured by Daniele, Inc., and black pepper sold by Wholesome Spice Company and Overseas Spice Company.  Another suit was filed on behalf of a Missouri man named Lee Hanks last week.

Raymond Cirimele regularly purchased the now-recalled salami product at a Costco in Cook County. He fell ill in November 2009 with symptoms of Salmonella infection, and visited his primary care physician. He was ill for almost a month, and visited his doctor several times about his illness. When a test revealed that he had been infected by the outbreak strain of Salmonella montevideo, Mr. Cirimele was placed on antibiotics. He is still recovering from his illness.

As of 9:00 pm EST on February 10, 2010, a total of 225 individuals infected with the outbreak strain of Salmonella Montevideo, which displays either of two closely related PFGE patterns, have been reported from 44 states and District of Columbia since July 1, 2009. The number of ill persons identified in each state with this strain is as follows: AK (1), AL (2), AZ (6), CA (30), CO (4), CT (5), DC (1), DE (2), FL (3), GA (3), IA (1), ID (2), IL (15), IN (3), KS (3), LA (1), MA (13), MD (1), ME (1), MI (4), MN (5), MO (2), MS (1), NC (10), ND (1), NE (1), NH (2), NJ (8), NM (2), NY (18), OH (9), OK (1), OR (9), PA (6), RI (2), SC (1), SD (3), TN (5), TX (7), UT (9), VA (1), WA (17), WI (1), WV (1), and WY (2). Because the main Salmonella Montevideo outbreak PFGE pattern is commonly occurring in the United States, public health investigators may determine that some of the illnesses are not part of this outbreak.

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It is Sunday, February 7, 2010; fifteen full days since Daniele Inc announced a recall of its salami products; and almost as long since the companies and investigating health authorities involved have either suspected or known that the ultimate source of illness in this large, and possibly growing outbreak, is black pepper.  But we, the food consuming public, continue to know nothing about the whereabouts of the contaminated pepper.  Why the silence?

To recap:  The CDC now counts 213 confirmed cases of Salmonella montevideo illnesses stretching from July 2009 to the present.  The cases are scattered across the country; 42 states in total; and California, Washington, Illinois, and Massachussets are the hardest hit states, with 30, 15, 13, and 12 cases respectively. Daniele Inc has recalled 1.28 million pounds of potentially contaminated product.  The Rhode Island health department announced on February 3 that it had detected the outbreak strain of Salmonella montevideo in pepper samples from two of Daniele Inc's pepper suppliers, Overseas Spice Company and Wholesome Spice.  Neither company, nor any government agency involved in the investigation (including FSIS, CDC, and USDA) has announced whether other food companies have received any of the contaminated pepper, or even whether the contaminated pepper is sitting on store shelves.  Nor has there been a recall of the contaminated pepper. 

From a public health standpoint, the proper flow of information would dictate that the public be made aware of where the contaminated pepper is; alternatively, if the companies involved and the governmental agencies investigating the outbreak have information to suggest that there really is no ongoing risk to the public, we should know that too. 

Most of the ire about the slow flow of information in this outbreak exists because of the potential that the outbreak is broader than simply contaminated salami.  We know that it wasn't the meat that was contaminated; it was contaminated pepper that ultimately caused the meat to become contaminated.  The pepper came from two companies who obviously had the same supplier of pepper.  Those pepper companies, Wholesome and Overseas, likely have more than one customer, thus creating the risk that more than Daniele is in possession of, or has used, the contaminated pepper.  And critically, there has been the suggestion, at least, that some people who are counted as outbreak cases (i.e. confirmed with the outbreak strain of Salmonella montevideo) did not even have any reported consumption of Daniele Inc salami in the days prior to their illnesses.  If true, this means that there must be more products that are making people sick, and may still be on store shelves. 

Some of the ire, though, exists because this is not an isolated instance of the slow flow of information in food outbreaks.  Recall that the E. coli O157:H7 outbreak linked to beef products from National Steak and Poultry was announced on Christmas Eve--probably the worst time possible to announce an outbreak and recall because most consumers simply aren't paying attention to recalls at that point in time.  Another example is the West Missouri Beef recall of 14,000 pounds of potentially contaminated boneless beef products.  Apparently, the meat was distributed to Chicago-area wholesalers, yet neither FSIS nor the company itself has disclosed the retail locations that received the potentially contaminated products. 

So the silence of the peppers continues.  If there is an ongoing risk to the public, we should have the benefit of knowing that so that we can make an informed choice about what products to buy.  If there is no ongoing risk to the public, we should have the benefit of knowing that information too. 

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The CDC has again revised its numbers in the Salmonella montevideo outbreak linked to Daniele Inc. salami and black pepper sold by Oversees Spices Company and Wholesome Spice.  There are currently 213 cases nationwide, stretching from July 2009 to the present.  California Washington, Illinois, and Massachussetts remain the hardest hit states, with 30, 15, 13, and 12 cases respectively. 

This outbreak has been thought provoking to say the least.  It highlights the need for better communication amongst public health agencies, and faster dissemination of crucial information to the public.  See The slow flow of information about food outbreaks.  It is also remarkable for its length, causing illnesses over at least a seven month period, and it remains to be seen whether the outbreak is even over.  Rhode Island has detected Salmonella in the black pepper sold to Daniele Inc by Oversees and Wholesome, and we still have no word on whether the contaminated black pepper is in consumers homes, on store shelves, or in other food products around the country. 

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The CDC's February 2 update on the Salmonella outbreak linked to salami and black pepper indicates that Washington, with 15 victims, is among the hardest hit states in the outbreak.  Only California and New York, with 30 and 16 victims respectively, have more sick residents.  Here is a distribution map of illnesses linked to the outbreak:

The latest update on the outbreak:

Rhode Island Department of Health has confirmed that the black pepper used to manufacture Daniele Inc's salami products has tested postiive for Salmonella Montevideo, thus confirming that the pepper was the ultimate source of contamination in the outbreak.  Rhode Island has also indicated that black pepper from two of Daniele Inc's spice suppliers (Wholesome Spices and Oversees Spice Company) has tested positive for the outbreak strain of salmonella.  This means that Wholesome and Oversees must have purchased their black pepper from the same supplier. 

This outbreak may not be over.  Unfortunately, the FDA and CDC have been largely silent on the nature of the ongoing risk to the public.  And Wholesome and Oversees have not yet heeded calls to tell the public whether they sold contaminated product to other companies, so we do not yet know whether other food producers have been using the contaminated product.  In fact, it seems very likely that they did.  There is some indication that certain outbreak victims had no exposure to salami whatsoever in the timeframe of their illnesses, yet they match the outbreak strain of Salmonella.  The implication is that there is, in fact, another food that is, or was, making people sick.

 

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The Rhode Island Department of Health announced today that recent test results strongly suggest black pepper is the source of the Salmonella outbreak associated with Daniele Inc. salami.  According to the CDC, the outbreak has sickened at least 207 people in 42 states.

Daniele purchased black pepper from two different distributors (Mincing Oversees Spice Company and Wholesome Spices) who buy imported black pepper. Samples of pepper from both distributors have tested positive for Salmonella. All other tests of employees and the facilities are negative at this time. These findings are consistent with Daniele Inc.’s history of no Salmonella findings by in-house testing and USDA periodic testing. No additional food items have been added to the recall list.

As part of the outbreak investigation, it was determined that both distributors who supplied black pepper to Daniele imported pepper from common sources.

“These recent findings show that black pepper used during the manufacturing process at Daniele was the likely source of this outbreak,” said Director of Health David R. Gifford, MD, MPH. “This outbreak only underscores the importance of closely monitoring food that is imported from other countries as they may not have the same food safety standards as we do.”

Adding even more concern to an already devastating outbreak, a spokesperson for the Rhode Island Department of Health indicates that some of the outbreak victims don't have a known exposure to salami.  What does this mean?  Bad news for the american consumer.  If there are lots of people out there who have been sickened by a strain of Salmonella that genetically matches the strain on Daniele Inc salami, there is a high likelihood that plain old pepper, or pepper on foods other than salami, is making people ill too. 

What needs to happen now is that both suppliers of black pepper to Daniele Inc.--Mincing Oversees Spice Co. and Wholesome Spice--need to tell the government and everybody else who they distributed potentially contaminated pepper to.  Pepper is a product with a long shelf life, and is ubiquitous in every home.  This makes it a particularly risky food when there is a possibility that it is contaminated. 

Oversees Spice and Wholesome:  do what's right.  If your products and sales are traceable, as they should be, then tell the public where the potentially contaminated product went.  You may be facing multiple lawsuits now, but there will be many more to come if this outbreak continues to grow. 

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In response to my AM's blog post about the true scope of the Salmonella salami/pepper outbreak, a reader states as follows:

Can't you read between the lines Drew. The contaminated pepper was sent to
food plants all over the country, to supermarkets, restaurants etc. Its
everywhere. The only safe products now may be from Daniele Inc..The RI dept
of health and FDA have both confirmed positive salmonella in unopened
pepper. The truth is too big for you to get your mind around. This is a
big huge mess and now could be a bigger cover up. Someone should inform
people of the truth...

Good point.  Where else is the contaminated pepper?  What do our national public health agencies know about the pepper product (other than that it's from Vietnam), and when do we get the benefit of having them disclose what they know?  Is there any ongoing risk to consumer health?  Is the pepper in our homes?

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Tomorrow morning, we will file a second lawsuit in the Salmonella outbreak linked to recalled salami (Daniele, Inc.) and pepper (Wholesome Spice).  The lawsuit will be filed on behalf of Lee Hanks, a resident of Lake Ozark, Missouri. 

Lee purchased the contaminated salami on January 17, 2010, at a WalMart store in Osage Beach, Missouri.  The Salmonella contaminated salami was one part of a variety package of Daniele Inc salami products.  At least one of the salami varieties contained pepper manufactured by defendant Wholesome Spice.

Lee Hanks consumed pieces of the contaminated salami the next day and fell ill late the same evening.  Symptoms began with cramps and nausea. Lee woke up in the early morning hours of January 19, 2010, feeling extremely nauseated, with alternating chills and fevers, and suffering from explosive bouts of diarrhea.

Lee's illness worsened over the next 48 hours, causing him to call his primary care physician the afternoon of Thursday, January 21, 2010. His physician prescribed anti-diarrheal and anti-nausea medications. Lee immediately began to take the medications that his doctor had prescribed, but he only became more ill, weak, and disoriented. Finally, on Saturday, January 23, 2010, Lee had become so ill that his wife demanded that he go to the emergency department at Lake Regional Hospital in Osage Beach, Missouri.

At the emergency department, Lee received several liters of fluid to correct his severe dehydration. He also received a potassium supplement, as his severe gastrointestinal losses had caused him to develop hypokalemia. Lee's attending physician ultimately diagnosed him with a severe bacterial infection and prescribed the antibiotic ciprofloxacin. And before being discharged, Lee submitted a stool sample for testing. 

