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

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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Sprouts are a food item that have been associated with outbreaks of foodborne disease on multiple occasions in the past decade, including a major Salmonella saintpaul outbreak between February and April of 2009.  In the 2009 outbreak, the CDC counted 235 confirmed outbreak victims, and likely thousands more people across the country were sickened. 

Today,the FDA issued a press release on a Louisiana sprout company that is doing its sprout-growing brethren across the country a major disservice by staying in business.  Hopefully, the FDA's actions will shut the company down permanently.  The press release states as follows:  

The Department of Justice, in an action initiated by the U.S. Food and Drug Administration, is seeking a permanent injunction against A Chau Sprouting Co., a sprout grower in Gretna, La., company owner and manager Quang “Mike” Trinh, and Hue Nguyen, the company production manager.

The complaint, filed on March 16, 2010, in the U.S. District Court for the Eastern District of Louisiana, charges the defendants with violating the Federal Food, Drug, and Cosmetic Act by preparing, packing, and holding sprouts under insanitary conditions, where they may have become contaminated with filth.

“The agency has repeatedly warned the company over several years that corrective actions need to be taken in this facility,” said Michael Chappell, acting associate commissioner for regulatory affairs at the FDA. “While no illnesses have been reported to date, this action is necessary to ensure that it remains that way.”

The ready-to-eat sprouts are distributed to wholesale suppliers, who in turn distribute them to customers located in Gulf Coast states, including Louisiana, Mississippi, Alabama, Florida, and Texas.

Five FDA inspections over the past nine years, including an inspection conducted between August 2009 and September 2009, revealed that the defendants failed to implement basic food sanitation principles and practices for their sprout growing operation, according to the complaint.

The complaint alleges violations that include equipment and facilities that were unclean or unable to be sufficiently cleaned, insanitary employee practices, and a poorly maintained facility.

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Yesterday, the CDC updated the case count in the Salmonella outbreak linked to recalled salami from Daniele Inc., red pepper from Wholesome Spice, and likely black pepper as well.  A total of 245 people are now counted by the CDC as cases in this outbreak, coming from 44 states and the District of Columbia.  But this is not the whole story.  The 245 figure does not include any Salmonella senftenberg illnesses, another strain of salmonella that we have long known has been causing illnesses in this outbreak. 

As for the Salmonella montevideo illnesses in this outbreak, as stated, there are 245 of them.  The distribution nationally is as follows:  AK (2), AL (2), AZ (7), CA (30), CO (5), CT (5), DC (1), DE (3), FL (3), GA (3), IA (1), ID (4), IL (19), IN (4), KS (5), LA (1), MA (14), MD (1), ME (1), MI (4), MN (6), MO (2), MS (1), NC (11), ND (1), NE (3), NH (2), NJ (9), NM (2), NY (18), OH (9), OK (1), OR (9), PA (7), RI (2), SC (1), SD (3), TN (5), TX (7), UT (9), VA (1), WA (17), WI (1), WV (1), and WY (2).

But what about Senftenberg?  The CDC says:

Salmonella Senftenberg, a different serotype of Salmonella, has been found in food samples from retail and a patient household during this outbreak investigation. PulseNet identified 6 persons who had illness caused by Salmonella Senftenberg with matching PFGE patterns between July 1, 2009 and today. Public health officials have interviewed 5 of the 6 ill persons with this strain of Salmonella Senftenberg and determined that two purchased a recalled salami product during the week before their illness began. These six cases are not included in the overall case count reported above.

One of the positive salami samples was from Lee Hanks, our client from Missouri whose salami twas truly a ticking time bomb, testing positive for both strains of Salmonella .  Lee tested positive for Salmonella Montevideo, so he is most likely included in the CDC's case count, but why are these 6 Senftenberg illnesses not included in the CDC's official case count?  Two of the 6 had purchased recalled Daniele salami in the week before their illnesses, but what about the other four?  Does the CDC suspect that the contaminated pepper is in other products, and that these Senftenberg illnesses may in fact be associated with the same contaminated pepper, just from another food product? 

Notably, the two potential suppliers of black pepper to Daniele (at least the two that are publicly known) have not recalled black pepper, despite an announcement by the Rhode Island Department of Health that a sample of the black pepper had tested positive for the outbreak strain of Salmonella Montevideo.  But, two days ago, Heartland Foods, Inc. an Indiana company, did recall black pepper.  Still many unanswered questions in this outbreak.

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Yesterday, Heartland Foods, Inc., an Indianapolis, Indiana company recalled "all sizes/containers of COARSE GROUND BLACK PEPPER shipped from their facility at 6815 E. 34th Street, Indianapolis IN. Potential distribution took place on or after October 19th, 2009 to February 17th, 2010." 

This recall comes on the heels of a major national outbreak linked to pepper-coated salami that has sickened at least 238 people in 44 states and the District of Columbia.  The outbreak has been making people sick since July, and has long been thought to be linked to contaminated pepper, both red and black.  In fact, Wholesome Spice Company, a Brooklyn, NY spice wholesaler, has also recently recalled red pepper.  The recall has spawned two lawsuits so far.  Also, yesterday's recall by Heartland Foods immediately followed the filing of a wrongful death lawsuit arising from a 2009 Salmonella outbreak linked to white pepper produced by UF Union International Foods, a California company. 

Heartland's recall prompts a few questions.  Is Heartland a customer of Wholesome Spice, or is it linked in another way to the Daniele/Wholesome outbreak and recall--e.g. were Heartland and Wholesome supplied by the same pepper exporter?  Wholesome has recalled only red pepper, but black pepper was originally fingered as the contaminated vehicle in the Daniele outbreak; so does Wholesome need to recall its black pepper too? 

Further, and more importantly from a public health standpoint, where is Heartland's contaminated black pepper?  Notably, it distributes to only retailers and food producers, meaning that its potentially contaminated products are used as ingredients in further processed foods.  Which ones, and where are they? 

And this just in, T. Marzetti Company has recalled its veggetable and chip-dip products due to potential salmonella contamination.  What was the contaminated ingredient in the dip?  Was it pepper?  Was it something else like hydrolized vegetable protein, which is the suspect vehicle in the recent recall of Johnny's french dip au jus recall? 

More answers to come, but with all the spice recalls and lawsuits lately, it would not be surprising to ultimately see some relationship between them.  See Spices:  emerging threat or clear and present danger. 

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Heartland Foods, Inc. of Indianapolis is voluntarily recalling all sizes/containers of COARSE GROUND BLACK PEPPER shipped from their facility at 6815 E. 34th Street, Indianapolis IN. Potential distribution took place on or after October 19th, 2009 to February 17th, 2010. These products have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, the elderly, and other with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

The product involved includes the following sizes: 1 lb Quart (jar), 4 lb Gallon, 8 lb Bucket (new pail). Each container is identified with an individual label showing the Heartland Foods company logo, the description: Coarse Ground Black Pepper, and the specific Net Weight of the container (i.e., 1 lb, 4 lb, 8 lb). Product distribution of Coarse Ground Black Pepper has been suspended while the FDA continues its investigation.

 

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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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Yet another food recall due to Salmonella contamination.  This one was announced this morning by Johnny's Fine Foods, a Tacoma, Washington food company, who is recalling powdered au jus due to potential contamination by Salmonella.  The FDA recall notice states as follows:

To date no known illnesses have been associated with this product.

Johnny's French Dip Powdered Au Jus is distributed nationwide and is sold in retail stores.

Johnny's French Dip Powdered Au Jus 6oz is packaged in a clear plastic bottle with a red, white and blue label. The expiration date for this product is 0332. Johnny's French Dip Powdered Au Jus 1.1oz is packaged in a red, white and blue foil packet. The expiration date for this product is 02212.

The product was made using hydrolyzed vegetable protein manufactured by Basic Food Flavors, Inc. Las Vegas, Nevada. Basic Food Flavors initiated a recall of the hydrolyzed vegetable protein due to Salmonella contamination.

 

Recall after recall after recall.  Food companies are failing in 2010.  There is no other way to put it. 

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The American Pecan Co., a Texas-based pecan company, announced a recall today of its small, medium, and large sized plastic bags of pecans.  The company is recalling the product due to potential contamination by Salmonella bacteria.  

American Pecan Co. said today that its one-pound bags of shelled pecans were sold to walk-up customers at their Yancey location in south-central Texas, as well as to mail-order customers in Texas, New York and Massachusetts.  The Salmonella contamination was discovered by the Food and Drug Administration during routine sampling and testing.

The company says no illnesses have been reported, but it has stopped producing and distributing the product.

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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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There has been no further word on the massive Salmonella outbreak that sparked a major recall by Daniele Inc. of salami products distributed nationally.  The latest CDC update on the outbreak was on February 18, at which point the CDC had identified 233 illnesses in 44 states linked to the outbreak.  But as of the date of the CDC's last update, there remained many unanswered questions in the outbreak investigation.

To recap, Daniele Inc has recalled a total of almost 1.4 million pounds of salami products, some produced as recently as mid February.  See list of recalled products.  It is widely thought that both red and black pepper used during production of the recalled salami products was the original source of contamination.  Daniele Inc's pepper suppliers are two companies called Overseas Mincing Spice Company and Wholesome Spice Company.  Daniele has terminated its relationship with Wholesome Spice Company and now reports that it is using irradiated pepper exclusively in its products. 

But it has been nearly a week since we have received any word on the status of the outbreak, despite epidemiological evidence that contaminated products may in fact still be in consumer households.  So, are people still getting sick?  Are we dealing with an ongoing threat to public health?  Has all potentially contaminated product been recalled?  And what is the latest on the status of the investigation into the pepper, both red and black, that has been identified as the original source of contamination?  Notably, neither pepper company, Overseas Spices or Wholesome Spice Company, has recalled any of its products.  What is the significance of this?  There are only three possibilities:  (1) the true source of contaminaton was at Daniele alone, (2) the pepper companies did not sell the contaminated pepper to any other companies, and they are confident that the Daniele recall is broad enough to include all potentially contaminated pepper, or (3) the companies simply have not acted to protect public health.  We would like to think, in this day and age and in this country, that the third possibility is, in fact, not possible, but events over the past several years are cause for concern.  Recall that we are only one year removed from the now infamous PCA salmonella outbreak, in which Stewart Parnell knowingly sent salmonella-contaminated product on to other companies for inclusion in peanut-based products.

 

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In the midst of ongoing salmonella and listeria outbreaks involving red pepper/black pepper/salami and Queseria Bendita cheese, we will file a lawsuit tomorrow in Oakland on behalf of the family of an elderly woman who died in April 2009 after ingesting white pepper contaminated by Salmonella rissen bacteria.  The defendants are the companies that manufactured and distributed the contaminated product.  It is apparent from the FDA's investigation records, and from letters the FDA sent to Union International, the spice company that manufactured the contaminated product, that the production environment had many critical food handling and production problems that contributed to the outbreak.  

During the FDA's inspection of Union International, fourteen swabs taken from different locations at the production facility tested positive for Salmonella.  Regarding the concerning findings, the FDA advised the company in a November 24, 2009 letter sent to Daniel Chen, Vice President & Manager, that:

Each of these positive subsamples was further serotyped and determined to be S. rissen, the same serotype with an indistinguishable Pulsed-Field Gel Electrophoresis (PFGE) pattern as isolated from the samples of finished product. Finding Salmonella very near to where food is exposed indicates a high risk of product contamination. Based on our analytical and inspectional findings, your firm's pepper and other spice products are adulterated within the meaning of Section 402(a)(4) of the Act, [21 U.S.C. § 342(a)(4)],

Further, serious violations of the Current Good Manufacturing Practice (CGMP) regulation for foods, Title 21, Code of Federal Regulations (CFR), Part 110 (21 CPR 110), including possible routes of cross-contamination, were identified by our investigators

This letter may not list all the violations at your facility. You are responsible for ensuring that your establishment operates in compliance with the Act and the CGMP regulation (21 CFR Part 110). Failure to implement lasting corrective action of these violations and prevent their recurrence may result in regulatory action being initiated by FDA without further notice. The Act authorizes injunctions against manufacturers and distributors of illegal products, and the seizure of such products, under sections 302 and 304 [21 U.S.C. §§ 332 and 334]. In addition, section 303(a)(1) of the Act [21 U.S.C. § 333(a)(I)] provides that there is criminal liability for all violations of the prohibited acts described in section 301 of the Act [21 U.S.C. § 331].

The company immediately acted to correct the violations, but not before a lot of people were sickened in a major outbreak in the western United States.  Suit will be filed tomorrow on behalf of a woman who died as a result of Union International's and supplier's mistakes.

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Yesterday evening, the USDA's Food Safety and Inspection Service (FSIS) announced that Daniele Inc is expanding its January 23 2010 recall of salami products to include another 115,000 pounds of potentially contaminated salami.  See list of recalled products.  The expansion is yet another twist in an outbreak that has continued to evolve, and with sometimes only limited information passed to the public by investigating health officials and the companies involved. 

But the recent expansion is more significant for the many questions that it creates.  It is based upon the presence of salmonella in salami packages that did not contain any black pepper, which has long been thought to have been the source of contamination in the outbreak.  Now, health authorities believe that crushed red pepper included in some of the Daniele Inc product may have been contaminated as well.

Here is a quick list of questions that need to be answered:

1.  Who is the supplier of red pepper? 

Why it matters:  if tests have indicated the presence of salmonella on the crushed red pepper that Daniele Inc used, the same contaminated pepper may have been distributed to other food producers or retailers, so more foods may be, or might become, contaminated.  Pepper has a long shelf life, so if this product is, indeed, elsewhere in the consumer chain of distribution, it represents an ongoing threat to human health.

2.  How many strains of Salmonella are implicated in this outbreak, and what are they?

The FSIS press release about the recall expansion tells us that crushed red pepper may now be contaminated, but says nothing about the strain of salmonella that was isolated.  We know Montevideo, and we know Senftenberg, It would seem unlikely, unless the supplier of the black and red pepper was the same, that both would be contaminated with the same strains of Salmonella.  Maybe the red pepper was contaminated with one, and the black with the other; or maybe the black with both known strains, and the red with a totally new strain.  Whatever the case, the public should have the benefit of this knowledge. 

3.  Have all potentially contaminated products been recalled?

Surely, the companies involved would say yes, but yesterday's announcement is, after all, effectively the third announced recall by Daniele, each one including more and different products.  So, has Daniele Inc taken a conservative approach to recall?  Or has it acted as broadly in scope as the ongoing risk to public health would seem to dictate. 

But at least Daniele has acted.  One thing causing great concern, here at least, is that there has been no recall of pepper, either the black or the red, despite tests that have confirmed the presence of salmonella in pepper from two, and maybe even three different companies.  Maybe Daniele was Overseas Spice and Wholesome Spice's only customer, and those companies have accurately determined that there is no ongoing risk because Daniele's recalls encompass all the potentially contaminated product.  We can only speculate at this point, but that doesn't sound like a sustainable business model. 

4.  Is the model currently in place for telling the public crucial information about outbreaks and recalls really the most efficient method we can think of?

The flow of information to the public about this major outbreak has been slow.  Recall that the CDC announced this outbreak in January by stating that the implicated product was "a widely distributed contaminated food product."  At the time of the CDC's announcement, it was certainly known by US Government that Daniele Inc's salami was the "widely distributed contaminated food product."  But instead of the CDC just saying that, it fell to Bill Marler, a private citizen way out in the northwest corner of the country, to announce what the product really was.

On her blog, Obamafoodorama.com, Eddie Gehman Kohan asked "How is it possible that a blogger notifies the public of a new Class I (you could die) recall of 1,240,000 pounds of meat before USDA does?":  She continued, "It's a grim situation when a private citizen is more on the ball than the federal agency that's supposed to be managing national food safety concerns (CDC's own e mail heads-up about the outbreak included no information, except that a product sold nationally was contaminated with Salmonella Montevideo)."

So back to the original question, is a system that is so reliant on the private sector--instead of first responders like the government, CDC, FDA, FSIS--to pass information about food outbreaks really an efficient model?  There are 230 recognized illnesses in this outbreak, many of which fell ill long before the pieces to the puzzle had fallen into place, but certainly some of whom fell ill after government and certain industry members knew the most essential details.  Clearly, this is not efficient from a public health standpoint, and some would certainly argue that it's not very efficient from a business standpoint either.  After all, the losses generated by the publicity surrounding these outbreaks in the form of reduced sales and lawsuits certainly compound the longer the outbreak remains in the public spotlight.  And one sure way of accomplishing that is to deliver information piecemeal and untimely.

 Many questions yet to be answered as this outbreak continues to unfold. 

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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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The CDC now counts 217 confirmed cases in the Salmonella montevideo outbreak linked to contaminated salami and pepper. 

As of 9:00 pm EST on February 8, 2010, a total of 217 individuals infected with a matching strain of Salmonella Montevideo 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 (5), CA (30), CO (4), CT (5), DC (1), DE (2), FL (3), GA (3), IA (1), ID (2), IL (14), IN (3), KS (3), LA (1), MA (12), MD (1), ME (1), MI (4), MN (5), MO (1), MS (1), NC (9), ND (1), NE (1), NH (1), 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 (15), WI (1), WV (1), and WY (2).

This outbreak was originally announced back on January 23, which is also the day that Daniele Inc recalled 1,240,000 pounds of salami products potentially contaminated by Salmonella.  Daniele later expanded the recall by over 17,000 pounds.  The products were distributed nationally and sold at many retail grocery outlets. 

Outbreak summary:  the 217--a number that will likely continue to grow--confirmed illnesses that the CDC has linked to the outbreak have occurred in 44 different states.  The Daniele Inc recalled salami product was contaminated with multiple strains of Salmonella, including montevideo.  There has been no official announcement of the other strains of salmonella involved in the outbreak.  We also know that the actual outbreak vehicle was the black pepper that was used to coat the recalled salami products.  Daniele purchased the contaminated pepper from two companies, Wholesome Spice and Overseas Spice Company.  Samples from unopened containers of pepper from both companies have tested positive for Salmonella. 

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We are currently investigating the illnesses of 15 people potentially sickened by Salmonella-contaminated Salami.  There is the possibility, as well, that other products are contaminated by Salmonella montevideo or other strains of salmonella, yet we know virtually nothing about the whereabouts of the pepper.  We were contacted yesterday by a young woman from Washington sickened in late January 2010 . . . after the Daniele Inc recall of 1.2 million pounds of potentially contaminated salami.  She bought the salami at Costco, but didn't consume it until after word of the outbreak and recall had been announced.  She just didn't know that the outbreak was occuring.

Had more effort been put forth to make people aware of the outbreak and dangers associated with consuming the implicated product, this woman's illness may not have happened, and she would not now be in danger of losing her job because of missed work days due to illness.  This outbreak is associated with a product--actually two products, pepper and salami--with very long shelf lives.  In such a situation, where there is more than a slim possibility that contaminated product will stay in people's homes well past public announcement of an outbreak or recall, better effort and more resources need to be devoted to informing the public of the risks they face. 

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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 massive Salmonella Saintpaul outbreak from February through April 2009 was featured in a story by WHAS 11 News in Louisville, Kentucky.  Drew Falkenstein spoke with Channel 11's Adam Walser about the outbreak:

 

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Blake Morrison and Peter Eisler report in today's edition of the USA Today:

The U.S. Department of Agriculture announced sweeping steps Thursday to "assure the safety and quality of food" purchased for the National School Lunch Program.

The measures include tightening requirements on companies that supply ground beef to schools, testing the beef more often and more thoroughly, and improving communications within the USDA to "identify potential food safety issues" before children get sick.

The initiatives come in the wake of a USA TODAY investigation that revealed failures in government programs intended to protect students from food-borne illnesses. More than 31 million children participate in the school lunch program.

The newspaper found that McDonald's and other fast-food chains are far more rigorous than the government in checking for bacteria and dangerous pathogens in beef. USA TODAY also found that the government lacks ways to quickly alert schools when products have been recalled or implicated in safety investigations.

The measures outlined Thursday are intended to address each of those points, bringing the standards and testing protocols in line with those used by the most selective restaurants and retailers. "It's a big deal," food safety consultant David Theno said of the USDA measures. He said the moves will push companies to "play to a higher standard" if they want to continue to supply food to schools.

The USDA also pledged to review the safety records of its school lunch suppliers more carefully and bar companies that have had repeated problems with their commercial products.

Such a move could affect companies such as Beef Packers, a Fresno company that recalled 826,000 pounds of ground beef last summer because it contained a drug-resistant strain of salmonella. Public health officials warned consumers to discard products from the company, which had a history of salmonella problems, but USA TODAY found that the USDA paid Beef Packers hundreds of thousands of dollars for 450,000 pounds of ground beef made during the period covered by the commercial recall.

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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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Today, the Rhode Island Department of health announced that the pepper that Daniele Inc used to produce its salami--now the subject of a major recall and outbreak--was contaminated, not the meat itself   Pepper has been suspected as the source of this outbreak since at least January 23, 2010, if not before.  A little frighteningly, Rhode Island also says that pepper from both of Daniele Inc's suppliers has tested positive for the outbreak strain (suggesting a common grower or shipper) of salmonella, and that a number of outbreak victims may not have eaten salami at all.  What's the implication?  That more than just Daniele Inc. has received contaminated  black pepper.  Is it in your home now?

The problem that this scenario brings to light is that the public is clearly not getting the information that it should . . . and in a timely fashion.  As I posted earlier today, the suppliers of pepper to Daniele (Oversees Spice Company and Wholesome Spice) should publicly disclose the list of customers who bought, or may have bought, the contaminated pepper.  After all, the fact that some of the people sickened with the outbreak strain of salmonella in this outbreak, and who did not have an exposure to salami, suggests that other food producers may in fact have received the contaminated pepper as well, and they may be producing and selling food that is contaminated.  Maybe the FDA doesn't have enough information to establish just who that or those food producers are, but Oversees and Wholesome could certainly protect a lot of people by disclosing their customer list. 

This problem--i.e. the stagnant flow of information in food outbreaks--is not all on food suppliers either.  Timely information published in a manner that effectively passes the information to the consuming public is not a strong point of our government either.  Bill Marler authored a highly insightful blog post several days ago about this problem.  Asking "why the silence of the steaks and the perjury of the peppers," he stated as follows:

why do the US Government and US Business not believe in Capitalism? The one thing that makes capitalism – free markets – work is knowledge and transparency. If you know who poisoned you, you can stop buying food from them. However, here – especially here – the government and industry do everything they can to not tell us the facts. In both instances they put the information out on a holiday or a Friday night, so no one but a loser blogger would be paying attention. More importantly is the fact that they withhold information about the ultimate source of the contamination? Why not say whom the supplier of steaks and trim is? Why not let the public know who produced the peppers and where they are from?