Lee Hanks continued to be extremely ill and weak over the course of the next several days. The frequent bouts of diarrhea finally began to slow on or about Monday afternoon, but Lee continues to suffer from gastrointestinal discomfort as a result of his Salmonella infection.

In discussions with health officials from Miller County and the State of Missouri, Lee earned that the stool sample he submitted while at the emergency department tested positive for Salmonella Montevideo, which is the strain involved in the national outbreak linked to Defendants’ salami and pepper products.

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A reader's comments about the journal post this morning titled "Unanswered questions remain in the Salmonella salami/pepper outbreak:"

As a former owner of a spice company that did extensive work with food processors, I agree that the public has a right to know the information pertaining to this outbreak. However, using and/or selling untreated pepper is much akin to playing Russian Rullette with 5 bullets in the chamber. The price you pay to have pepper treated to lower micro's and eliminate things like e-coli, salmonella, and mold is nominal compared to the potential damage allowing untreated product to go out the door. I place the blame on three equally guilty parties; the importer who bought and shipped this product without testing or probably not requiring testing at the shipping point, Wholesome spice for selling product that they did not take due care to make sure micro's were within acceptable specification from ASTA (American Spice Trade Assoc), and Daniele's for accepting inferior product probably due to price considerations and not requiring COA's (Certificate of Analysis) that would show testing for and reduction of salmonella

This is products liability 101 with a good dose of concern for public health.  Well said.

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The Tremeloes got it wrong.  Silence is far from golden when it comes to matters of public health.  We now know that the salami Salmonella outbreak linked to Daniele Inc.'s pepper-coated salami occurred because of contaminated pepper, and that the pepper came from a company called (oh the irony) Wholesome Spice, a New York distributor.  But there remain too many questions with regard to this outbreak, not to mention other significant public health matters (see "the silence of the steaks and the perjury of the peppers"), to say that consumer health is being adequately monitored and protected. 

Wholesome Spice is merely a distributor, meaning that the company did not grow, harvest, or package the contaminated pepper.  We do not yet know where the contamination occurred, but odds are that it happened prior to receipt of the product by Wholesome Spice.  The implications are clear.  Wholesome Spice may have only received a portion of the contaminated product.  This is certainly something that the CDC and FDA have considered and are likely looking into.  The significance of this fact to public health?  Contaminated pepper may be in the homes of American consumers in other forms, and on other products.

It is possible, also, that there is no further threat to consumer health in America.  Wholesome Spice may be the only American company to receive the contaminated pepper, and Daniele Inc may be the only company to have purchased and sold the contaminated pepper to consumers.  But that doesn't sound very logical.  Is Wholesome Spice the exclusive seller of pepper to Daniele Inc., or vice versa?  Isn't it more logical to assume that the contaminated pepper has reached American consumers in other forms? 

The flow of information to the public in this particular outbreak and recall has not exactly been unimpeded, timely, or free.  Recall the CDC's statement to the public late on the friday evening that the outbreak and recall was announced:  "A widely distributed contaminated food product might cause illnesses across the United States."  In fact, the CDC commented in the same statement on the outbreak that other products may be implicated.

So we know the distributor of the pepper, but we don't know what country it came from or the identity of the company who grew, harvested, or packaged it.  We don't know whether other American food companies received the contaminated pepper, not to mention other companies worldwide, whose residents are just as susceptiblle to illness and death from Salmonella as we are.  We don't know whether other products are contaminated, and there has been no further word from the CDC on the issue, despite the obvious wide-spread contamination and the early suspicion about whether other products were implicated.  Nor do we even have any official statement on what other strains of Salmonella the CDC, or other State health departments, have found in the contaminated Daniele salami products.  Recall the CDC's statement on this issue:

This recall followed isolation of Salmonella in a private laboratory from a retail sample of a salami product produced by Daniele International. FSIS reviewed and affirmed these private laboratory results.  This Salmonella strain is different from the strains causing the outbreak. In addition, this product was different than the sliced salami variety pack purchased at different grocery store locations by the 11 ill persons.

We have the right to know these things.

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The USDA's Food Safety and Inspection Service (FSIS) just published its current list of retailers who may have received recalled salami implicated in the national salmonella outbreak. 

1.  Costco--all stores nationwide

2.  Fred Meyer--Stores in Alaska, Idaho, Oregon, and Washington

3.  Fry's Food and Drug--Stores in Arizona

4.  Haggen--Stores in Oregon and Washington

5.  Hilander--Stores in Illinois

6.  Kroger--Stores in Alabama, GZ (???, FSIS, do you mean GA for Georgia?), Illinois, Indiana, Kentucky, Louisianna, Michigan, Missouri, North Carolina, Ohio, South Carolina, Tennessee, Texas, Virginia, and West Virginia

7.  Market Basket--Stores in Massachusetts and New Hampshire

8.  Quality Food Center (QFC)-Fresh Fare--Stores in Oregon and Washington

9.  Ralphs-Ralphs Fresh Fare--Stores in California

10.  Sam's Club--All stores nationwide

11.  Scotts--Stores in Indiana

12.  Smiths-Smith's Marketplace--Stores in Arizona, Idaho, Montana, New Mexico, Nevada, Utah, and Wyoming

13.  Stop and Shop--Stores in New Jersey and New York

14.  Top Food--Stores in Washington

15.  Waldbaums--Stores in New York

16.  WalMart--All stores nationwide

17.  Weis--Stores in Maryland, New Jersey, New York, and Pennsylvania

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The Centers for Disease Control and Prevention is an arm of the Department of Health and Human Services.  The CDC is one of the foremost investigative bodies in the world when it comes to tracking foodborne illness and foodpoisoning.  The agency's role in the investigation of foodborne illness outbreaks--e.g. the Salmonella outbreak linked to pepper covered salami products manufactured by Daniele, Inc.--is critical to the safety of our food supply and the lives of every person in the country.   

The CDC's role in national foodborne illness outbreaks:

Interestingly, though, the CDC is often not the agency that "discovers" otubreaks of foodborne disease like the salami Salmonella outbreak.  On its website, the CDC details its typical role in the investigation of many foodborne illness outbreaks:

Most foodborne outbreaks are identified and investigated by local and state health departments. CDC provides consultation on some of those, as well as assistance on request for outbreaks that are particularly large, unusual, or severe.

In recent years, large multi-state foodborne outbreaks have become more common, because better surveillance identifies outbreaks that would previously have been missed and because an increasingly centralized food supply means that a food contaminated in production can be rapidly shipped to many states causing a widespread outbreak.

The Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC) works with a number of public health partners, including state, county, and city health departments, and the federal regulatory agencies, such as the United States Food and Drug Administration (FDA), the United States Department of Agriculture - Food Safety and Inspection Service (USDA/FSIS) , and the Environmental Protection Agency. During a multi-state foodborne disease outbreak, CDC serves as lead coordinator between public health partners to detect the outbreak, define its size and extent, and to identify the source.

CDC maintains and monitors several disease surveillance and outbreak detection systems in collaboration with public health partners. PulseNet, a sophisticated outbreak detection system, is a national surveillance network of CDC, state, and local public health laboratories and federal food regulatory agency laboratories. PulseNet performs pulsed-field gel electrophoresis (“DNA fingerprinting”) on disease-causing bacteria that may be foodborne to find clusters of cases that might be related.

Once a potential multi-state outbreak has been detected, CDC’s OutbreakNet Team engages to investigate it. By collaborating with public health partners, OutbreakNet leads the epidemiologic investigation of multistate outbreaks. OutbreakNet coordinates communications among states and may lead epidemiologic studies. These are studies to develop a short list of suspect foods or other exposures (“hypothesis generation”), to identify food exposure associated with illness (“case control studies”), and to determine how the food became contaminated. CDC also provides assistance in the field to any state requesting it. CDC’s laboratories maintain PulseNet surveillance to identify new cases, conduct advanced laboratory tests of disease-causing microbes, test suspect foods, and provide technical support to OutbreakNet and public health partners as part of the investigation.

The Salmonella outbreak linked to salami

The salmonella outbreak and recall linked to Daniele, Inc's salami product is a perfect example of how the CDC works with states around the country in the investigation of these outbreaks. This outbreak involved some admittedly tough circumstances, including a product with a long shelf life, national distribution, and the fact that many people eat salami fairly casually and without specific recall. These are all circumstances that can frustrate the efforts of public health officials trying to investigate a known cluster of salmonella illnesses.

Despite the fact that people were falling ill as early as July 2009, it was not until this month (january 2010) that the puzzle pieces finally fell into place. Bill Keene, PhD, the senior epidemiologist with the State of Oregon, first called the link between Daniele, Inc's salami product and the Salmonella montevideo illnesses nationally. The following excerpts from a discussion with Dr. Keene appeared in articles in both the Oregonian and the Washington Post via the AP on January 23:

“This is a weird outbreak in a lot of ways because it’s been such a long investigation,” Keene said. "We've gone down a lot of dead ends until the puzzle pieces started to fit together."

Many of those questioned did not point to salami, Keene said. “They were questioned left and right and they were asked about salami and very few of them said yes,” he said.

Keene said, investigators re-interviewed people who were thought to be part of the outbreak, such as members of a hunting party from the South who had been to the Great Plains and responded to new questions with answers such as, "Now that you mention it, we did stop at a Wal-Mart in South Dakota and buy some salami."

Keene said Saturday that the cause of the sickness was difficult to track and some questions remain, such as whether it was the meat or the pepper that was contaminated. Some scientists suspect that the pepper on the salami, which is known to pose a risk for salmonella, is at the heart of the outbreak.

“The company doesn’t test or process the pepper that they buy,” Keene said. “That doesn’t mean that they’re bad people, but it may have slipped through their quality assurance program.”
 

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With the food safety spotlight currently, and squarely, on sausage (Daniele, Inc. salami linked to 184 illnesses in 38 states; at least 38 hospitalized; see FSIS press release), it might be worth the consumer's while to spend a few minutes reviewing some sausage safety basics.  Here are some common questions and answers about sausage:

1.  Besides the manufacturer, who is responsible for ensuring the safety of sausage sold in the United States?

Answer:  Sausage is a meat product regulated by the USDA's Food Safety and Inspection Service.  FSIS inspects all sausages in interstate commerce and all sausages that are exported to other countries. But sausages made at a retail establishment may be under the jurisdiction of that State's health or agriculture department.

2.  Is sausage a risky food to consume?

Answer:  It depends on who you ask, but the composition and preparation of sausage might be a factor that predisposes this product to bacterial contamination.  Sausage is obviously made from a variety of meat types and cuts, and just like ground beef, there are, as a result, many critical points in the sausage-making process where adequate controls are required in order to reduce or eliminate the likelihood that the product will become contaminated.  One such control that may often be overlooked is the safety of the spices (e.g. pepper) used to enhance flavor.  NOTE:  one working theory about the Salmonella Montevideo outbreak linked to Daniele, Inc salami is that the pepper in or on the sausage was contaminated.  All the more reason for manufacturers to know, and investigate, the food safety practices of their suppliers.