As for steaks, the event that got Bill talking was the recall of 124 tons of tenderized beef products manufactured by National Steak and Poultry and sold to a variety of major restaurant chains throughout the country.  The recall was announced by USDA's Food Safety and Inspection Service on . . . Christmas Eve.  Other than a few lawyers and the CDC, who is paying attention to FSIS recall notices on Christmas Eve?  Or the following day?  Or really any day for the rest of the year?  And for that matter, on New Year's day too?  Virtually nobody, particularly not a very significant percentage of the food consuming public. 

This kind of information should not come on Christmas Eve, Friday night, or any other time of the year clearly designed to lessen the flow of information to the public, thereby protecting the interests only of the business that manufactured or sold the contaminated product.  Eddie Gehman Kohan said it much better on her blog, Obamafoodorama.com, posing the question "How is it possible that a blogger notifies the public of a new Class I (you could die) recall of 1,240,000 pounds of meat before USDA does?":

It's a grim situation when a private citizen is more on the ball than the federal agency that's supposed to be managing national food safety concerns (CDC's own e mail heads-up about the outbreak included no information, except that a product sold nationally was contaminated with Salmonella Montevideo).

If the answer to these valid questions is that notifying the public will encourage lawsuits, or make them easier to prove, the failure to do so is only going to allow outbreaks to happen.  And that's when the lawyers come in. 

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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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The size and breadth of the Salmonella outbreak linked to Daniele Salami - 202 people in 42 states since last July - is a big part of the reason the source of the illnesses has been pinpointed.  The CDC has estimated that there are 75 million cases of food-poisoning in the U.S. each year.  Only a fraction of these illnesses are ever tied to a specific food item.

The epidemiological work of local and state health officials that respond to reports of illness is the first step to a connection.   State laws require that positive lab results for Salmonella  (among other pathogens) be reported to health officials.   Once alerted, health officials then contact the ill individual and attempt to determine his or her potential exposures.   In an isolated case, making determinations can be tricky.   When multiple people share the same bacteria strain however, looking for a common exposure factor can be more fruitful.   

A spokesman for the Washington State Department of Health explained some of its involvement in the national investigation in response to a report of a Jefferson County man who was one of 15 Washington residents reported as part of the outbreak:

Donn Moyer, state Department of Health spokesman, said the outbreak was unique in that a national study actually pinpointed the source of the salmonella montevideo contamination. "Often you don't find the source," he said. "In this case you've got a number of people exposed to the same source. That's why this was an outbreak."

Moyer stated that  a review of shopping receipts verified that 13 cases showed purchases of the same salami variety pack before getting sick.

The investigation also relied upon laboratory evidence, both from private and public labs, in Washington and elsewhere.  These tests not only confirmed the presence of Salmonella in the Daniele product, but also suggested the product was contaminated with multiple strains:

A private Washington state lab tested a different salami product, also produced by Daniele, and found it contained another type of salmonella.  A bacterial culture from the private lab, but not the salami product, was provided to the Washington State Department of Health for additional testing.Results from the state lab tests of that bacterial culture on Monday identified two types of the bacteria. One type matched the findings of the private lab, and the other matched the outbreak strain of salmonella montevideo.

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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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Updated list of retail locations who may have received Salmonella-contaminated sausage products, including salami/salame, from Daniele International, Inc.:

1.  Albertsons:  AZ, CO, ID, LA, MT, NM, OR, TX, UT, WA, WY

2.  Beverages & More:  CA

3.  Bi-Lo:  SC, TN

4.  BJ's:  All stores nationwide

5.  Bloom:  MD, NC, SC, VA

6.  Bottle King:  NJ

7.  Brookshire Bros.:  TX

8.  Costco:  All stores nationwide

9.  D'Agostino Supermarket:  NY

10.  Dave's Market:  RI

11.  Earth Fare:  NC, TN

12.  Food Emporium:  NJ

13.  Fred Meyer:  AK, ID, OR, WA

14.  Fresh Fields:  TX

15.  Fry's Food and Drug/Fry's Marketplace:  AZ

16.  Giant Food Store:  MA, PA, VA, WV

17.  Haggen:  OR, WA

18.  Harris Teeter:  DC, DE, MD, NC, SC, TN, VA

19.  Hilander:  IL

20.  Kings:  NJ, PA

21.  Kroger:  AL, GA, IL, IN, KY, PKG, LA, MI, MO, NC, OH, SC, TN, TX, VA, WV

22.  Market Basket:  MA, NH, NJ

23.  Martins Food Market:  MD, PA, VA, WV

24.  Pathmark:  NJ, NY, PA

25.  Piggly Wiggly:  SC

26.  Quality Food Center/QFC-Fresh Fare:  OR, WA

27.  Ralphs/Ralphs Fresh Fare:  CA, NY

28.  Roche Bros.:  MA

29.  Sams Club:  All stores nationwide

30.  Scotts:  IN

31.  Shoppers Market:  MD, VA

32.  Shop-Rite:  NJ

33.  Smith's/Smith's Marketplace:  AZ, ID, MT, NM, NV, UT, WY

34.  Stop and Shop/Super Stop and Shop:  CT, MA, NH, NJ, NY, RI

35.  Super K-Mart:  IL, IN, MI, NY, OH, PA, SC

36.  The Fresh Market:  NC

37.  Top Food:  WA

38.  Waldbaums:  NY

39.  Walmart:  All stores nationwide

40.  Wegmans:  NY

41.  Weis:  MD, NJ, NY, PA

42.  Whole Foods:  TX

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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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Today Daniele, Inc. announced that tests have confirmed the presence of salmonella in the black pepper that the company used to coat the salami product that has been implicated in a massive national salmonella outbreak. The outbreak, which has sickened at least 189 people in 40 states, involves multiple strains of Salmonella bacteria. Today’s announcement confirms what Daniele, Inc. seems to have suspected since announcing the recall back on January 23, 2010.

But the announcement also leaves some major questions unanswered, like who was the supplier of the contaminated pepper?  FSIS, FDA, and CDC have not acted promptly enough in informing the public about the circumstances of this outbreak and recall, so Daniele, Inc. should take the initiative in the name of public health and tell the public who supplied it with contaminated pepper. At this point, for all we know, the pepper could be in the homes of many people across the country.

Also, outbreaks linked to pepper are by no means a new phenomenon. In August 2008 the Canadian Food Inspection Agency (CFIA) and Pak National Foods Limited warned the public not to consume the National Black Pepper Powder because the product may have been contaminated with Salmonella. The product had been distributed in Alberta and British Columbia. The importer, Pak National Foods Limited, Richmond, British Columbia, voluntarily recalled the affected product from the marketplace.

In March 2009, a Northern California company recalled two product lines: "Uncle Chen" white and black peppers and "Lian How" dry spices, after health officials identified Lian How-brand white pepper as the culprit in a recent Salmonella outbreak. At least 42 people had fallen sick in the four-month outbreak. Three other states besides Washington have were also involved in the outbreak: California, Nevada and Oregon.

And in August 2009 Adams Extract and Spice announced a voluntary recall of products because they had the potential to be contaminated with Salmonella. The products contained a specific lot of ground red pepper supplied by Van de Vries Spice Corporation. This lot of ground red pepper initially tested negative for Salmonella. Subsequently, Adams Extract and Spice was informed that another sample drawn from the same lot was confirmed positive for Salmonella.
 

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Winter 2010 is shaping up to be a rough one for West Coast residents, who are often insulated from the weather woes of the rest of the country.  Southern California has been hammered by constant rain causing mudslides, evacuations, and any number of other weather-induced perils.  Meanwhile, Salmonella bacteria have been finding their way into the homes of many California residents for months now.  The vehicle, of course, is salami produced by Daniele, Inc., a Rhode Island company, and at least 30 California residents (and that's only the confirmed cases) have been sickened.  Washington residents have not fared much better.  At least 14 people from the State have been sickened in the outbreak. 

Here is the CDC's map showing the distribution of recognized cases nationally:

Link to the CDC's interactive map. 

As of 9:00 pm EST on January 24, 2010, a total of 187 individuals infected with a matching strain of Salmonella Montevideo have been reported from 39 states since July 1, 2009. The number of ill persons identified in each state with this strain is as follows: AL (2), AZ (5), CA (30), CO (3), CT (4), DE (2), FL (2), GA (3), IA (1), IL (11), IN (3), KS (3), LA (1), MA (12), MD (1), ME (1), MI (1), MN (4), MO (1), NC (9), ND (1), NE (1), NH (1), NJ (7), NY (15), OH (9), OK (1), OR (8), PA (3), RI (2), SC (1), SD (3), TN (4), TX (7), UT (7), VA (1), WA (14), WV (1), and WY (2).

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Salmonella is back in the news again on the heels of 187 illlnesses in 39 states linked to Daniele Italian Sausage Products.  Salmonella is generally associated with gastrointestinal symptoms, including diarrhea, vomiting, fever, and abdominal cramps.   Salmonella infection carries with it, however, the risk of complications.  One of these, endocarditis, is a very rare, but  serious complication.

According to wikipedia, endocarditis is an inflammation of the inner layer of the heart, the endocardium. It usually involves the heart valves.  Endocarditis can be both infectious and non-infectious in etiology. Salmonella infection is associated with infectious endocarditis. The infectious type is particularly problematic, in part because immune response to the heart valves is blunted due to a lack of dedicated blood supply.

There have been a number of reports of a connection between salmonella infection and endocarditis over the years.  The complication is thankfully very rare, but each time the number of infected goes up, the risk of serious complications like this one go up with it.

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

Friday's recall:  (from FSIS press release)

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

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

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

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

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

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

 

 

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We hear about them so often these days--recalls of all kinds of products, from foods, to medications, to kids toys--that "recall" has become a working concept in everybody's vocabulary.  But what is a recall?  Who has the legal obligation to announce them?  And what legal ramifications are there ot being involved in one?  

First, despite not having the legal authority to actually recall products, the FDA and USDA are frequently involved.  In fact, the USDA's Food Safety and Inspection Service (the agency arm responsible for ensuring the safety of meat, poultry, and eggs) sets the standards for when, and what kind of, a recall is required.  

The FSIS defines three kinds of recall actions that can fairly be included under the same umbrella.  A "Class I recall" should occur in "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."  (Editor's note: "should" is italicized because sometimes food product manufacturers do not issue class I recalls even when circumstances require it.)  Under this definition, a Class I recall should occur any time a food product is known or suspected to be contaminated with any foodborne pathogen, whether bacterial or viral.  The reason:  bacteria and viruses make people sick, and as a result, food contaminated by them will make people sick.

A "Class II recall" should occur in "a situation in which use of or exposure to a violative product may cause temporary or medically reversible adverse health consequences or where the probability of serious adverse health consequences is remote."  This is a little less clear than the definition of a Class I recall, but I certainly believe that the consequences of foodborne disease are simply too extreme for food companies to play fast and loose under these definitions.  A Class I recall should occur every time a food manufacturer knows, or has reason to know, that a product it has produced is or may be contaminated with a foodborne pathogen.  Every time.

Finally, a "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.

A "market withdrawal" has no place in the world of food contamination.  Again, salmonella and e. coli and campylobacter and hepatitis and every other foodborne pathogen are simply too dangerous for companies to try to avoid their obligations by calling what should be a recall a "market withdrawal"--something done purely to avoid the media ramifications of saying that you're product has been recalled.  This has been done before under circumstances where a Class I recall was surely warranted. 

Who has the legal obligation to recall a food product when it is known or suspected to be contaminated with something that will make people sick?  The unfortunate answer is that its not the USDA or FDA.  Nor is it any other state or federal regulatory body.  The answer is that the company who produced the contaminated product is the only entity with the legal authority to recall a product.  The CDC can announce that the product has caused an outbreak, but the company itself is the only entity that can truly and effectively act. 

A recall is a firm’s action to remove product from commerce (e.g., by manufacturers, distributors, or importers) to protect the public from consuming adulterated or misbranded products. Although it is a firm’s decision to recall product, the Food Safety and Inspection Service (FSIS) coordinates with the firm to ensure it has properly identified and removed recalled product from commerce by verifying the effectiveness of the firm’s recall activities. FSIS also notifies the public about product recalls.

See http://www.fsis.usda.gov/Search/Search_Results/Index.asp?q=%22market+withdrawal%22&mode=simple&num=10&as_occt=any&site=FSIS

Finally, with regard to the legal ramifications of announcing a recall, again the real threat comes from the private sector.  Penalties and fines are not necessarily assessed simply because a recall happens.  Often, it is only private citizens who have been injured by the contaminated product that take legal action against a company that has recalled its product. 

Aside from lawsuits (which are an insufficient check, by themselves, on food safety because they are largely reactive rather than preventative) FSIS may issue public health alerts or perform product detentions and seizures, to mitigate the risk to the public when firms have inadequately removed recalled product from commerce. The Agency will investigate if it appears that a firm’s recall strategy or execution of that strategy is ineffective and, based on its findings, FSIS may seek enforcement action against the recalling firm or its consignees.

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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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The FDA announced Friday that Hines Nut Company of Dallas, Texas has recalled of 270 packages of Pine Nuts, due to potential contamination with Salmonella.   The nuts were packaged under the brand name Harris Teeter Farmers Market.   According to the FDA press release:

The recalled product was sold in 8 oz foam trays wrapped in cellophane and carry the UPC code 0 72036 88121 0. The Pine Nuts were distributed solely to Harris Teeter Markets in North Carolina. Consumers who purchased this product between December 30, 2009, and January 14, 2010 should contact Hines Nut Company for information on how to return the product for a refund.

There have been no complaints or any reported illnesses related to the products to date.

The problem was discovered through routine sampling by the supplier, Red River Foods in Camarillo, CA.
 

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So how does the principle of strict liability--i.e. liability without regard to fault--which is applicable in foodborne illness cases, apply to bottles of Tylenol that make people sick?  The answer:  very well.

For some background, Johnson & Johnson today expanded its recall of various Tylenol products, which, like many food items, are regulated by the FDA, due to potential contamination with a substance that produces a chemical odor that has made a bunch of people ill with gastrointestinal symptoms.  (see primer on strict liability). 

Despite some differences in the way the fifty states apply the doctrine, strict liability holds manufacturers of defective products liable to people injured by the product defect.  It's pretty simply applied in food cases.  A beef company that produces ground beef, or any meat, contaminated with E. coli O157:H7 is liable to the people who become ill because contaminated ground beef is defective.  Similarly, a restaurant that serves a meal that became contaminated with Salmonella because an infected foodworker prepared it is liable to the customer who then contracts the disease.  In both situations, it does not matter whether the defendant (i.e. the beef producer and the restaurant) was negligent.  Simply making and selling contaminated food makes the defendant liable. 

Tylenol, whether the bottle it is sold in or the indvidual pills themselves, that is contaminated with a substance that makes people ill is also defective.  Johnson and Johnson is strictly liable to the people who have become ill, as would be the company that made the pallets that were contaminated with the substance that has made people sick.  Both produced a defective product in the eyes of the law.

This concept sounds offensive to some people. But when you pause for a moment to think where the safety of our food and pharmaceutical supply might be without the media attention that these recalls and outbreaks have gotten, and without lawsuits that put the immense costs of illnesses and medical treatment squarely back in the food producer's hands, the concept begins to seem a little less grim.

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Yes, even wooden shipping pallets.  These days, it seems that nothing is immune from being linked to an outbreak of foodborne disease.  Spinach, lettuce, sprouts, peanut butter, cookie dough, pizza, shellfish . . . everything.  And now, a pharmaceutical recall highlights the potential risks posed by something as seemingly innocuous as wooden shipping pallets. 

This news comes in the midst of a recall, by McNiel Consumer Healthcare, of Tylenol arthritis pain caplets that were shipped on wooden pallets treated with a chemical known to cause potentially severe gastrointestinal symptoms.  But this particular Tylenol recall highlights the broader problem of potential bacterial or viral contamination of products during the shipping process.  On December 16, 2009, Intelligent Global Pooling Systems announced that,

a random sampling of wood pallets used to ship food in Portland, ME, and Philadelphia, PA, numerous pallets tested positive for Listeria and abnormally high counts of bacteria that could potentially create health hazards for consumers. The new data bolster the findings of previous wood pallet testing conducted in the Washington-Baltimore area, further illustrating the unsanitary conditions and unacceptable risks to our nation’s food supply from wood pallets.

"How much more evidence does Congress and the FDA need?," Bob Moore, IGPS Chairman and CEO asked in an article on PR Newswire.  "The TYLENOL recall proves wooden pallet shipping platforms are a dangerous threat to the pharmaceuticals we depend on, while recent independent studies we've commissioned in four cities demonstrate the dangers they pose to our food supply," 

"The one to two billion wood pallets in circulation in the United States are the common denominator in the supply chain - practically every product we ingest is shipped on a wood pallet. Congress and FDA cannot afford to overlook them any longer as they consider ways to strengthen our national food safety law."

Well said.  The risks are clear, particularly for the select few (actually, pretty much all of us) who participate in an integrated, international food supply.  And even for locavores who would rather not rely on the spotty food safety records of foreign producers, the food still has to be shipped a certain distance.  Odds are, there's a wooden pallet somewhere in the chain. 

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Over at the New York Times, writer Michael Moss has published yet another excellent piece, titled Company’s Record on Beef Treatment Questioned, regarding a meat industry practice that many folks likely have never heard of--ammonia-treated meat trimmings used in many pre-fabricated beef patties.

And while most of the public may not be familiar with this particular addition to their meat, most fast-food companies, and the federal school lunch program, certainly are.  "With the U.S.D.A.’s stamp of approval, the company’s processed beef has become a mainstay in America’s hamburgers. McDonald’s, Burger King and other fast-food giants use it as a component in ground beef, as do grocery chains. The federal school lunch program used an estimated 5.5 million pounds of the processed beef last year alone."

Not only has the practice by Beef Products Inc., been endorsed by the USDA, but they believe it is so effective at killing deadly pathogens like E. coli and Salmonella, that starting in 2007--when USDA began routine testing of hamburger meat sold to the public--the ammonia-treated meat was deemed exempt from testing.

As Mr. Moss's article reveals, the pathogen-free safety of this stomach-churning meat additive is not so iron-clad after all.  Read on by clicking HERE.

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Consumer Reports has unveiled the results of a study that provide a frightening look at commercially sold uncooked chicken in the U.S. - two thirds of the chicken tested was positive for either Salmonella, Campylobacter, or both. 

The consumer organization tested 382 chickens from 100 different stores in 22 states.  Here are a few of their findings:

• Campylobacter was in 62 percent of the chickens, salmonella was in 14 percent, and both bacteria were in 9 percent.

• Store-brand organic chickens had no salmonella at all, showing that it's possible for chicken to arrive in stores without that bacterium riding along...57 percent of those birds harbored campylobacter.

• The cleanest name-brand chickens were Perdue's: 56 percent were free of both pathogens.

• Most contaminated were Tyson and Foster Farms chickens. More than 80 percent tested positive for one or both pathogens.

• Among all brands and types of broilers tested, 68 percent of the salmonella and 60 percent of the campylobacter organisms we analyzed showed resistance to one or more antibiotics.

No doubt that some confronted with these findings will dismiss it - "everyone knows that you have to cook chicken before you eat it."  Such an attitude understates the problem associated with these eye-opening findings.   

First, the risks of cross-contamination in the home are not often fully appreciated.   Any contact between these raw products and other surfaces - knives, hands, counter tops- that will then come in contact with ready-to-eat foods, puts consumers at risk.

Second, the severity of the risk is likely under-appreciated.  The bacterial pathogens on these chickens can cause severe illnesses.  The 2008-2009 Salmonella outbreak associated with PCA peanut butter killed nine people.   Campylobacter infections are a known cause of Guillain-Barre Syndrome (GBS).  GBS  is a disorder in which the body's immune system attacks part of the peripheral nervous system. It often leads to paralysis, and can be fatal. 

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The FDA has announced that 114,350 pounds of shelled hazelnuts have been recalled due to concerns that they may be contaminated with Salmonella.  The nuts  were marketed by Willamette Shelling of Newberg, Oregon.  To this point, no illnesses have been reported.

The FDA provided this information on identification of the products involved:

All products subject to recall were packed in 25 lbs. and 50 lbs. corrugated boxes with lot code numbers 296091A, 299091A, 300091A, VH3696BO, and 310091A. Those corrugated boxes bore the following brand names: Kunze Farms, Evonuk Oregon Hazelnuts, Canadian Hazelnuts, and Firestone Farms.

In the past decade, nuts of various types have been more widely recognized as potential sources for Salmonella contamination, following a number of outbreaks:  PCA peanut butter, 2009; ConAgra peanut butter, 2007; raw almonds, 2004.   There have been other nut recalls as well, including a recall of pistachios in 2008. 

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An editorial from today's Bismark Tribune hits the nail squarely on the head--the job of public health departments is to protect and oversee the public's health.  That's why it is somewhat frustrating that many months after 150 people became ill from Salmonella infections after consuming or being exposed to contaminated food prepared by an unlicensed caterer in North Dakota, no official action has been taken against the business.

For a quick recap: "the unlicensed caterer continued to prepare and serve food after being issued a cease-and-desist order by the First District Health Unit following the outbreak one weekend in Washburn and before the second bout of food poisoning the following weekend."

"The board of directors of the First District Health Unit met in July, when all of the facts may not have been in, and decided to take not action at that time. That board isn't scheduled to meet again until sometime in February. While the Tribune can appreciate that the board of directors have a schedule they might want to adhere to, the caterer, victims and public deserve a certain timely attention. Public health issues are just that: "public" health issues."

"For those that might believe this is much to do about nothing, consider the cost for hospital visits and testing paid for by the victims and their health insurance companies. One out-of-state family said they spent about $4,000 in airline fares and hotel rooms dealing with their part of the crisis, and that doesn't include the cost of hospitalization of the husband and wife, both in their 70s."

"And then there's the physical price of being sick."

"The public needs to know that the Health Unit and other public health officials are focused on public safety. Good intentions and professional distance are fine things, but there's something to be said for taking care of business. The board of directors of the Health Unit should have met again months ago but now should meet as soon as possible and resolve all parts of this issue."