3.  What must be on the label of uncooked sausages (i.e. not "ready to eat")?

Answer:  Labels for sausages that are not ready to eat must contain safe handling instructions, among other things.  Sausages that are NOT ready to eat must bear certain features such as, safe handling instructions. In cases where the sausage is partially cooked or otherwise appears cooked but requires cooking by the consumer for safety, FSIS requires additional labeling features such as a prominent statement on the principal display panel, for example, "Uncooked, Ready to cook, Cook before eating, Cook and serve" or "Needs to be fully cooked." In addition, the product should display cooking directions that are sufficient for the intended user. The manufacturer would have to validate that the cooking directions are sufficient to destroy any pathogens that could be present.

If a sausage is perishable, the label must say "Keep Refrigerated." Some federally inspected shelf-stable sausages are not ready to eat. If so, they will be labeled as above but will not have "Keep Refrigerated" on the label.

4.  Are any Sausages Shelf Stable?

Answer:  Some dry sausages are shelf stable (in other words, they do not need to be refrigerated or frozen to be stored safely). Dry sausages require more production time than other types of sausage and result in a concentrated form of meat. If the product is shelf stable and ready to eat, the product is not required to have a safe handling statement, cooking directions or a "Keep Refrigerated" statement.

5  Should people "At Risk" eat dry sausages?

Answer:  Because dry sausages are not cooked, people "at risk" (older adults, very young children, pregnant women and those with immune systems weakened by disease or organ transplants) might want to avoid eating them. The bacterium E. coli O157:H7 can survive the process of dry fermenting, and in 1994, some children became ill after eating dry cured salami containing the bacteria.

After the outbreak, FSIS developed specific processing rules for making dry sausages that must be followed or the product must be heat treated. These products are included in the FSIS microbial sampling program for E. coli O157:H7, and in 1997, FSIS began to test fermented sausages for Salmonella and Listeria monocytogenes.

6.  What is the significance of dates on packaged sausages?

Answer:  Although dating is a voluntary program and not required by the Federal government, if a date is used it must state what the date means. The product can be used after the date, provided it was stored safely. Follow the guidelines on the following page for maximum quality in sausage products.

"Sell By" date - tells the store how long to display the product for sale. You should buy the product before the date expires. "Best if Used By" date - date by which product should be used for best flavor and quality. It is not a purchase or safety date. "Use-By" date - the last date recommended for use of the product while at peak quality.

7.  How should I store sausage?  

Answer:  All sausage — except dry sausage — is perishable and therefore must be kept refrigerated. The following storage times should be followed for maximum quality.

If the sausage has a "use-by" date, follow that date. It is the last date recommended for the use of the product while at peak quality. The date has been determined by the manufacturer of the product. If the sausage has a "sell-by" date, or no date, store it for the times recommended below.
Freeze sausage if you can't use it within times the times recommended for refrigerator storage. Once frozen it doesn't matter if the date expires because foods kept frozen continuously are safe indefinitely.

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California based NewStar Fresh Foods today recalled green onions due to possible Salmonella contamination.  772 cartons of iced jumbo green onions are subject to the recall, sold under the brand names Omo and Fu Choy, and distributed from three locations:  R.A.M. Produce Distributors of Detroit, Michigan; Franzella Distributing of San Francisco, CA; and United Food Service of East Point, GA.

No illnesses have been reported. The product is packaged in a 48-count iced carton, item numbers 02487403 and 02487452, product lot numbers 40550707 and 40510707, with production dates of July 20th and July 21st 2009.

All affected product within the foodservice channel has been accounted for and destroyed, at least 58 cartons were shipped to, and possibly sold from, small grocery outlets in the Detroit and San Francisco areas.  Consumers in California may have purchased the product from Larry’s Produce in Fairfield, La Loma Produce, Good Life Grocery and El Grande, all San Francisco, and Valley Produce & Meat Market, San Pablo. Consumers in Michigan may have purchased the product from Confers Supermarket in New Lothrop, Ryan’s Food in Detroit, Brothers Supermarket and Al Jazeera Market in Dearborn and Sahara Market in Warren.

The jumbo green onions are past their shelf-life, but the recall was announced as a cautionary measure in the event that consumers might have purchased from the listed retail outlets and still have the product in their home refrigerators.

 

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The recall of over 826,000 pounds of ground beef, produced by Beef Packers Inc (aka Cargill), due to Salmonella contamination has resounded loudly in the food biz . . . but unfortunately not because a recall linked to ground beef is such a rarity.  It most certainly is not.  This recall has been big news, in large part, because the contaminant is antibiotic resistant Salmonella Newport, which only increases the public health nightmare associated with an already dangerous foodborne pathogen.  

In trying to understand why E. coli O157:H7 is an adulterant according to the USDA-FSIS, but other very common (and very lethal) pathogens are not, one can't help but be impressed by the rather common-sense argument that these bugs just aren't good for people; and as a result, they should be considered nothing if not an adulterant on any food product.  

 There are lots of reasons why the list of "adulterants" on federally inspected meat products should be expanded. Bill Marler has been addressing those reasons, and his concerns about why not, loudly and clearly for years. But what about others, outside the US, outside of government and industry; what do they have to say on the subject?

Obviously Dr. Margaret Chan has too much on her plate presently with H1N1 and a likely global pandemic to give our government's wooden adherence to its senseless policy on the subject. But at least she, and her important organization, can speak a little to the merits. And just a quick google search will reveal, pretty clearly, that the WHO recognizes the imminent, growing public health threat posed by antibiotic resistant Salmonella.

Quoting from a WHO page dedicated exclusively to the subject, the organization says:

Since the beginning of the 1990s, strains of Salmonella which are resistant to a range of antimicrobials, including first-choice agents for the treatment of humans, have emerged and are threatening to become a serious public health problem. This resistance results from the use of antimicrobials both in humans and animal husbandry. Multi-drug resistance to "critically important antimicrobials" are compounding the problems.

The WHO continues:

Multidrug-resistant (MDR) strains of Salmonella are now encountered frequently and the rates of multidrug-resistance have increased considerably in recent years. Even worse, some variants of Salmonella have developed multidrug-resistance as an integral part of the genetic material of the organism, and are therefore likely to retain their drug-resistant genes even when antimicrobial drugs are no longer used, a situation where other resistant strains would typically lose their resistance. ***  Drug-resistant Salmonella emerge in response to antimicrobial usage in food animals.

And the WHO concludes as follows:

The emergence of Salmonella strains that are resistant to commonly used antimicrobials should be particularly noted by clinicians, microbiologists and those responsible for the control of communicable diseases, as well as the food producers including the food industry. Control of drug-resistant Salmonella is most efficiently achieved through the reduction of antimicrobial use. Prudent usage in food animals should be combined with good husbandry, good abattoir practice and good hygiene at all stages in the food production chain, from processing plants to kitchens and food service establishments. These combined efforts should reduce the numbers of the relevant strains in food animals and lower the risk of contamination by resistant Salmonella at all stages in the food production chain.

I know something else that might help the effort.  

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Whether its just extremely competent public health officials, or that this particular state just got more of the bad meat than everybody else, Colorado is currently at the epicenter of a national outbreak of antibiotic resistant Salmonella Newport linked to ground beef.  To date, at least 21 Coloradans have been sickened in the outbreak, with the following breakdown of counties:  Arapahoe (3), Broomfield (3), Denver (3), Douglas (1), Elbert (1), Garfield (1), Jefferson (5), Mesa (1), Pueblo (1) and Weld (2).  The Boulder Food Examiner reports that there may be 3 cases in Boulder County as well.  The contaminated meat was distributed to Safeway and Sam's Club stores in Colorado, and has use or freeze by dates ranging from the end of June to July 11, 2009.  See http://www.fsis.usda.gov/News_&_Events/Recall_041_2009_Release/index.asp for more detail on which products are subject to the recall.   

 

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 In 1999, several states reported clusters of Salmonella Newport, an antibiotic resistant strain of the bug, with an indistinguishable PFGE pattern and the same anti-microbial resistance pattern.  The states reported to PulseNet, the national database for foodborne disease surveillance, which prompted an investigation into the cause of the outbreak.

In the investigation, health officials found that 7 out of 8 people in the clusters had eaten ground beef within several days before the onset of illness.  Ultimately, the investation identified a single producer that had distributed the contaminated meat to grocery stores, and an unopened package of ground beef ultimately tested positive for the outbreak strain of Salmonella Newport.  Investigators also found that, from 1997-1999, 1% of all Salmonella in meat processing facilities was Salmonella Newport.  

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This post is about a brutal illness caused by Salmonella.  It happened to one of our clients several years ago.  Don't stop reading just because you think you've seen, or heard about, every varient of a Salmonella illness. I assure you that you've never seen one quite like this before.

At the request of our former client, I have changed the names and locations in this narrative:

Our client, Ron, was infected with Salmonella during a sporting banquet in Indiana. His illness began on July 27, 2004. At first, he suffered from predominantly gastrointestinal symptoms that were, in light of what was to come, relatively mild.

By August 1, Ron was in the emergency room at a nearby hospital The attending physician there noted repetitive diarrhea and, though the vomiting had subsided, that Ron continued to feel “somewhat nauseous and gaggy.” Ron was re-hydrated with a liter of normal saline, and twenty-five milligrams of Phenergan, an anti-nausea medication, were introduced intravenously. He was discharged several hours later with a prescription for Ciprofloxacin, an antibiotic.

Ron’s course over the next two months is one that defies clever adjectival description: He felt generally ill pretty much all of the time. He did manage to return to work after a couple of day’s absence, but he struggled to be as productive as usual, was frequently irritable, and seemed constantly besieged by abdominal discomfort. It was during this time that Ron learned that his stool sample had cultured positive for Salmonella, group D.

The same state of ill health persisted throughout August and September. “Then,” as Ron recalls, “came the first weekend in October,” and “any thoughts I had that the first bout in July was the sickest I’d ever been faded quickly.”

Ron’s memory of the onset of symptoms is vivid:

I returned from a short shopping trip and sat in my favorite chair to look at the printer I bought for my digital camera. While I was sitting there I was suddenly taken very ill. I don’t know how to explain it other than it was as sudden as if a bone were broken or a switch was flipped. I had very severe pain in my lower abdomen and started vomiting. I felt just like I did in July, only worse.

The symptoms persisted for the next two days, while Ron tried treating himself with simple, over-the-counter remedies. He had no reason to suspect that his intestines had started to rot. By Tuesday, October 5, the pain turned frighteningly severe, and Ron drove himself, once again, to the hospital emergency room.

The hours that Ron spent waiting to be seen he describes as “the most uncomfortable [] of my life.” He was eventually seen and admitted soon after, the attending physician having become concerned at the intensity of the sub-umbilical pain that “spread across [Ron’s] entire abdomen,” which suggested acute appendicitis. A CT scan revealed some inflammation in the small bowel mesentery, but “no convincing inflammatory changes around the appendix to confirm the diagnosis of acute appendicitis.”

Afterward, Ron was wheeled to his own room, where he slept intermittently throughout the night. By morning, he was running a high fever, had become nauseated, and his stomach was plagued by intense cramps and pains.