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The FDA refused 19 shipments of Canadian canola meal from Cargill in October after finding they contained the harmful bacteria salmonella, according to Reuters.   According to the report:

The shipments all come from Cargill's Clavet, Saskatchewan canola-crushing plant, according to reports posted on the FDA's website. The plant was already under shipping restrictions from the FDA for earlier canola meal shipments with salmonella.

Cargill did not provide a statement or response for the story.

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Ok, I admit that even the abstract from this article goes a bit over my head.   What I can decipher is scary enough - "Our findings indicate a varied spectrum of co-resistance traits is present in [antibiotic resistant] Salmonella in the U.S. meat supply."  The study was conducted on strains of Salmonella detected in retail meat in the U.S. between 2002-2006.

The presence of antibiotic resistant Salmonella in the U.S. meat supply is an ongoing threat to consumer health.  Earlier this year, Cargill was forced to recall over 800,000 of ground beef due to contamination with antibiotic resistant Salmonella Newport.

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Earlier this week, we reported here on the multi-state outbreak of Salmonella linked to pet turtles.   107 people were sickened in the outbreak, primarily children.   A report on the outbreak was published this week in the medical journal "Pediatrics."   Here is a link to the abstract of the article.   

The basics of the outbreak:

We identified 107 patients with outbreak-strain infections. The median patient age was 7 years; 33% were hospitalized. Forty-seven (60%) of 78 patients interviewed reported exposure to turtles during the week before illness; 41 (87%) were small turtles, and 16 (34%) were purchased in a retail pet store.

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After issuing a request for readers of the New York Times to submit their favorite rules about eating well, author Michael Pollan, of The Omnivore's Dilemma fame, has posted twenty of his favorites.  He starts with my personal favorite, "Don't eat egg salad from a vending machine."  No really, please don't.

Check out the other nineteen here.

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A newly published report provides more evidence of the long-term risks associated with foodborne pathogens Salmonella and Campylobacter.  Research by Dr. Lyn Sue Kahng was published in the journal "Gastroenterology" looking at the connection between these bacterial infections and Irritable Bowel Disease (IBD).  IBD is, according to the Mayo clinic:

"a common disorder that affects the large intestine (colon). [IBD] commonly causes cramping, abdominal pain, bloating gas, diarrhea and constipation."

Dr. Kahng's study finds that those that suffer Salmonella and Campylobacter infections are significantly more likely to develop IBD than the population at large.  Marler Clark has represented numerous individuals that have developed IBD, most commonly following Salmonella infections.   Some of these foodborne illness victims have slowly recovered their previous health, but many have been left chronically ill. 

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New research conducted in Israel suggests that the method that some bacteria, including Sallmonella, are enetering leafy greens is connected to light exposure, as reported today on an L.A. Times blog. 

The new study was published in the journal "Applied and Environmental Microbiology."  The findings, as reported by the L.A. Times:

Salmonella penetrates the lettuce leaf's deeper surfaces by entering little pores called stomata. These are the pores plants use to obtain and release gases during photosynthesis--the vital process by which light energy is captured and turned into sugars. There are rather nasty pictures in the article of rod-like salmonella clustered all around these stomata, seemingly going down into them and thus into the inner parts of the leaf.

The infromation could prove useful in limiting bacteria's access to leafy greens.  Such a step might help stem the tide of foodborne illness outbreaks tied to spinach, lettuce and other greens, involving pathogens like E. coli O157:H7, Salmonella, and Hepatitis A.

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They say you learn something new everyday, and even though its not lunchtime, I am ahead of that pace today.   The Sydney Morning Herald is reporting that several Salmonella illnesses in Western Australia have been linked to "pawpaw.":

West Australians have been warned to thoroughly wash pawpaw following several cases of food poisoning, including one in which a person required hospital treatment. The WA Department of Health issued a statement on Tuesday saying seven cases of salmonella poisoning linked to the tropical fruit had been uncovered over the past six weeks.

The first question in my mind, upon reading, was what is "pawpaw?"   Thanks to Al Gore's Internet, I have some ideas.   Turns out that at least two fruit go by the name "pawpaw."  The first, according to its "wiki" is native to the U.S.:

Pawpaw (Asimina) is a genus of small clustered trees with large leaves and fruit, native to North America. The genus includes the largest edible fruit indigenous to the continent. They are understory trees found in well drained deep fertile bottomland and hilly upland habitat. Pawpaw is in the same family (Annonaceae) as the custard-apple, cherimoya, sweetsop, ylang-ylang and soursop, and it is the only member of that family not confined to the tropics.

Since this didn't seem like the culprit, I pressed on to find in Australia the tropical papaya, or Carica papaya, is referred to as the "pawpaw".

So, if you have been as ignorant of these facts as I have, note a few things.  First, that there is a pawpaw fruit in the U.S.  Also, in Western Australia, the papaya is referred to as "pawpaw."  And right now, it makes sense to make very sure your Western Australia "pawpaw" is thoroughly washed, or perhaps avoided altogether for a few days.

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 On Tuesday, the FDA certainly took a step in the right direction by implementing the Reportable Food Registry, under federal regulations codified at 21 USC 350f.  The FDA's action essentially requires any food producer who knows of a microbial risk (e.g. bacteria or virus that can make you sick) in a food it produced, processed, packed, or held to report the problem to the FDA via the Reportable Food Registry.  As a somewhat necessary evil in drafting legislation or binding regs, the FDA regulations contain some big words that will, unfortunately, leave dedicated compliance to the food producer.  

Actually, I use the phrase "food producer who knows of a microbial risk" above more than a little loosely.  The actual wording, set forth at 21 USC 350, requires a food producer to report "an article of food (other than infant formula) for which there is a reasonable probability that the use of, or exposure to, such article of food will cause serious adverse health consequences or death to humans or animals."

Well, what constitutes a "reasonable probability?"  I can think of more than one instance where a food producer, either in PR statements or through their attorneys in litigation, has offered the excuse to liability that "so and so's E. coli [or any other pathogen] positive stool sample was only presumptively positive."  In other words, initial testing detected the presence of the bacteria, but the bacteria was not conclusively (more loose words) identified as the pathogen de jure by further confirmatory testing.  

The problem would unfold under the Reportable Food Registry very simply . . . something like this:  lettuce producer A generates a positive test for Salmonella in a certain lot of product intended for shipment to grocery stores.  Producer A's positive test came from its own private lab, or any independent third party laboratory--doesn't really matter.  Producer A does not report the initial, presumptively positive test because it believes, realistically or not, that a presumptive positive does not constitute a "reasonable probability that the use of [the lettuce] will cause serious adverse health consequences."  After all, it's only a presumptive positive, not confirmed as something dangerous until the confirming test occurs.  

Well, in this example, the confirming test does, in fact, occur, and it does, in fact, confirm that the bacteria that looked liked salmonella, walked like salmonella, and talked like salmonella was actually . . . salmonella.  In the meantime, the product has been shipped and sold by the grocery stores.  Consumers have eaten it and become ill.  Producer A does finally report the confirmed positive test, but not until after all the damage is done.  

I will point out here that this is not an impossible scenario.  Just last month, a strange sequence of events occurred where more than two weeks passed after a positive test until Melon Acres farm recalled cantaloupes that it had received a salmonella-positive test on.  Now the situation is not identical, but it illustrates the point that delays in testing, and reporting the results of tests, are not unheard of.  I'm sure we'd all be shocked to know how many positive tests actually occur on the food we consume generally.  

And lest we forget, we're only a few short months removed from the massive salmonella outbreak associated with peanuts from Peanut Corporation of America.  If you're reading this, you'll no doubt recall that PCA did not report or recall lots of product for which it received an initial positive test result for Salmonella.  Read this for a brief refresher on this despicable situation.  

In the end, just like the ultimate responsibility for producing safe food, the onus will rest squarely on the shoulders of the food producer to take necessary action to prevent people from getting sick from a product that the producer knows, or really should know, contains a microbial risk.  I admit to being a little biased, maybe even jaded in my confidence that all producers will fully and honestly discharge their obligations under the FDA's new regs.  Time will tell.  

Editor’s note:

According to the FDA press release: “The reporting requirement applies to all foods and animal feed regulated by the FDA (Excludes all beef, poultry, lamb and swine) …. The requirements apply to any person who has to submit registration information to the FDA for a food facility that manufactures, processes, packs, or holds food for human or animal consumption in the United States …. Facilities that manufacture, process or hold food for consumption in the United States now must tell the FDA within 24 hours if they find a reasonable probability that an article of food will cause severe health problems or death to a person or an animal …. Some examples of reasons a food may be reportable include bacterial contamination, allergen mislabeling or elevated levels of certain chemical components (So, if companies limit or stop end product testing? What you do not know will not hurt you? Customer’s perhaps?) …. These people are termed responsible parties.” A responsible party:

1. Must investigate the cause of the adulteration if the adulteration of food may have originated with the responsible party (So, if your supplier causes the contamination, you need to do nothing?) ….

Here is my major beef with this press release: “A responsible party is not required to report if it found the problem before the food was shipped, and corrected the problem or destroyed the food.” So, if a plant tests a sample of the product, but has not yet shipped it, no reporting required? Consider this, sample product testing does not assure that the product is NOT contaminate, only that the sample is. Sample product testing is a method of testing whether your manufacturing process is working. So, if you are getting positive sample tests, you have a problem – a problem that does not need to be reported? A few years ago, we had a case where a manufacturing facility tested end product for E. coli O157:H7 and found positives – for 30 days in a row. The company retained and destroyed those tested lots. However, it was a very small portion of a day’s production. Guess what happened? But, no reporting required?

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In my last post regarding a recent recall of cantaloupes in the upper midwest due to Salmonella contamination, you can tell that I was struck by the sequence of events being reported.  Melon Acres' recall notice went up on August 27; the FDA reported the Salmonella-positive test result on which the recall was based on August 21, a full six days before Melon Acres' recall notice; and the FDA's salmonella-positive test actually occurred on August 11.  Problem is, the melons were shipped to grocery stores, and maybe into consumers homes, on August 13 or 14.

We don't know all the details yet, but I'm not sure how many ways there are to spin this.  The bottom line appears to be that the Salmonella positive test result occurred more than two weeks before Melon Acres issued its recall notice, by which point the cantaloupes had certainly been distributed . . . and very likely sold to consumers. 

When seeing this, my immediate thought was, "what's the shelf life for cantaloupes after harvest" Pragmatism dictates that we at least look at whether the delays were justified, or not as big a deal as they appear to be at first blush.  I googled it and found an answer that, although a bit dependant on ripeness at harvest and other factors, the shelf life is not long enough to explain away a more than two week delay in recalling affected product.  Ripe cantaloupes should be consumed in not more than a few days.  Thus, there is much more than a theoretical risk that contaminated product will be consumed, particularly considering that these melons were distributed on August 13 or 14. 

Maybe nobody will get sick from these bad melons.  No way to tell yet because, if people did get sick, the epidemiological data is certainly not in the public domain yet.  But this episode is nonetheless distressing.  If a company's motivation for delaying recalls boils down to dollars and cents, they should take a lesson from companies, in fact entire industries, who have recently felt the economic impact of massive product recalls (PCA peanut recall cost the industry 1.5 billion dollars).  

Companies faced with a potential recall situation should consider this:  What really generates the damage are illnesses caused, not whether a notice goes up on the FDA website.  The reason is that illnesses, not simply recall notices, are what drive the sometimes frenetic media response.  

The media attention and other buzz that affects the bottom line will be much less significant if there are no illnesses, and I assure you that the best way to avoid making people sick, assuming that you know your product is contaminated, is to take it off of store shelves if you've got the chance.  Indeed, the only way for a food seller to protect its consumers is know the risks, and effectively communicate those risks to the public.  

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A company called Melon Acres, which is located in Oaktown, Ind., recently recalled cantaloupes that it had shipped to three states in the Midwest due to Salmonella contamination.  The bad, or potentially bad, melons made their way on August 13-14 to the Aldi's store in Greenwood Indiana, and Meijer stores in Lansing and Newport Michigan and Tipp City Ohio.  The company's recall notice indicates that nobody has yet become sickened by the contaminated melons.  The recall was prompted by FDA testing, which generated a positive result for Salmonella in the affected lots.

The affected melons were identified as 41 MG 10, bin numbers 4753-4980; the release didn't say how many bins were included in the recall. One melon in a sample of 20 tested positive for salmonella, according to the company's release.

Now recalls and outbreaks happen all the time--and this certainly is not the first go 'round for cantaloups--but I certainly hope that there is some explanation (it is probably too beurocratic to be comprehensible) for the FDA's failure to report the positive result for 10 days, as well as Melon Acres' failure to recall the melons until six days after receiving the report from the FDA.  

If people do end up getting sick as a result of ingesting Salmonella bacteria from these melons, we will be interested to find out the real answers to these seeming failures.  Unacceptable answers, at least from a civil-liability standpoint, will be that Melon Acres did not know precisely who received the contaminated melons; or that the test result was merely a presumptive positive rather than being confirmed by further testing days later.  

I understand that outbreaks are going to happen; and everybody agrees, i think, that everybody in the chain needs to do a better job of policing stores, testing for pathogens and preventing contamination from occuring in the first place.  But all efforts will undeniably be in vein if the regulators, and more importantly the companies being regulated, do not act quickly when their products are, in fact, contaminated.  That is the proverbial deal-breaker.  The entities with the last clear chance absolutely must be willing and able to act, preferring consumer safety over profit margins.  

 

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Ocean Mist Farms, a Castroville, California vegetable company, has issued a voluntary recall of iceless green onions due to potential contamination by Salmonella bacteria.  The company decided to issue the recall after confirmation from federal regulators of a positive test for salmonella on green onions supplied by Circle Produce to several shippers, including Ocean Mist Farms.

“The health and safety of our customers and their consumers always comes first. As soon as we learned of the positive test, it became our immediate responsibility to begin a voluntary recall of the product in the interest of protecting public health,” said Ed Boutonnet, president, Ocean Mist Farms. “We quickly traced back the product using our tracking system and will work closely with our customers and officials.”

Ocean Mist states that they have not yet been notified by, or heard of, any illnesses occurring as a result of the contamination.  Ocean Mist indicates, however, that It is possible that a small amount of product has already been purchased by consumers.

The recalled iceless green onion pack styles and code dates are as follows:

• 4 x 12 count
• 2 x 24 count
• 36 count 5.5 oz Cello Bag
• 40 count 5.5 oz Cello Bag

Trace Back Code: 95ONCP7G
Production Dates: 80309; 80709; 80809; 81109; 81209; 81309

Green onions and foodborne pathogens.  Certainly not the the first rodeo for this pair.  In late-October 2003, Chi-Chi's mexican restaurant in Pennsylvania was the sight of  a massive hepatitis A outbreak linked to raw green onions.  Ultimately, 650 people were confirmed to have been infected and multiple people died.  We represented about 50 people in the outbreak, including a gentleman named Richard Miller who had a liver transplant as a result of his illness.  Read more.
 

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The presence of antibiotic resistant Salmonella at the slaughterhouse may be one thing, but its presence in retail meat (i.e. its final stop before consumption) is yet another.  So how much retail meat (ground turkey, chicken, beef, and pork) is actually contaminated at the point of purchase?  And with what? 

An article in the New England Journal of Medicine reported on a study that answers these specific questions.  And the results of the study provide only more grist for the mill regarding the current debate over the non-adulterant status of antibiotic resistant Salmonella and other pathogens.  Click on image below to view entire article.

The scientists who performed the study selected 200 samples of ground meat (ground turkey, chicken, beef, and pork) being offered for sale at three grocery stores in the greater Washington, DC area:  98 from one store, 54 from the second, and 48 from the third.  Testing revealed an alarming level of contamination . . . in my opinion.  Salmonella isolates were recovered from 41 of the 200 samples, with 4 samples testing postive for more than one strain of Salmonella.  In total, 13 different strains accounted for the 45 Salmonella isolates.  Adding to the level of concern, and hopefully the debate over the USDA/FSIS definition of "adulterant," was that 38 of 45 isolates (that's 84%) displayed resistance to at least one antibiotic, and 24 of 45 isolates (53%) displayed resistance to at least three antibiotics. 

Constructive dialogue on this important issue can only help delineate the arguments, both for and against expanding the USDA/FSIS's current definition of adulterant to include more bugs that kill people.  I guess you could say i'm biased because the people who have been injured or killed, or their families, are the folks we work for.  But even putting that aside, doesn't it make just plain good sense that something as harmful, and apparently as prevalent, as antibiotic resistant Salmonella and other dangerous pathogens should be considered "adulterants" on the foods we consume?  What are the counter arguments?   I know they can't be that this is just an issue of passing concern.  As one commenter on one of my recent blog posts puts it:   

It is unlikely we can reverse this process or reduce their existance by not using antibiotic resistant bacterial. Once these new organism is formed they only multiply and spread. You can see what happened with HA-MRSA since 1980s.

So what are the counter arguments?

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The Canadian Press is reporting that the Canadian Food Inspection Agency has issued a salmonella warning about green onions sold at six stores in the Windsor-Essex area of southwestern Ontario.

The report states:

The agency is warning people not to eat the jumbo green onions imported by Vitale Produce of Windsor, because they could be contaminated with salmonella.

The onions were sold at Food Basics in downtown Windsor, Isaac's Foodtown in Comber, Sanford and Son in Harrow, The Stoney Point Supermarket, and Westside Foods and Vitale Produce in Windsor.

To this point, no illnesses have been reported.   Green onions have been connected to outbreaks in the past, including the notorious Hepatitis-A outbreak at a Chi-Chi's restaurant in the Pittsburgh area in 2003.

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The health staff writers over at the LA Times have written a great article, Eating With the Enemy, on the growing prevalence of widespread foodborne illnesses stemming from products as seemingly disparate as ground beef, romaine lettuce, cilantro, Anaheim peppers, granola nut clusters, alfalfa sprouts and of course, peanuts.  The article serves as a preface to a fantastic and informative in-depth piece, The Science of Salmonella, covering many details of the ubiquitous Salmonella bacteria.  This is the same bacteria responsible for the laundry list of food items just mentioned, and includes the current antibiotic-resistant Salmonella Newport outbreak associated with Fresno, California’s Beef Packers, Inc (aka Cargill). ground beef products.

As the writers aptly point out, “Food-borne illnesses have always been with us, but outbreaks of food poisoning are no longer confined to a select few who ate improperly cooked antelope or who chose unwisely at the company picnic. The sheer complexity of modern food production gives the bacteria responsible for food-borne illnesses almost infinitely greater range.”  This point was well illustrated just this past winter when Salmonella contaminated peanuts manufactured by the now-defunct Peanut Corporation of America managed to sicken over 700 people (although the actual number is probably closer to 25,000), and resulted in the recall of over 4,000 products at a economic cost estimated to be hovering somewhere around $1.5 billion.  And it all resulted from a 90 person company accounting for only 2.5% of the US's entire annual peanut crop.

To that end, the federal government has finally taken some forward steps beginning with the House’s recent passage of HR 2749, a bill that would, among other things, overhaul US food safety laws by increasing the Food and Drug Administration's authority to inspect food manufacturers and requiring it to craft a better way of tracing food-borne illnesses and giving it greater recall powers.  For a more in-depth analysis of this dense piece of legislation, check out Marler Blog here.  Farmers and food processors would be required to do their part as well under the new laws.  The Senate is expected to consider a similar measure after its August recess.

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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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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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Today the USDA Food Safety and Inspection Service (FSIS) announced a recall of ground beef products due to possible Salmonella contamination. According to the press release, “Beef Packers, Inc. [BPI]…is recalling approximately 825,769 pounds of ground beef products that may be linked to an outbreak of salmonellosis.” The link between confirmed Salmonella infections and consumption of BPI ground beef products was first discovered by the Colorado Department of Public Health, and a subsequent traceback investigation conducted by FSIS.

This recall was, for me, surprising news—and also inexplicable given the USDA’s long-held position that Salmonella is not an adulterant per se in raw meat, and the meat industry’s prior success in getting a court to invalidate Salmonella performance standards that the USDA had tried to implement as part of its Pathogen Reduction, HACCP regulations adopted in 1996. So when I read about this recall, my first thought was to wonder why BPI agreed to the recall. (Remember: FSIS lacks the statutory authority to compel a recall.) And my second thought was: I wonder if the meat industry is going to sue the USDA to try and prevent the Agency from seeking a second recall in the future based on possible Salmonella contamination.

I obviously cannot answer either of these questions. But I can provide some useful background information about why this particular recall is so surprising, and so inexplicable. (And, by the way, by inexplicable I mean that it is nearly impossible to explain how FSIS could take this action in light of 25 years worth of policy and court decisions that would appear to suggest that the Agency has no authority to do what it did. The recall is certainly NOT inexplicable from a public health and safety perspective, which is certainly ironic given the fact that the FSIS has the term “safety” in its name, and doing something in favor of safety should not be inexplicable.)

And so now onto some history:

In 1971 the American Public Health Association (APHA) sued the USDA on the grounds that its mark of inspection (“USDA inspected for wholesomeness”) was misleading because, even though the USDA had put its stamp of approval on meat—literally—it did not, for example, test the meat for bacteria. Moreover, APHA argued that raw meat was commonly contaminated with Salmonella, which posed a risk to the public health. According to APHA, the USDA should instead require that meat carry both a warning label and cooking instructions. The USDA opposed the APHA, helped ably (and predictably) by the meat industry. As quoted by Marion Nestle in her great book, Safe Food, the USDA’s position was that, given how many foods are contaminated with Salmonella, “it would be unjustified to single out the meat industry and ask that the [USDA] require it to identify its raw products as being hazardous to health.” Nestle at 66. (Note to Reader: No, I am really not making this up.)

In 1974, the DC Circuit Court of Appeals upheld the position of the USDA and the meat industry, doing so in a way that was as nonsensical as it was sexist. The court stated that: “The presence of salmonellae on meat does not constitute adulteration within this definition [of ‘adulterated,’ provided in 21 U.S.C. § 601 (m)]….As it said in its letter of August 18, 1971 ‘the American consumer knows that raw meat and poultry are not sterile and, if handled improperly, perhaps could cause illness." In other words, American housewives and cooks normally are not ignorant or stupid and their methods of preparing and cooking of food do not ordinarily result in salmonellosis.’” APHA v. Butz, 511 F.2d 331, 334 (1974).