Shortly before noon, Ron met a gastroenterologist in consultation. The gastroenterologist’s note presciently draws the first link to Ron’s recent bout with Salmonella, Group D. The doctor stated, “other than the bout of Salmonella noted above, he never had problems with chronic diarrhea or abdominal pain. There is no family history of inflammatory bowel disease or colitis.” The doctor decided to do laparascopic/exploratory surgery to address the worsening fluid collection and inflammation of Ron’s small intestine.

What was found on introduction of the exploratory laparoscope was not what was expected: “upon induction . . . there were multiple socked-in small bowel loops that were adherent to the anterior abdominal wall as well as to each other.” The surgeon was unable to detach and mobilize the small bowel and consequently had to convert to laparotomy.

Upon exploratory laparotomy, the small bowel had a densely fibrotic reaction throughout most of its length. There was one area in particular, it was in the distal ileum, that had the appearance of a chronic perforation that was very diseased. This was not salvageable.

The surgeon stopped the operation at this point, preferring an intraoperative consultation with yet another surgeon, who noted:

The small bowel was also examined in its entirety from the ligament of teitz to the ileocecal valve. The small bowel in general was very inflamed and beefy red. There were areas of dusky serosa. There was one loop of small bowel, however, that appeared near-necrotic. This loop had been involved with the abscess. It was inflamed and stuck to itself. The mesentery of this portion of the small bowel was also thickened and inflamed . . . It was felt that this portion of the small bowel was the primary process and cause of the peritonitis and abscess.

The doctors concurred that removal of the “near-necrotic” portion of Ron’s small intestine—between twelve and sixteen inches—was required. This was done with no complication and, after copious abdominal irrigation, the functional ends of Ron’s resected intestine were stapled and sutured. And as if this alone was not enough, Ron’s appendix was noted to be “inflamed throughout its course.” Accordingly, the surgeon removed the appendix as well. The surgery concluded with the placement of a Penrose drain in the subcutaneous fat.

Afterward, in search of an infectious cause, the surgeon sent the resected intestine and appendix to pathology; he also ordered that tissue samples from Ron’s abdomen be sent to the lab for culture. The pathology report states, in part:

The morphologic findings . . . confirm the clinical impression of intra-abdominal abscess formation. Although acute inflammation is present in the wall of the appendix, it may be secondary to intra-abdominal inflammatory process. The patient has a previous history of Salmonella infection (July 2004) and correlation with the pending culture results is essential.

The culture report from Ron’s abdominal tissue sample would return later in the month with a positive result for Salmonella enteritidis, group D1.

In the days following Ron’s surgery, his wife Mary spent most of every waking hour at the hospital by her husband’s side, leaving only to sleep or get the kids to their various after-school activities. The kids were required, by parental rule, to stay out of the hospital room. Mary thought that they had enough to endure at present without having to see their incapacitated father in a hospital bed with tubes down his throat and sticking out of his abdomen. But dad was not far from everybody’s thoughts. Ron soon had a large mail delivery, which consisted of get-well-soon cards from every boy and girl in his ten-year-old son’s class.

Meanwhile, Ron’s treatment continued with Ciprofloxacin, Zosyn, Zofran, and repeat dosages of morphine, which was available to Ron, in regulated amounts, at the touch of a button.

Until October 11, with a few minor bumps along the way, Ron progressed well. But that day, a Monday, Ron began to suffer greater pains in his abdomen than he had since surgery. Ron was wheeled to radiology that afternoon for another CT scan of his abdomen and pelvis. The exams showed increased fluid collection in Ron’s abdomen, most prominently in the paracolic gutter region in the lower left quadrant.

The next day, a drainage catheter was installed. In detail not meant for the squeamish, Ron recalls the process by which this drain, and others, was inserted. Beginning with the following caveat, “When [doctors] say they are sorry they have to hurt you as part of the treatment—they mean it,” he states:

The process of inserting a drain, at least in my case, was one of technology and brute force. It is done while lying on the movable platform of a CT machine. First, they run a CT scan to determine the best spot to drain the fluid. Then they prepare the area and push a wire through your side into the abdomen. The first time I had this done I think they went in 11cm. I think that’s a little more than 4 inches. With the wire inserted they run you through the CT machine again to make sure it’s properly placed. If it is in place they then push a larger tube over the wire until it is in place, run the CT again, and try to draw off as much fluid as they can. After that’s done they attach a collection bag that is Velcroed to your leg, and tape the tube to your side. I’ve never been stabbed by a knife or run-through with a sword but I think I can imagine the feeling. Unfortunately a couple of days later, while hauling myself out of bed, I snagged the tube and pulled it out.

In addition to the drain difficulties, Ron continued to suffer a variety of complications from his illness. He was confirmed with a Clostridium difficil infection around October 13, for which he was given another antibiotic called Flagyl. He also experienced a dramatic loss of appetite, which would plague him for months afterward. Fluid and gas continued to accumulate in the area of Ron’s bowel resection, requiring the placement of another catheter on October 15—another unwelcome, painful procedure.

Not all was pain and misery, however. The consensus amongst the doctors was that, under the circumstances, their patient had progressed well. Ron had, after all, had nearly twelve inches removed from his small intestine, and had lost one organ entirely, to say nothing of the gastrointestinal discomfort he suffered for two months prior to hospitalization. Also, Ron’s diarrhea had slowed significantly, and he felt far less fevered.

After nearly two weeks hospitalization, Ron was finally discharged on Saturday, October 16, 2004. The principal diagnosis was intra-abdominal abscess, and the principal procedures were noted to be “1. Exploratory laparotomy [] with a partial small bowel resection. 2. Antibiotic therapy. 3. CT-guided intra abdominal drain placement times two.” As for the resected portion of Ron’s small bowel, the pathology report concludes as follows: “Small bowel with subserosal abscess formation with extensive acute inflammation, acute serositis, fat necrosis, foreign body giant cell reaction and serosal adhesions.”
 

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An outbreak of Salmonella in Memphis Tennessee linked to a local bar-be-que restaurant has resulted in legal action.  A lawsuit was filed today in the Circuit Court for Shelby County, Tennessee against A&R Bar-be-que, LLC. The lawsuit was filed by Seattle foodborne illness law firm Marler Clark and by John Day of the Tennessee firm Day & Blair on behalf of a Memphis father and son.

As many as 20 llnesses reported to the Shelby County Health Department by customers of the A&R Bar-be-que restaurant at 3701 Hickory Hill Road prompted the Health Department to launch an investigation, which started on July 14. The restaurant closed voluntarily on July 25 and remains closed while the investigation continues.

On July 9, 2009, Eric Phillips Sr. purchased food at the Hickory Hill A&R Bar-be-que restaurant. He and his son consumed the food on July 9 and 10. On Friday, July 10, the 15-year-old began to feel ill and quite nauseous. His condition worsened over the weekend, and he was taken to the doctor on Tuesday. The family doctor gave instructions to keep the young man hydrated and he was sent home with the expectation that he would improve. However, his symptoms increased in severity and he experienced vomiting, nausea, and diarrhea over the next few days. On the following Monday, July 20, he was admitted to Le Bonheur Children’s Hospital,and diagnosed with Salmonella.

Meanwhile, Eric Phillips Sr. was experiencing similar symptoms over the same period of time. He was eventually admitted to Methodist Germantown Hospital in Memphis.Both father and son suffered acute kidney failure as a result of their Salmonella infections, requiring extensive medical treatment, including dialysis. They both remain in the hospital.

“The impact on this father and son—and family—will be life-long,” said the family’s attorney, Andy Weisbecker. “No one can change that, but what we can do is to make sure that they have a way to pay for the care they will need.”

Salmonella is a bacterium that causes one of the most common intestinal illnesses in the US: Salmonellosis. It can be present in uncooked or undercooked meat, poultry, eggs, or unpasteurized dairy products, as well as other foods contaminated during harvest, production, or packaging. Symptoms can begin 6 to 72 hours from consumption, and include diarrhea, abdominal cramps, fever, nausea, and/or vomiting.

 

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The United States Department of Agriculture's Food Safety and Inspection Service (FSIS) announced that King Soopers, Inc. of Denver, Colorado, was recalling 466,236 pounds of ground beef products due to potential Salmonella Typhimurim DT104 contamination yesterday.  The recall was initiated after public health officials from the Colorado Department of Public Health and Environment and the Centers for Disease Control and Prevention traced a Salmonella Typhimurim DT104 outbreak among Colorado residents to the ground beef products.

Salmonella Typhimurium DT104 is an antibiotic-resistant strain of Salmonella, which can prove to be problematic for physicians treating patients who have eaten the contaminated ground beef and have become ill with Salmonella infections. 

In her 1997 paper, "Emergence of a Highly Virulent Strain of Salmonella typhimurium," M. Ellin Doyle, Ph.D. at the Food Research Institute at the University of Wisconsin-Madison wrote:

Some evidence indicts the increased use of veterinary drugs as a factor in the dramatic increase in drug resistance. Resistance to ciprofloxacin in DT104 isolates has increased from 1% in 1994 to 6% in 1995, coincident with the licensing of this drug for veterinary use in the UK in 1994 (2). Resistance to trimethoprim (present in 27% of DT104 isolates) may have been acquired in response to the use of this drug to combat bovine infections with DT104 resistant to other drugs. Surveys of S. typhimurium isolates from cattle and humans in Australia (16), France (17), Hong Kong (18), and Spain (19) all reveal an increased incidence of resistance to multiple antibiotics in this organism.

As yet, there have been no reports of S. typhimurium DT104 in the USA, but the rapid rise of this organism in the UK warns us in the USA to be vigilant. Increasing resistance to so many different antibiotics makes it very difficult to treat severe cases of human salmonellosis.

By 2000, if not before, Salmonella Typhimurium DT104 had spread to the United States.  Researchers from the Department of Veterinary Microbiology and Pathology, Washington State University-Pullman published an article titled, "Multiresistant Salmonella Typhimurium DT104 infections of humans and domestic animals in the Pacific Northwest of the United States" after investigating a Salmonella Typhimurium DT104 outbreak among residents of the Pacific Northwest. 

In his testimony on food safety before the U.S. House Committee on Energy and Commerce last March, William K. Hubbard stated:

Those peanut butter, pepper and spinach examples are just a few of the breakdowns that have caused our citizens to question their leaders’ ability to carry out this most quintessential governmental function – the safety of commodities that are so necessary for a healthy society. Indeed, some argue that our food supply is becoming less safe despite the progress that has been made in science and medicine in recent decades. It is certainly clear that there are trends that cry out for intervention by the Congress, namely:

• New pathogens have emerged in foodstuffs, some unknown to science in years past, that are especially lethal when they contaminate our food. They have exotic names, such as Enterobacter sakazakii, E Coli 0157:H7, Listeria monocytogenes, Vibrio cholerae 0139, and Salmonella Typhimurium DT104, (emphasis added) but they all pose a significant threat of severe illness and death when our citizens contract them. And there is an expectation among scientists that yet more of these threats will be discovered in the future.