This remained the position of the USDA and the meat industry until 1994 when, in an act of both common-sense and bravado, Michael Taylor, then FSIS Administrator, announced that E. coli O157:H7 would be deemed an adulterant in raw ground beef. The Agency did not, however, change its tune with regard to any other pathogens, especially Salmonella. Indeed, in 1999, when FSIS announced it inane distinction between E. coli O157:H7 in “intact” meat versus “non-intact” meat, the Agency continued to focus on how a given meat was “customarily cooked” as a chief determinant of whether it must be treated as an adulterant. Thus, for example, because it decided that “intact steaks and roasts are customarily cooked in a manner that ensures that these products are not contaminated with E. coli O157:H7,” there was no need to treat this deadly pathogen as an adulterant on intact cuts of meat. Of course, this FSIS policy is also one that appears to have been silently jettisoned by the Agency of late. (For more on this, see my prior post “More Doubletalk from the USDA on E. coli and Swift Meat Recall,” at  www.foodpoisonjournal.com/2009/07/articles/food-policy-regulation/more-doubletalk-from-usda-on-e-coli-and-swift-meat-recall/)

The Agency’s position on Salmonella and meat came back to haunt it in a big way when FSIS tried to shut down Supreme Beef Processors, Inc. for repeatedly failing Salmonella performance standards that, according to the Agency, was proof that the ground beef being made there was being processed under “insanitary conditions.” Supreme Beef sued the USDA and not only won an injunction, but it succeeded in having the Salmonella regulations struck down as being “beyond the authority granted the Secretary [of the USDA] by the Federal Meat Inspection Act.” Supreme Beef  v. USDA, 275 F.3d 432, 434 (5th Cir. 2001). Explaining its holding, the Court wrote:

The difficulty in this case arises, in part, because Salmonella, present in a substantial proportion of meat and poultry products, is not an adulterant per se, 21 meaning its presence does not require the USDA to refuse to stamp such meat "inspected and passed." 22 This is because normal cooking practices for meat and poultry destroy the Salmonella organism, 23 and therefore the presence of Salmonella in meat products does not render them "injurious to health" 24 for purposes of § 601(m)(1). Salmonella-infected beef is thus routinely labeled "inspected and passed" by USDA inspectors and is legal to sell to the consumer.

Supreme Beef, 275 F.2d at 438-39. And, of course, not surprisingly, the court in this case was quick to cite the decision in APHA v. Butz, and to note that even now the “USDA agrees that Salmonella is not an adulterant per se.” Id. at 439 n. 21.

In my view the Supreme Beef decision is poorly reasoned and ill-informed. (For example, could not someone at the Court figure out that it is impossible for meat to be “infected” with Salmonella, and the proper term here is “contaminated”?) But the real lesson of Supreme Beef is that the USDA was, and continues to be, an Agency that is unable to decide whose side it is on. Sometimes it puts on its public safety hat, and sometimes—actually, most often—it puts on its pro-meat industry hat. And, unfortunately, these roles are too often contradictory. That is why USDA policy when it comes to meat safety is also too often contradictory.

So how does the USDA square today’s recall of Salmonella-contaminated meat with the last 25 years of Agency policy on meat adulteration standards? It cannot. But let us hope that if the meat industry decides to sue to scuttle what appears to be a new and better policy on Salmonella in meat that this time the USDA decides to stand with the public on the side of meat safety.

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 United Food Group announced several days ago that a number of its products contained instant non-fat dried milk subject to the already massive recall of food products made with instnat non-fat dried milk from Plainview Milk Products Cooperative.  In June of this year, Plainview Milk Products recalled dried milk produced at its Plainview, MN facility during most of 2007, all of 2008, and most of 2009 (up until the time that the problems were discovered and the recall announced).  The recall was announced due to possible Salmonella contamination of the milk.

Plainview's dried milk apparently is an ingredient in an enormous quantity of products distributed throughout the United States.  This has forced an impressive list of food manufacturers to recall products that include Plainview's dried milk as an ingredient.  The current, complete list of recalled products can be found at http://www.accessdata.fda.gov/scripts/Milk/.  

During an investigation of the Plainview facility, FDA found that some of the equipment was contaminated with Salmonella. At this time, the Centers for Disease Control and Prevention has not linked any human illnesses to potentially contaminated products from the Plainview facility.

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The Colorado Department of Public Health and Environment (CDPHE) issued an updated Salmonella outbreak alert on Juy 31. In it, CDPHE announced that 21 cases of antibiotic-resistant Salmonella Newport have been reported in Colorado. Most ill individuals sick with Salmonella Newport reported experiencing symptoms of Salmonella infection beginning in late June or early July, and while CDPHE did not announce that a second ground beef recall had been issued, the agency did warn consumers about the possibility that ground beef they have in their freezers could be contaminated with antibiotic-resistant strains of Salmonella.

This most recent drug-resistant Salmonella outbreak follows on the heels of a July 22, 2009 USDA announcement that King Soopers was recalling ground beef for Salmonella contamination. The recalled meat was also contaminated with antibiotic-resistant Salmonella (DT104), and was source of a Salmonella outbreak among residents of several states. According to news reports, most of the illnesses reportedly associated with the earlier Salmonella DT104 outbreak were also among Colorado residents. 

In its July 31 press release, CDPHE stated:

This is the second large Salmonella outbreak that the department has investigated in July. Both outbreaks have been linked to ground beef. Further investigation with the USDA in to the source of the meat in this outbreak is ongoing.

Alicia Cronquist, the foodborne disease epidemiologist at the state health department, said, “We can’t be certain that ground beef is the source of these infections, but we are concerned enough that it might be and want consumers to be aware.”

Antibiotic-resistant Salmonella contamination in ground beef has increasingly been implicated as the source of human illness. On its drug-resistant Salmonella page, the World Health Organization states:

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.

While activities addressing the occurrence of antimicrobial resistance in foodborne microorganisms are ongoing, the magnitude of the problem is largely unknown in many countries. International collaborative efforts, including efforts in support of surveillance and risk assessment, need to be increased.

H.R. 1549 - Preservation of Antibiotics for Medical Treatment Act of 2009 proposes the restriction of antibiotic use in feed animals to therapeutic purposes only to prevent the emergence of additional antibiotic-resistant strains of Salmonella and other foodborne pathogens in our food supply. The passage of this bill could be a huge step toward preventing future outbreaks like the two that have struck in Colorado this summer. 

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The FDA announced several days ago that Frontera Produce of Texas was recalling cilantro due to potential contamination with Salmonella.  Neither the FDA nor Frontera, however, provided the identities of the retailers where the cilantro in question had been sold.  Thankfully, state health officials in Colorado have identifed a set of Wal-Mart stores that are implicated, according to the Colorado AP.    It appears that Frontera has also now confirmed that the cilantro was sold at Wal-Mart stores in the Alamosa, Trinidad, La Junta, Cortez, and Durango areas.   Further:

State health official say people who bought the cilantro between July 20 and July 27 should check their refrigerators and toss it or return it.

The product's lot number is 118122. The cilantro bunches have a white twist tie with pink lettering spelling the word 'cilantro' and the UPC number 033383801049.

Interestingly, Wal-Mart previously claimed that Frontera was the supplier of jalapeno peppers to the Cortez, Colorado Wal-Mart that later tested positive for Salmonella Saint Paul in connection with a 2008 outbreak that sickened over 1,000 indiviudals.    

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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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Frontera Produce, of Texas, is recalling a lot of cilantro that may be contaminated with Salmonella, according to The Packer.    Frontera is not, however, releasing  to the public the names of the retailers that received the recalled lot.  According to the story:

Frontera identified the lot as 118122, and said it was distributed to two retail chains that have stores in Texas, Oklahoma, Colorado, Louisiana and New Mexico.  Frontera did not identify the retailers.

Frontera said it has advised both supermarket chains of the situation and provided each with case tag identification.

Consumers are advised to destroy the cilantro which could have been purchased between July 20-27.

The cilantro bunches have a white twist tie with pink lettering spelling the word ‘Cilantro’ and the Universal Product Code number 033383801049. 

If Frontera is honestly trying to have consumers heed the recall, they need to provide the names of the retailers.   And FDA should be requiring the information to be public as well. 

Frontera was previously named as a defendant in litigation following last summers Salmonella Saint Paul outbreak.   In that case, the plaintiffs' left-over jalapeno peppers, purchased at Wal-Mart, tested positive for Salmonella Saint Paul.   Wal-Mart disclosed that the peppers in question were distributed by Frontera.

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Today's Boston Globe features a recipe for grilled chicken salad with pecans and cranberries.  I make variations of this recipe frequently, and was excited to see whether the Boston Globe recipe included any new ingredients that I could add to my mix.  I read through the ingredient list and didn't find anything particularly inspiring that I haven't already used before, but when I got to the instructions I was shocked to read the first one, which included the sentence, "When the grill is hot, cook the chicken breasts for 25 minutes, turning once, or until the juices run clear."

Cook until juices run clear used to be a standard instruction for poultry recipes before we learned that Salmonella is not just an egg problem, and that Salmonella can grow inside chickens.  When the juices from the piece of chicken you are cooking run clear, this is not an assurance that the chicken has reached a USDA-recommended 165 degrees Fahrenheit for poultry.

USDA's press release on the minimum internal temperature to ensure the safety of cooked poultry includes the following information:

The single minimum internal temperature requirement of 165°F was recommended by the National Advisory Committee on Microbiological Criteria for Foods (NACMCF).

"The Committee was asked to determine a single minimum temperature for poultry at which consumers can be confident that pathogens and viruses will be destroyed," said Under Secretary for Food Safety Dr. Richard Raymond. "The recommendation is based on the best scientific data available and will serve as a foundation for our programs designed to reduce foodborne illness and protect public health."

Scientific research indicates that foodborne pathogens and viruses, such as Salmonella, Campylobacter and the avian influenza virus, are destroyed when poultry is cooked to an internal temperature of 165°F. FSIS recommends the use of a food thermometer to monitor internal temperature. In addition, consumers should follow important tips for handling raw poultry. These tips can be summarized in three words–clean, separate and chill. Clean means to wash hands and surfaces often; separate means to keep raw meat and poultry apart from cooked foods; chill means to refrigerate or freeze foods promptly.

The only way to know whether your chicken is cooked to a hot enough temperature to ensure food safety is to use a thermometer to ensure that the internal temperature reaches 165.  Don't rely on visual clues such as the juices running clear. 

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Tanimura & Antle, Inc. recalled one lot of romaine lettuce for Salmonella contamination yesterday after a Wisconsin Department of Agriculture test came back positive for the bacterium. According to a press release on the Tanimura & Antle website:

Within hours of being notified yesterday, Tanimura & Antle, Inc. traced back the entire lot of romaine and advised all customers who received the recalled product of the test result. Tanimura & Antle, Inc. has instructed these customers to destroy the product. Although the recalled product is past its shelf life, the company is issuing this voluntary recall out of an abundance of caution to ensure that any product purchased by consumers will also be destroyed. Consumers who have purchased the recalled romaine as described above should not consume it, and should destroy the product.

The cartons of bulk or wrapped romaine being recalled are marked with the lot code 531380 and were harvested June 25 - July 2. This recall includes only this single lot of romaine; no other products are involved.