That Salmonella Typhimurium DT104 had not been identified as the source of an outbreak in the United States prior to 1997, and this "especially lethal" pathogen has been identified as the source of several outbreaks, including the current outbreak among Colorado residents, is alarming. 

The Colorado Salmonella Typhimurium DT104 outbreak should spark more conversation about HR 1549 - Preservation of Antibiotics for Medical Treatment Act of 2009, which aims to preserve the use of antibiotics in food animals strictly for therapeutic use.

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According to an article in the Bismarck Tribune, the North Dakota Department of Health is investigating a Salmonella outbreak among McLean County residents.  The apparent outbreak occurred last week, and sickened members of two groups who ate foods catered by the same unlicensed caterer.  Nine people were hospitalized, and approximately 40 people became ill after attending the two events - a family reunion in Wilton and a wedding in Washburn. 

Symptoms of Salmonella infection

include diarrhea, abdominal cramps, fever, nausea, and/or vomiting. In mild cases diarrhea may be non-bloody, occur several times per day, and not be very voluminous; in severe cases it may be frequent, bloody and/or mucoid, and of high volume.

Fever generally occurs in the 100°F to 102°F (38°C to 39°C) range. Vomiting is less common than diarrhea. Headaches, myalgias (muscle pain), and arthralgias (joint pain) are often reported as well. Whereas the diarrhea typically lasts 24 to 72 hours, patients often report fatigue and other nonspecific symptoms lasting 7 days or longer.

Salmonella infections usually resolve in five to seven days, and many times require no treatment unless the patient becomes severely dehydrated or the infection spreads from the intestines. Persons with severe diarrhea may require re-hydration, often with intravenous fluids.

Treatment with antibiotics is not usually necessary; however, if the infection spreads from the intestines, or otherwise persists, the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, ceftriaxone, amoxicillin, or ciprofloxacin. The length of treatment varies depending on the extent of a patient’s illness, and can range from 14 days for enteric fever to six weeks for bactremia (Mayo Clinic, 2007, April 12). Some Salmonella bacteria have become antibiotic-resistant.

Consult your healthcare provider if you believe you have become ill with salmonellosis.

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Good Lord, where do I start?  Well, to begin with, thank you to Mr. Orwig (picture left), Caudill Seed, and Jim Prevor, aka "the Perishable Pundit" (the latter thank you being entirely without my tongue in my cheek--I really do enjoy Jim's weekly emails) for a wealth of extremely valuable information.  What I'm referring to here is an interview that the Pundit had with Lyle Orwig, spokesman for Caudill Seed, who is now embroiled, despite any remonstrances to the contrary, in a public health nightmare--i.e. national Salmonella outbreak--linked to its alfalfa sprout seeds.  Read the interview here. 

There are lots of things to talk about, legal and otherwise, after reading the interview.  Much of it will have to wait for official discovery and trial, but I do want to highlight just a couple of things:

Pundit:  FDA says the preliminary epidemiology ties the alfalfa salmonella outbreak to Caudill seeds. What can you tell us?

Orwig:  The seeds have been implicated but there is no proof. While the seeds are said to be epidemiologically linked, FDA hasn’t been able to conclusively tie the source of the salmonella in the sprouts back to where it actually occurred. FDA would need an exact fingerprint serotype match, but it has no confirmed test.

From the seed company perspective, we encourage all sprouters to follow FDA food safety guidance. Back in ’99, they did all that work to establish best practices. If the seeds are treated with recommended soaking chemical and the sprouters do that and test and hold, we wouldn’t be talking about this problem now. Not everyone tests and holds.
 

The voice of reason (that's debatable):  I don't mean to tell anybody how to do their job.  That is for bosses, and I'm not there yet.  Mr. Orwig is a public relations guy who works for a prominent PR firm called Charleston Orwig.  Here is my one bit of advice for Mr. Orwig:  you do not do your business or, more importantly, your client's business any good by trying to obscure the issue.  I don't know, maybe it's a legitimate PR tactic to deny and then hedge, but the reality is that Caudill has been linked to a massive salmonella outbreak.  How do I know?  What do 228 people across the country who are sick with Salmonella Saintpaul have in common?  You guessed it.  I don't need a genetically matched sample from the grounds or product at Caudill Seed to convince a jury of that. 

Pundit:

Are food safety measures conducted at the seed level? Does the seed company hold some responsibility here? On your website, it says all of the alfalfa sprouting seed provided by Caudill has been tested for germination, purity and absence of salmonella and E coli. How does that work?

Orwig:

We sell a raw agricultural product. What that means is that the alfalfa seed is either put into the ground to grow, or the sprouter will use it to produce edible product. It can be the same seed. Part of the seed industry law, in and of itself, is that when we sell, there’s a seed tag that shows what the germination is of that bag of seed, as well as the purity and process it has gone through. This is part of the federal law we follow that has to go on every bag we send out. When we buy seed, it’s sorted, tested and bagged and when it’s bagged and the tag goes on it, we’ve followed our legal duty. Then it’s the sprouter’s responsibility.
 

The voice of reason (highly debatable):  Mr. Orwig gives yet another example of the attitude that, in my view, is responsible for many, many of the foodborne illnesses that occur in this country every year.  Essentially what he's saying is, "our responsibility for food safety begins when the seeds come through our doors, and our responsibility ends when the seeds leave."  Is bullshit too strong a word here?  I don't care about FDA guidance, if any, on this issue.  Caudill, you and every other food manufacturer in the country has a continuing obligation to protect the people you profit from--i.e. consumers--before you receive your product and after you sell it.  This means, at a minimum, knowing the companies you do business with, and knowing all intended uses.  It also means TAKING ADEQUATE STEPS TO PROTECT THE CONSUMERS WHEN YOU KNOW, OR HAVE REASON TO KNOW, THAT A PROBLEM EXISTS.  See my post yesterday about recalls and market withdrawals.  I guess the good thing in this kind of attitude is that it will keep us in business.  I don't know how this helps consumers of your products though.

Pundit: To what degree, if any, do you have control over the growers and the conditions under which product will be grown? Are you using any preventive measures to insure good agricultural practices are being followed? Do you test specific fields and conduct regular audits?

Orwig:  We do inspections, but I can’t tell you how often. We don’t do audits.

Just a guy from Seattle:  Ummmm . . . see my last comment above.

Pundit:  Have you conducted inspections of the farms connected to this seed lot in Italy?

Orwig:  We have not yet visited the production area in Italy associated with this problem; that was planned for this month, but will not happen now because of the time commitment to this issue.
 

My creativity is spent:  That's convenient.  In addition, dare I say . . . see my last two comments???

 

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I'm doing my best to find any reference to a recall of the seeds implicated by the FDA and CDC in the recent Salmonella Saintpaul outbreak, which is now responsible for at least 228 illnesses in 13 states.  I can't find any action by Caudill Seed taken to actually recall the product.  I'm not talking about a market withdrawal, or any other less-than-serious effort to obscure the reality of this very significant public health nightmare.  I'm talking about a recall . . . something that is supposed to voluntarily happen when a company (Caudill Seed) sells a product (alfalfa sprout seeds) that pose a significant public health risk (228 illnesses and counting). 

Maybe the answer from Caudill Seed would be "well, we issued a market withdrawal."  Here's how the FDA defines "market withdrawal:"  "occurs when a product has a minor violation that would not be subject to FDA legal action. The firm removes the product from the market or corrects the violation. For example, a product removed from the market due to tampering, without evidence of manufacturing or distribution problems, would be a market withdrawal."

By comparison, the FDA defines a Class I Recalls as follows:  "a situation in which there is a reasonable probability that the use of or exposure to a violative product will cause serious adverse health consequences or death."

This is not a market withdrawal situation.  There are 228 confirmed illnesses in 13 states.    These are human beings who have been exposed to something that can kill them.  

Moreover, I've done some research to find out that alfalfa sprout seeds have an extremely long "shelf-life"--we're talking years--the significance of which fact needs very little explanation here.  If Caudill Seed doesn't act quickly and, this time, with resolute action that is not done for purely PR purposes, but to actually PREVENT THE FURTHER SPREAD OF DISEASE, we may be having this same discussion for months.  A Class I Recall was, and remains, warranted. 

It is actions like this--which amount to little more than veneers of concern by foodmanufacturers--that keep Marler Clark in business.   

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By the end of this year, I hope to have more devoted readers than there are sprout outbreaks and recalls.  As I sit here today, it's pretty much neck and neck, and I'll be honest, my competition is relentless.  See my earlier post (TODAY!!!) on the ongoing Salmonella outbreak in Michigan .  And this just in:  The California Department of Health warns consumers not to eat Los Angeles Calco, Inc. brand alfalfa sprout products "because the products may be contaminated with Salmonella."  

What a shocker.  Salmonella and sprouts; sprouts and Salmonella.  Though there are not yet any illnesses known to be linked to Calco, Inc's products, we must wait for the public health folks in California, who are no strangers to outbreaks associated with raw produce, to connect all the dots.  We'll see what tomorrow brings.   

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Public health officials in South Dakota have confirmed 22 cases of Salmonella Newport that is similar to a strain of Salmonella Newport that has been identified as causing illness among residents of four other states.  An outbreak investigation is under way to determine whether victims of the outbreak ate the same food, but so far investigators have not been able to pinpoint the source of the outbreak. 

Genetic "fingerprinting" of the Salmonella strain isolated from victims' stool has helped public health agencies in the five states and at the Centers for Disease Control and Prevention (CDC) in their investigation.  The process of obtaining the DNA fingerprint is called Pulse Field Gel Electrophoresis, or PFGE. This technique is used to separate the DNA of the bacterial isolate into its component parts. It operates by causing alternating electric fields to run the DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments — or “fingerprints” — in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of E. coli O157:H7 as well as strains of listeria and campylobacter, and other pathogenic bacteria.  The PFGE pattern of the bacteria can then be compared and matched up to the PFGE pattern of the strain of infected persons who consumed the contaminated product. When PFGE patterns match, they, along with solid epidemiological work, are proof that the contaminated product was the source of a person's illness.

The Rapid City Journal reported on the outbreak today:

So far, health officials have confirmed 22 cases of a specific strain of the bacterial-borne intestinal disorder in the four states. All of South Dakota's 11 cases -- nine adults and two children -- were in the Black Hills area. Six of the 11 victims were hospitalized, five at Rapid City Regional Hospital.

"Everybody's recovering," state epidemiologist Lon Kightlinger of the South Dakota Department of Health in Pierre said Monday. "But since we've had so many of these cases hospitalized, which is fairly unusual, it leads me to believe it is a fairly potent strain."

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Over three dozen people in Arizona, California, Idaho, and Nevada have become ill with a strain of Salmonella since early October, according to reports in the Tucson Citizen and Arizona Republic.  Public health officials from the four states are investigating the source of the outbreak, and presently believe the source to be a food item. 

The Tucson Citizen reported on the outbreak:

Though salmonella outbreaks are not unusual, authorities are trying to identify a common source. A store chain, but likely not a restaurant, may have distributed a food product that hospitalized a dozen people — seven from Arizona — said Shoana Anderson, an infectious disease epidemiologist in Phoenix.

Arizona had 14 cases in all, California 18, Nevada three and Idaho one, Anderson and food-borne disease epidemiologist Joli Weiss said. The illnesses were reported between between Oct. 4 and Nov. 9 and all involved the same strain of the disease.

According to the Centers for Disease Control and Prevention, most people infected with Salmonella develop diarrhea, fever, and abdominal cramps 12–72 hours after infection. Infection is usually diagnosed by culture of a stool sample. The illness usually lasts 4 – 7 days. Although most people recover without treatment, severe infections may occur. Infants, elderly persons, and people with impaired immune systems are more likely than others to develop severe illness. In severe infection, Salmonella spreads from the intestines to the bloodstream and then to other body sites, and death can occur if the person is not treated promptly with antibiotics.

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Quiznos is back open for business after ten confirmed cases of salmonella shut it down. Officials were able to zero in on that particular Quiznos because the bacteria in each case matched.

The state health department inspected the restaurant on Wednesday.

Officials say the bacteria could have come from a contaminated product or possibly from an employee handling the food.

 

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A Minnesota couple is suing Omaha-based ConAgra Foods for the salmonella outbreak that allegedly made their 19-month-old daughter sick. 

Amy and Joshua Reinert took their daughter Isabelle to the emergency room in August when she had a seizure and lost consciousness. Reinert said her daughter continued to have diarrhea for nearly six weeks. 

It’s the first federal lawsuit stemming this week’s announcement to pull ConAgra’s Banquet and generic pot pies from the shelves due to a potential salmonella contamination.

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The ConAgra plant that produces the company's Banquet pot pies was closed yesterday among concerns of Salmonella contamination in Banquet chicken pot pies that had been manufactured in the plant.  The Associated Press reported on the closure today:

ConAgra Foods Inc. voluntarily stopped production Tuesday at the Missouri plant that makes its Banquet pot pies after health officials said the pies may be linked to 139 cases of salmonella in 30 states.

ConAgra officials believe the company's pies are safe if they're cooked properly, but the Omaha-based company told consumers Tuesday not to eat its pot pies until the government and company investigations are complete.

The U.S. Department of Agriculture also issued a health alert Tuesday afternoon to warn consumers about the link between the company's product and the salmonella cases.

The federal Centers for Disease Control and Prevention has been tracking reports of the salmonella cases since Wednesday. A CDC spokeswoman said the largest numbers of salmonella cases had been reported in Wisconsin, Pennsylvania and Missouri. 

The Centers for Disease Control and Prevention (CDC) issued a statement about the pot pie Salmonella outbreak, encouraging consumers to avoid any ConAgra-brand pot pies with a code of P-9, since they were produced in the same facility as the Banquet pot pies.

At this time, CDC recommends that people do not eat any Banquet pot pies or pot pies made by ConAgra Foods that have a printed code ending in “P9.” Other brands of pot pies made in the ConAgra Foods factory that makes Banquet brand pot pies and sold under other brand names may also be contaminated with Salmonella. These other pot pie boxes also have a printed code ending in “P9”. If you have any of these products at home, the safest thing to do is to discard them.

This information conflicts with what ConAgra has been telling the public, maintaining that if the pot pies are cooked properly they will be safe for human consumption.  The AP article stated included a few sentences on ConAgra's take on the outbreak:

[ConAgra spokeswoman Stephanie] Childs said ConAgra is confident in the safety of its chicken and turkey pot pies when all the cooking instructions on the package are followed. It is especially important to follow the directions when the pies are cooked in a microwave."

And on the International Food Safety Network's Barf Blog, Dr. Doug Powell wrote his family's experience with purchasing ConAgra-brand Banquet chicken pot pies and their attempt to get proper cooking information from ConAgra:

So Amy and I went to the local supermarket after dinner. We found the products in question, with the P-9 on the side, and on sale, 2-for-$1.

I called the number suggested by ConAgra (see above). After listening to a recorded message, I spoke with a human, who wanted to know my name, zip code, state, and when she got to address, I said, I just want to know how to properly cook these in the microwave, cause the press release says they're safe if cooked properly.

The human hung up.

Amy and I then examined the ingredient list, which included cooked chicken, and mechanically deboned chicken -- but did not specify whether the meat was coked or not. So maybe there is raw poultry in the pot pies, which could be a source of salmonella, or maybe it's all cooked but there was a failure in reaching 165F. Don't know at this point.

With the CDC reporting at least 139 cases of Salmonella epidemiologically linked to the ConAgra outbreak in 30 states - and that number growing - more information certainly will be available for Dr. Powell and others concerned about food safety very soon.

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Idaho health officials are warning that a Salmonella outbreak in southern Idaho has been ongoing since mid-September.  KTRV TV reported on the outbreak:

A number of Salmonella infections have been reported across southern Idaho since mid September.

Experts at the Idaho Health and Welfare Department believe they could be linked to undercooked chicken pot pies.

Residents are being warned to follow cooking instructions carefully -- since some frozen convenience foods are not pre-cooked.

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The Reno Gazette-Journal's Jason Hidalgo reported on the reopen of Jazmine, a restaurant that was recently identified as the source of a Salmonella outbreak, yesterday - the same day that the International Food Safety Network came out with an infosheet about the outbreak.  From the Gazette-Journal article:

Jazmine was ordered closed by the Washoe County District health Department on Aug. 23 after it tested positive for salmonella. The restaurant, which serves up popular Asian fare such as pot stickers, dim sum dumplings, pork ribs and sushi, re-opened its doors for dinner on Aug. 29. The restaurant could have opened two days earlier but had to wait for most of its employees to get approved to return to work.

Despite receiving a clean bill of health to operate again, the restaurant is still struggling to get back customers who have stayed away following the incident.
“Business has dropped tremendously,” said manager and co-owner David Tran. “We’ve lost more than half of our business right now.”

The health department hasn’t been able to trace the source of the outbreak to any particular food in the restaurant. That makes it likely that the source of the outbreak was an infected food handler, said Randall Todd, director of epidemiology at the district health department.

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During 2005--2006, four large multistate outbreaks of Salmonella infections associated with eating raw tomatoes at restaurants occurred in the United States. The four outbreaks resulted in 459 culture-confirmed cases of salmonellosis in 21 states (Figure). This report describes the epidemiologic, environmental, and laboratory investigations into these four outbreaks by state and local health departments, national food safety agencies, and CDC. The results of these investigations determined that the tomatoes had been supplied to restaurants either whole or precut from tomato fields in Florida, Ohio, and Virginia. These recurrent, large, multistate outbreaks emphasize the need to prevent Salmonella contamination of tomatoes early in the production and packing process. Current knowledge of mechanisms for tomato contamination and methods of eradication of Salmonella in tomatoes is incomplete; the agricultural industry, food safety agencies, and public health agencies should make tomato-safety research a priority.

Salmonella Newport: Multiple States, July--November 2005

A total of 72 culture-confirmed S. Newport isolates with indistinguishable pulsed-field gel electrophoresis (PFGE) patterns (PulseNet XbaI pattern JJPX01.0061 [/ BlnI pattern JJPX01.0021]) were identified from stool specimens collected during July--November 2005 in 16 states (Delaware, Illinois, Maine, Maryland, Massachusetts, Missouri, New Hampshire, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Tennessee, Vermont, Virginia, and Wisconsin) (1). Median patient age was 29 years (range: <1--75 years); 42 (58%) patients were female. Eight (11%) patients were hospitalized, and no deaths were reported.

Investigators determined that the implicated tomatoes were grown on two farms on the eastern shore of Virginia. The outbreak strain of S. Newport was isolated from irrigation pond water near tomato fields in this region in October 2005. This region also had been the source of tomatoes for a multistate outbreak of S. Newport infections in 2002 (1); strains from both outbreaks had the same PFGE pattern.

Salmonella Braenderup: Multiple States, November--December 2005

A total of 82 culture-confirmed S. Braenderup isolates with indistinguishable PFGE patterns (PulseNet XbaI pattern JBPX01.0050 [/ BlnI pattern JBPA26.0004]) were identified in eight states (Illinois, Indiana, Kentucky, Massachusetts, Michigan, Ohio, Pennsylvania, and West Virginia) during November--December 2005. Median patient age was 34 years (range: 6--78 years); 51 (67%) patients were female. Eighteen (35%) patients were hospitalized, and no deaths were reported.

The implicated tomatoes had been grown in one of two tomato fields in Florida and were prediced and packaged at a firm in Kentucky before being shipped to chain restaurant A. The environmental investigation revealed that multiple potential animal reservoirs of Salmonella (e.g., cattle, wild pigs, wild birds, amphibians, and reptiles) were present in and adjacent to the drainage ditches. Environmental samples from the farm, including drainage ditch water and animal feces from around the tomato fields, yielded Salmonella of different serotypes than the outbreak strain.

Salmonella Newport: Multiple States, July--November 2006

A total of 115 culture-confirmed S. Newport isolates with indistinguishable PFGE patterns (PulseNet XbaI pattern JJPX01.0061 [/ BlnI pattern JJPX01.0021]) were identified from stool specimens provided during July--November 2006 in 19 states (Colorado, Connecticut, Delaware, Georgia, Illinois, Kentucky, Maine, Massachusetts, Maryland, Michigan, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Virginia, and Washington). The PFGE pattern was identical to the pattern observed during the 2005 S. Newport outbreak. Median patient age was 28 years (range: <1 month--86 years); 54 (50%) patients were female. Eight (32%) patients were hospitalized, and no deaths were reported.

Salmonella Typhimurium: Multiple States and Canada, September--October 2006

A total of 190 culture-confirmed S. Typhimurium isolates with indistinguishable PFGE patterns (PulseNet XbaI pattern JPXX01.0604 [/ BlnI pattern JPXA26.0174]) were identified during September--October 2006 in 21 states (Arkansas, Connecticut, Georgia, Indiana, Kentucky, Maine, Massachusetts, Michigan, Minnesota, Nebraska, New Hampshire, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, Tennessee, Vermont, Virginia, Washington, and Wisconsin). The median age of patients was 34 years (range: 2--88 years); 112 (58%) patients were female. Twenty-four (22%) patients were hospitalized, and no deaths were reported.

Implicated tomatoes were traced to a single packinghouse in Ohio supplied by three tomato growers from 25 fields in three counties. Tomato production had ended by the time the packinghouse was implicated. As a result, FDA deferred the investigation until the next growing season and completed the investigation in August.

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Pennsylvania health officials are investigating a Salmonella outbreak that may have been caused by close contact with dogs that ate Salmonella-contaminated food.  Lancaster online reported today:

The illness being investigated by the health department is caused by an uncommon strain of salmonella called schwarzengrund. Most of the infections occurred in households with pets or where people are in close contact with pets, but there is no evidence any human consumed pet food.

"While the department is working very closely with federal investigators to identify a specific cause and source for these illnesses, it is important that pet owners understand and follow steps to prevent salmonella infection from occurring," state Health Secretary Dr. Calvin B. Johnson said.

Newsinferno also covered the story:

The Pennsylvania Department of Health said that it is working in conjunction with the Food and Drug Administration to determine the source of the Salmonella poisoning. There are usually around 2,000 cases of Salmonella in Pennsylvania each year. The Pennsylvania outbreak is only the latest bout of Salmonella poisoning to make news recently. In February, more than 600 people were sickened by Salmonella-tainted Peter Pan and Good Value brand peanut butters. This summer, another outbreak that sickened nearly 100 people was traced to seasoning used on Veggie Booty snack mix. And in July, over 700 people in the Chicago area became ill from Salmonella after they ate at the Pars Cove Restaurant food booth at the Taste of Chicago Food Festival.

The Pennsylvania Department of Health issued recommendations for purchasing and properly handling dry dog food in a press release that also contained information about the outbreak:

Since January 2006, Pennsylvania has identified 21 individuals with illness caused by a specific strain of Salmonella serotype Schwarzengrund. Many of the illnesses linked to this strain involve infants and young children, who are especially vulnerable to Salmonella infections. Most of the cases have occurred in households with pets or where people are in close contact with pets, but there is no evidence that any human consumed pet food.

“While the department is working very closely with federal investigators to identify a specific cause and source for these illnesses, it is important that pet owners understand and follow steps to prevent Salmonella infection from occurring,” Dr. Johnson said.

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The City of Chicago Department of Public Health (CDPH) issued an update on the number of Salmonella illnesses the department is investigating in connection to a Salmonella outbreak at the Pars Cove Persian Cuisine booth at the Taste of Chicago festival.  CDPH announced that as of noon today, 717 people have reported illness they believe to be associated with the consumption of food purchased from the Pars Cove booth.  Of those reporting illness, 116 have been confirmed ill with Salmonellosis through laboratory testing.  78 have been confirmed ill with Salmonella Heidelberg, the outbreak strain.  CDPH reported that 31 people are known to have been hospitalized with Salmonella infections after visiting the Taste of Chicago festival.

The Taste of Chicago Salmonella outbreak is believed to have been caused by contaminated hummus shirazi, a fresh herb tomato cucumber salad over a bed of hummus, -- the only dish served at the Pars Cove booth that was associated with illness. CDPH had yet to determine whether the hummus dish was contaminated by an ill food worker, or if a food ingredient was the source of contamination.

CDPH has stressed in all public announcements that this is the first foodborne illness outbreak associated with Taste of Chicago in at least 20 years.  This week's Food Safety Infosheet from the International Food Safety Network stresses how challenging food safety can become at a festival such as Taste of Chicago:

Festivals provide great food experiences but because they are temporary sites, food preparation, storage and transport can be problematic. What you need to worry about in a kitchen at a festival:

• Temperature control
• Cross-contamination
• Personal Hygiene
• Acquiring food from safe sources

This outbreak highlights that food safety problems happen, even if many inspectors are around -- what matters most is what happens when inspectors aren’t there.

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From Chicago Tribune staff report:

More than 500 people have reported digestive problems after eating at the Pars Cove Persian Cuisine booth at Taste of Chicago, Health Department officials said this afternoon.  As of noon today, 529 people had called claiming symptoms of salmonella poisoning, according to a news release.  Fifty cases have been confirmed as salmonellosis. Of the 50, 36 have been identified as salmonella heidelberg, one of the more common forms of salmonella poisoning in the United States, the release said.  Seventeen people have been hospitalized.

You can keep up to date on the Pars Cove/Taste of Chicago Salmonella outbreak on the Marler Clark Web site.

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Grant County, Washington, health officials have reported that a Salmonella outbreak in the county has sickened 11 people since February.  Seven people have been confirmed ill with Salmonella senftenberg since the outbreak began, and four possible cases have submitted samples for testing. 

The Columbia Basin Herald interviewed Grant County health officer Alexander Brzezny for its story on the outbreak:

In the past three weeks the cases in Grant County have been connected through DNA as all being from the same bug, Brzezny said. The health district has several leads on the origin, he said.

"If we find out where it's coming from, I think it's going to be very publishable data because it's rare and it's in Grant County," he said.

Senftenberg salmonella was only discovered in the 1990s, Brzezny noted.

He said the cases in Grant County seem to be isolated and not part of a broad, countywide outbreak.

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KOTV.com and the Chicago Tribune reported that the number of food poisoning cases tied to the Taste of Chicago event had increased to 378 on Friday.  At least 12 people were hospitalized with Salmonella infections after eating at the Pars Cove booth at Taste.  Testing is still being conducted to help health officials determine the extent of the Salmonella outbreak.  According to KOTV:

The only dish connected to the outbreak was an herb tomato cucumber salad that was served on hummus, health officials said. All the reports of sickness came from people who ate at the booth run by Pars Cove Persian Cuisine.

The health department ordered Pars Cove to stop serving hummus at its restaurant until further notice as a precaution. The restaurant's management was cooperating fully in the health department's investigation, officials said.

The Chicago Tribune reported that 38 people had been confirmed ill with Salmonella, and quoted Chicago Commissioner of Public Health, Terry Mason, who said, "The hummus shirazi is implicated -- at least that's one thing that we know now, but the investigation is not complete."

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Andrew Bridges with the Associated Press continued coverage of the Salmonella outbreak traced to Veggie Booty yesterday with a story on the suspected source of the Salmonella in the Veggie Booty.

A New Jersey spice importer supplied the salmonella-contaminated seasoning used on snack food that has sickened 60 people, most of them infants and toddlers, the company recalling the snacks said Thursday.

Robert's American Gourmet Inc. purchased the seasoning from Atlantic Quality Spice & Seasonings, said Robert Ehrlich, president and chief executive of the snack food company. The Sea Cliff, N.Y., company has recalled its Super Veggie Tings Crunchy Corn Sticks and Veggie Booty snack foods, both of which used the spray-on seasoning.

The Centers for Disease Control and Prevention issued an update on its investigation into a Salmonella outbreak traced to Veggie Booty, a snack food popular with infants and toddlers, on July 10.  CDC stated in part:

As of July 10 at 11AM ET, 60 persons infected with Salmonella Wandsworth have been reported to CDC from 19 states: California, Colorado, Connecticut, Georgia, Illinois, Indiana, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Oregon, Pennsylvania, Tennessee, Texas, Vermont, Virginia, Washington, Wisconsin. Among the patients for whom clinical information is available, 77% developed bloody diarrhea and 10% were hospitalized. No deaths have been attributed to this infection. Onset dates, which are known for 58 patients, ranged from March 4, 2007 to June 15, 2007. Most (90%) of cases have occurred in children aged 10 months to 3 years. During the initial phase of the outbreak, the number of cases gradually increased, with only 8 cases reported from 6 states before May 1, 2007. Health department and CDC investigators worked for weeks conducting interviews with parents of ill children to develop theories about possible sources of infection.

A multi-state case-control study demonstrated a strong association between illness and consumption of Veggie Booty, a snack of puffed rice and corn with a vegetable coating. CDC OutbreakNet staff shared this information with colleagues at the Food and Drug Administration (FDA) on June 27. After being informed about the outbreak by FDA, the company that manufactures the product issued a voluntary recall on June 28. None of the 60 known illnesses from Salmonella Wandsworth had onset after the product recall date. Persons are advised to discard any product in their possession.

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At least 17 people became ill with Salmonella infections after visiting a particular booth at the Taste of Chicago festival, held last weekend.  The Pars Cove Perisian Cuisine booth at Taste was the common denominator among victims of a Salmonella outbreak that sent at least three people to the hospital, according to the Chicago Tribune.

City of Chicago health department workers are investigating what is believed to be the first food poisoning outbreak traced to food served at the festival in 20 years.  Foods eaten at the Pars Cove booth included cucumber hummus and pomegranate chicken.

In a story for the Chicago Tribune, Emma Graves Fitsimmons and Robert Mitchum reported on the Salmonella outbreak:

In recent days, state labs have confirmed nine cases of stomach illness caused by the Heidelberg strain of salmonella. The number of victims could increase as doctors report patients with salmonella and more serotyping and interviews are completed, she said.

As news of the salmonella outbreak spread Wednesday, the Persian restaurant at 435 W. Diversey Pkwy. was still open for business. Health officials inspected Pars Cove the last two days and tested stool samples from workers for the bacteria.

The inspectors this week found several violations at the restaurant, including unsanitary conditions, improper refrigeration and mouse droppings, said Frances Guichard, director of food protection for the Chicago Department of Public Health. The eatery, which has no record of major problems with the department, was fined $250 for the rodent issues, she said.

The reporters noted that the City of Chicago sent four health department inspectors to visit each Taste of Chicago booth at least four times a day and that at one point during this year's event, inspectors threw out food from the booth in question.

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The Food and Drug Administration (FDA) announced today that Robert's American Gourmet Food, Inc. is recalling all Veggie Booty Snack Food for potential Salmonella contamination.  The recall announcement was made after the Centers for Disease Control and Prevention identified 51 people in 17 states with Salmonella infections that were traced to the consumption of Veggie Booty.  According to the FDA announcement, the victims of the Salmonella outbreak are predominantly children three years of age or younger.

Veggie Booty was distributed nationwide and in Canada in supermarkets, vending machines, health food stores, and through online and telephone orders.  The product was sold in 4 oz., 1 oz., and 1/2 oz. bags. 

Marler Clark has represented thousands of victims of Salmonella outbreaks, and is investigating claims that may be related to the Salmonella outbreak traced to Veggie Booty.

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FDA announced today that it was introducing a multi-year tomato safety initiative to reduce the number of foodborne illnesses traced to tomato consumption in the United States.  The initiative comes on the heels of two Salmonella outbreaks traced to tomatoes last summer and fall.

In a press release announcing the initiative, FDA stated:

The initiative, part of FDA’s Produce Safety Action Plan, is a collaborative effort between FDA and state health and agriculture departments in Florida and Virginia. Several universities and members of the produce industry also are part of the effort. It will begin during this year’s growing season for Virginia in the summer and for Florida in the fall.

During the past decade, the consumption of fresh and fresh-cut tomatoes has been linked to 12 different outbreaks of foodborne illness in the United States. Those outbreaks include 1,840 confirmed cases of illness. The majority of these outbreaks have been traced to products from Florida and the eastern shore of Virginia; however, tomato-associated outbreaks also have been traced to tomatoes from California, Georgia, Ohio, and South Carolina. The effort will include identifying practices or conditions that potentially lead to product contamination, which will allow FDA to continue to improve its guidance and policy on tomato safety. The initiative will evaluate the need for additional produce safety research, education, and outreach.

FDA also said that the Tomato Safety Initiative will go hand in hand with the Leafy Greens Initiative, which was launched in 2006.

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Josh Funk reported for the Associated Press on the CDC's latest update on the number of people confirmed ill with Salmonella infections after eating contaminated Peter Pan and Great Value peanut butter produced by ConAgra:

The number of people sickened since August by peanut butter tainted with salmonella has grown by more than 200, according to a new federal report.

The outbreak, first reported in February, now includes 628 cases in 47 states, the Centers for Disease Control and Prevention said Thursday. It is the first update on the number of cases linked to the outbreak since early March, when officials said 425 cases had been confirmed in 44 states.

ConAgra Foods Inc. recalled all its peanut butter after government investigators linked the bacteria outbreak to the Omaha-based company's Peter Pan and Great Value peanut butter.

Thousands of people became ill with symptoms of Salmonella infections after eating the peanut butter, but did not seek medical treatment, or were never confirmed as being part of the outbreak through laboratory testing.  Marler Clark has been contacted by nearly 5,000 people who were part of the outbreak.

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Racine County health officials are investigating what appears to be a Salmonella outbreak among residents of Racine County.  At least 20 people have been laboratory-confirmed as suffering from Salmonella infections, and it is possible that more cases exist, but that not all people who became ill with Salmonella as part of the outbreak have been diagnosed.  According to an article in the Racine Journal Times:

"The health departments are looking into all reports of illness and all possible sources of acquisition," [health officer Margaret] Gesner said.

The health departments were interviewing affected people to find any potential links, such as an event everyone attended, which would help track down a cause, Gesner said. The health departments were first made aware of a possible outbreak on approximately May 7 when All Saints notified the health department of an increase in Salmonella cases, she said.

Based on current data, it's possible the outbreak has already ended, Gesner said. But she cautioned that could change.

The onset of symptoms in currently reported cases range from May 2 to May 8, Gesner said. People exposed to salmonella can experience an incubation period of up to 72 hours before symptoms appear. Build in time before a person goes to the doctor and time for laboratory testing and it appears no new cases are emerging.

Health officials are also investigating the possibility of whether Salmonella cases in Waushara, Milwaukee, and Kenosha Counies could be connected to the outbreak.

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The bands My Chemical Romance and Muse were forced to cancel recent concerts when band and crew members became ill with food poisoning.  Health officials investigating the incident conducted testing and determined that members were suffering from Salmonella poisoning.  The investigation ultimately led to the determination that the Salmonella outbreak source was the Green Leafe Cafe in Williamsburg, Virginia. 

According to a story at WDBJ7:

Peninsula Health Department officials are focusing their investigation on people who ate food from Williamsburg's Green Leafe Cafe over the weekend of April 27th through the 29th. They've confirmed that the culprit is salmonella bacteria.

Members and crew of the two bands got sick after performing April 28th at the College of William and Mary. Members of a private wedding party and a William and Mary a cappella singing group also got sick.

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Salmonella outbreaks in Kane County, Illinois, and Cochise County, Arizona, are perplexing health officials, who are trying to trace the outbreaks to their sources.  The Courier News reported on the Kane County outbreak:

Health department officials are working to create awareness of this specific form of salmonella. They also are attempting to identify the cause, but it has proven ultra-difficult, given that the cases have been widespread -- eight were reported in Aurora and seven more in the Elgin/Carpentersville area.Of the 15 cases, six were reported to the health department in December.

"We're seeing it at both ends of the county," said Claire Dobbins, the county's director of preparedness and communicable disease control. "If we create awareness, our mission becomes twofold: We could possibly prevent future infection by taking proper food-safety precautions, and if someone seeks medical attention it might help us locate the source.

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The Beacon News is reporting that Kane County is continuing its investigation into a Salmonella outbreak that began at the end of 2006 and has extended into 2007.  From the report:

Though salmonella does not discriminate by race or gender, infants and elderly people are more likely to contract the disease, said Maria Montero, manager of infection prevention at Rush-Copley Medical Center in Aurora. In Illinois, between 1,500 and 2,500 cases of the foodborne illness are reported each year.

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A Salmonella outbreak in Sierra Vista, Arizona, has sickened at least 47 people since September 1, 2006.  Local and state health officials have been unable to identify the source of the ongoing outbreak, which sickened two more people at a daycare last week.  Investigators from the Centers for Disease Control and Prevention have joined the investigation, but have not yet determined the source.  According to an article from the Sierra Vista Herald:

The CDC team, along with state and local health officials, will be looking at a possible connection between the two confirmed children on Fort Huachuca and cases in the Sierra Vista area, Garner said. In addition, the CDC will be looking at food preparation throughout the installation, just as they are investigating food handling practices in restaurants throughout the Sierra Vista area. The CDC is here to offer its expertise, while allowing local health officials to take the lead in the investigation.

Salmonella is a bacterial infection that is typically acquired by eating infected food sources. It is also acquired through infected water sources, close contact with infected individuals and from handling animals, especially reptiles.

Health officials are continuing to urge all community members to practice good hygiene by washing hands thoroughly, especially after using the bathroom, changing soiled diapers and handling raw meats. To prevent cross-contamination of raw meat, clean hands and surfaces before handling other foods.

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Kelli Hernandez of the Valdosta Daily Times reported last week on the salmonella illnesses tied to the Arby's in Lowndes County.  Full story link is here - 72 cases of Salmonella infection found in Lowndes County.

The Georgia Public Health Laboratory (GPHL) contacted the Notifiable Diseases Epidemiology Section (NDES) of the South Georgia Health District (SGHD) that the lab had received eight Salmonella Montevideo isolates from South Georgia Medical Center between Aug. 28 to Sept. 5, according to a report filed by the Department of Human Resources Division of Public Health.

The report released last week found that "the fast food restaurant Arby’s was considered a possible source for the outbreak."  In fact, 10 swab samples were taken from surfaces in the restaurant and delivered to GPHL and tested for Salmonella.  One of the salmonella positive samples the investigators found was on a meat slicer.  The restaurant had been closed for remodeling and reopened on Aug. 18, 2006, and was utilizing a brand new meat slicer following the reopening.

Nineteen days after the restaurant was identified as the possible source of the outbreak, on Oct. 25, GPHL reported that one of the swab samples collected from the new meat slicer was positive for the Salmonella outbreak strain and the slicer was immediately removed from service.

Thirty-one additional samples were taken from the restaurant that same day. Though the new slicer had been cleaned and sanitized, Salmonella was still detected on the blade cover.

The report’s discussion concluded that though the initial cause of the salmonella was not discovered, salmonella persisted between the blade cover and handle due to lack of a seal in spite of frequent cleaning just after the restaurant reopened.

I find it a bit odd that after 72 people reported ill, and multiple positive salmonella samples, that the restaurant was not shut down. 

I also find it a bit odd that Arby's has made no public statements nor offered to pay the ill customers' medical expenses and lost wages.  Well, that is why salmonella litigation seems necessary. 

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Fox News reports that contaminated fresh tomatoes served in restaurants were the cause of a recent salmonella outbreak that sickened dozens of people in 21 states, health officials said Friday.

The outbreak, now over, sickened at least 183 people, according to the Centers for Disease Control and Prevention. There were no reports of deaths, although 22 people were hospitalized. Interviews with victims, including detailed surveys of what they had eaten and where before falling sick, led investigators to suspect restaurant tomatoes as the cause.

"We have identified tomatoes eaten in restaurants as the cause of this outbreak. We don't have any information that a name or a certain type of restaurant is involved. As far as we can tell, it's across the board,"said Dr. Christopher Braden, a foodborne outbreak and surveillance expert with the CDC.

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The Centers for Disease Control and Prevention (CDC), in collaboration with state departments of health and the Food and Drug Administration (FDA), is investigating an outbreak of infections caused by a type of Salmonella called Salmonella typhimurium. This infection has no relationship to typhoid fever, which is caused by another organism.

Salmonella typhimurium typically causes an illness with fever and non-bloody diarrhea which commonly resolves after about one week. This illness is different from that caused by E. coli O157:H7, which produces bloody diarrhea, severe cramps, and in some persons, severe kidney disease.

PulseNet, the network of public health laboratories that performs molecular subtyping (“DNA fingerprinting”) on bacteria that cause foodborne illnesses, has identified a specific strain of Salmonella typhimurium that has caused this outbreak. Cases caused by the specific strain have been detected regularly at low frequency (average , 86 cases per year) for the past 5 years, indicating the presence of this strain at low levels in the environment and the food chain.

The outbreak has involved 171 cases of infection by this strain in 19 states reported since September 1, 2006. The median age of patients is 36 years, and 59% are female. As with most infections caused by Salmonella , most patients had a febrile diarrheal illness. Of 73 patients for whom clinical data has been reported, 14 (19%) were hospitalized; there have been no deaths reported. At this time few new cases are being detected, and there is little evidence of continuing risk to the public.

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Canada.com reports that a salmonella outbreak potentially linked to produce has sickened at least 172 people in 18 states, health officials said Monday.

Health officials think the bacteria may have spread through some form of produce; the list of suspects includes lettuce and tomatoes. But the illnesses have not been tied to any specific product, chain, restaurants or supermarkets.

No one has died in the outbreak, which stems from a common form of salmonella bacteria. Eleven people have been hospitalized, health officials said.

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Health department officials have confirmed another five cases of salmonella poisoning in Tasmania, boosting the total number of people affected to 57. The food poisoning outbreak is centred on two bakeries - the Trevallyn Gourmet and the Sugar Shack - located in the northern city of Launceston. The bakeries have been shut down since Thursday, and a microbiologist has been hired to assist in the investigation.

Public and Environmental Health Service senior medical adviser Avner Misrachi tonight said all 57 cases appeared to be linked to the bakeries. Of the six people in hospital, three have been discharged and three remain in a stable condition.

The infection is usually caused by eating contaminated foods, such as raw or undercooked eggs, milk, meat or poultry.

Dr Misrachi said authorities had ruled out any commercially available ingredients - such as eggs, shortening or fondant (a type of icing) - as being responsible for this outbreak.

Salmonella symptoms include nausea, vomiting, diarrhoea and abdominal pain. The incubation period is between six and 72 hours.

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Kim Kozlowski of The Detroit News reported this morning that the Michigan Department of Community Health is investigating a possible outbreak of salmonella poisoning that appears to be linked to unpasteurized orange juice that has been voluntarily recalled at local Westborn and Nino Salvaggio stores.

The food-borne illness struck 11 Michigan residents, who drank juice manufactured by Orchid Island Juice Co. in Fort Pierce, Fla., between early May and June, according to the Michigan Department of Community Health. Of the 11 cases, eight were children and five people were hospitalized. Other cases are under investigation.

The company bottles the juice, labeled freshly squeezed, under various brands, including the Westborn and Nino Salvaggio labels. Those with the disease all bought the juice at stores in Wayne, Oakland, Macomb, Livingston and Washtenaw counties.

Last week, the FDA issued a warning about drinking unpasteurized juice under brand names by Orchid Island Juice. But Marygrace Sexton, the company's CEO, said officials still are investigating and have not confirmed that salmonella was found in the juice. However, the company decided to voluntarily recall the orange juice with expiration dates through July 25.

Health officials said that about 2 percent of orange juice in the country is unpasteurized and they reminded Michigan residents of the risks.

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