The recalled romaine was sold to retail, wholesale and food service outlets in Canada, Puerto Rico and the following 29 states: Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Kentucky, Texas, Massachusetts, Louisiana, Pennsylvania, Tennessee, North Carolina,

 Michigan, Missouri, Nebraska, New Hampshire, New Mexico, Nevada, Ohio, Oregon, Utah, Virginia, Wisconsin, Wyoming.

Produce can become contaminated with Salmonella in a number of ways. Contaminated farm equipment can contaminate produce if it comes into direct contact with raw untreated manure, untreated compost, contaminated water, animals that shed Salmonella in their feces, or with people who somehow become contaminated. Fresh produce exposed to flood waters that carry Salmonella can become contaminated pre-harvest. Runoff water that could potentially carry Salmonella should be diverted from fields growing fresh produce and should not be used for irrigation. 

Fresh produce fields in rural areas next to wetlands or wildlands are particularly susceptible to exposure by wild animals such as deer and wild boars that harbor Salmonella and other pathogenic bacteria. Domestic animals and livestock that make their way into fields can also contaminate fresh produce, as can field workers who are shedding Salmonella in their stool if they do not use proper hand-washing techniques, or if proper toilet facilities are not available to them in the fields where they work.  

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The FDA announced recently another recall of sprouts.  Here is the release:

Kowalke Family Sprouts of Los Angeles CA is recalling all Kowalke Family Sprouts Brand Alfalfa Products with sell-by dates from June 18 through June 30 because they may be contaminated with Salmonella, which can cause serious illness. Mike’s Produce, Inc. dba Kowalke Family Sprouts is voluntarily recalling the alfalfa products after receiving notification that a surveillance sample taken at a retail location with a June 21 sell-by date tested positive for Salmonella.

No illnesses have been reported from these products. Kowalke Family Sprouts has informed the Food and Drug Administration of its actions and is fully cooperating with the Agency.

The alfalfa sprouts tested negative for the presence of Salmonella prior to being shipped to retailers. Nonetheless, the firm is recalling all sprouts from this seed lot out of abundance of caution in response to being notified of alfalfa sprout seeds that may have been contaminated with Salmonella.

Kowalke Family Sprouts meets all FDA disinfection, processing, and pathogen testing guidelines. In addition, the FDA tested for the presence of Salmonella on sprout growing equipment, food contact surfaces, walls, floors, and drains at the Kowalke Family Sprouts facility. All tests results were negative. The FDA found no Salmonella at the Kowalke Family Sprouts facility.

Kowalke alfalfa products are sold in 4 oz, 8 oz, 1 pound and 5 pound clear plastic, clam shell packages. Two other Kowalke products also contain alfalfa sprouts - the Dinner Salad in a 6 oz package and the Onion/Alfalfa Mix in a 4 oz package.

These products were sold to produce distributors in Los Angeles and to retail stores in Southern California, Nevada, and Arizona. It is possible the sprouts may have been transported to other states.
 

I will note that the Kowalke seems to have done the right thing in initiating a voluntary recall after receiving a positive test result for Salmonella on product back in June.  We hope that the recall had its intended effect.  Too many have become ill from sprouts lately.

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Georgia's agricultural problems continue as Anaheim peppers are recalled from distribution in Ohio and two other states.  WTTE and the Associated Press report that Herring Produce is recalling half-bushel boxes of the peppers due to Salmonella contamination.  The affected peppers carry the lot number 0801206.

Georgia agriculture suffered quite a blow when the Peanut Corporation of America's facility in Blakeley, GA was determined to be the source of a nationwide outbreak of Salmonella in peanut products that sickened 700 and caused the deaths of nine.  Consumers stayed away from peanuts, and consumption dropped 25%.  Georgia, the country's largest peanut producer, felt the chilling effects of that drop.

In the wake of the PCA outbreak, Georgia tightened regulation for foodborne pathogens in processing plants.  According to Beth Bland of the Georgia Fruit and Vegetable Growers Association, that regulation does not change oversight of fresh food growers.

Ms. Bland also knew the other states involved in the recall, New York and Massachusetts.  "There was only one positive sample found," she said.  "And that was in New York."

No illnesses have been associated with the contaminated peppers. 

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Another day, another product pulled over Salmonella fears.   Minnpost.com is reporting that General Mills has recalled "some" of its Nature Valley Granola Nut Clusters products due to concerns over potentially contaminated pecans.  The recall includes products with the following "best if used by dates": 07MAR2010, 08MAR2010, 09MAR2010, 10MAR2010, 11MAR2010.

General Mills says in its press release: "This action is being taken as a precaution because pecans received from a supplier and used in the product may be tainted with salmonella."

Sure would be nice to know which supplier, and whether or not this supplier has any other customers beyond General Mills.  Are there more products and recalls to follow?  Is there a regulatory agency involved?

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This is no way to get healthy, and certainly much too dangerous of a way to lose weight.  The number of recalls related to Salmonella grew again today with the addition of two new products - "Stealth" brand powdered dietary supplement and "Weigh Down" chocolate flavor nutrition drink.  The two recalls, according to the Associated Press:   

• Vital Pharmaceuticals Inc. is recalling 17 lots of Stealth Chocolate and Stealth Vanilla powdered dietary supplement. The supplements were available nationwide. Details: by phone at 800-954-7904.

Lewis Laboratories International Ltd. is recalling select lots of Weigh Down chocolate flavor nutrition drink mix. The recalled product has one distributor in New York and was sold online and through mail order. Details: by phone at 800-243-6020.

Thankfully, no illnesses have yet been linked to the product.

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 At 10:30 AM today, Agriculture Secretary Vilsack, HHS Secretary Sebelius, and Vice-President Biden will issue “key finding,” according to an email from Nick Shapiro, Office of the Press Secretary, in The White House, that was sent to several media outlets. According to press release, entitled President’s Food Safety Working Group: Delivering Results, the Obama administration is going to implement “a new public health-focused approach to food safety based on three core principles: (1) prioritizing prevention; (2) strengthening surveillance and enforcement; and (3) improving response and recovery.” Although these principles are laudable, and anything would be an improvement over the Bush administration’s efforts to put industry profits above the public health, most of what is being announced today is recycled from Clinton years, and all are incremental steps that seek improvements around the edges rather than the much needed structural change to the U.S. food safety system.

What follows is a point-by-point commentary and critique of today’s announced policy changes and renewed initiatives. As I think you will see, there is not a lot radical going on here. (Please click on the Continue Reading link to read more.)

Preventing Salmonella Contamination: Here the press release notes that,” Despite support from consumer advocates and the egg industry, the Federal government has been unable to finalize basic rules on egg safety to prevent contamination.” And this is true, but eggs stopped being the biggest cause of Salmonella infection quite some time ago. In 2007, for Salmonella infections attributed to a food source, the outbreaks were caused by contaminated peanut butter, frozen pot pies, and puffed snack food. Moreover, hard data does not exist with regard to the prevalence of Salmonella in eggs in the United States, making the estimates about potential savings and illness-reduction speculative at best. As the USDA Agricultural Research Service pointed out in a report issued in 2007:

Market egg sampling data has never been collected in the United States on a national basis and no regional sampling data has been collected in 10 years. Salmonella outbreaks continue to be attributed to eggs and no progress has been made in several years in decreasing incidence.

The report then concluded: “USDA does not believe that this project is feasible given current budgets, limited extramural funding sources, and the existence of more pressing food safety issues such as attribution of illness to produce.” Full report here: www.ars.usda.gov/research/publications/publications.htm

The press release also touts an effort of the USDA to, by the end of the year, “develop new standards to reduce the prevalence of Salmonella in turkeys and poultry.” But here, again, the approach is incremental (if not merely symbolic), and fails to consider a better alternative: namely, the ELIMINATION of Salmonella (and Campylobacter) from eggs and poultry, something that was years ago achieved in other countries, like Denmark.

Reducing the Threat of E. coli O157:H7: According the press release, there is going to be “stepped up enforcement in beef facilities,” including “ issuing improved instructions to [inspectors]…to find this pathogen, focusing largely on the components that go into making ground beef.” There is no lack of irony in this announcement given that it is being made as we are in the midst of the second huge recall in two years of intact cuts of beef linked to large numbers of serious E. coli O157:H7 infection—the current recall being that linked to JBS Swift meat processed in Greeley, Colorado, and the previous one involving Nebraska Beef Ltd.

The release also touts the fact that USDA Food Safety and Inspection Service (FSIS) is “increasing its sampling to find this pathogen.” But as a senior FSIS official has already admitted about this increase in E. coli testing, the sampling plan does not even come close to attaining statistically significant results. (I have previously blogged about the largely symbolic nature of this increased testing, and that blog-post can be found here: www.foodpoisonjournal.com/tags/zero-tolerance/

Preventing Contamination of Leafy Greens, Melons, and Tomatoes: And perhaps in what is my favorite bit of tap-dancing and window-dressing, the press release announces that, “[b]y the end of the month, FDA will issue commodity-specific draft guidance on preventive controls that industry can implement to reduce the risk of microbial contamination in the production and distribution of tomatoes, melons, and leafy greens. These proposals will help the Federal government establish a minimum standard for production across the country. Over the next two years, FDA will seek public comment and work to require adoption of these approaches through regulation.” OH, YIPPEE!!! Yet another “draft guidance” from the FDA on produce safety, and a promise that, in two years or so, the agency will “work to require adoption of these approaches.” In other words, no change here. And if you would like to have a look at just how long the FDA has been making“suggestions” on produce safety, have a look at the produce safety initiative announced on May 6, 1998, and the issuance of ‘‘Guidance for Industry: Guide to Minimize Microbial Food Safety Hazards for Fresh Fruits and Vegetables,’’ which was the FDA’s first attempt to the same thing it says it is going to this time try to do again. See here: www.fda.gov/ohrms/dockets/98fr/050698b.pdf And: www.foodsafety.gov/~dms/prodguid.html

One other suggestion of my own: If the FDA wants to get serious about produce safety, then it should read the multiple reports issued by the Food Safety Project at Georgetown University, which can be found here: www.producesafetyproject.org/reports

The press release announces other mostly recycled initiatives, which I will address in a follow-up post. So let me end here by saying that increased food safety efforts are nice, but results are all that matters. And the initiatives announced today may sound good, but they are unlikely to change much.  What is needed is a structural overhaul of the US food safety system. 
 

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Over the 4th of July holiday, many Americans will get together for picnics, barbeques, and other gatherings.  For many, food will take center stage, and hopefully proper food safety practices will ensure that in the days following these gatherings people will not be doubled-over in pain, running to and from the bathroom because of something they ate.  The FDA has published recommendations for keeping food safe when eating outdoors that could be useful in helping prevent foodborne illness among your friends and family. 

For some, water - not drinking water - will take center stage.  And water sources can contain some of the same pathogens as food sources.  Pools, recreational water, and even municipal water sources have been pinpointed as the source of E. coli, cryptosporidium, Salmonella, and other outbreaks in recent years.   (See Cryptosporidiosis: A Recreational Water Threat That Hasn’t Gone Away)

Water sources can become contaminated with E. coli and other pathogens in a variety of ways. Water that is downstream from cattle pastures, feed lots, or barns can easily become contaminated with pathogens from runoff. When lakes become contaminated, several weeks or months can pass before water quality conditions improve or return to normal.  

Pools can become contaminated with E. coli by animal feces or through fecal contamination from an infected person. Children who are not yet toilet trained and soil diapers while playing in water have been identified as the source of several outbreaks. Proper chlorine levels must be maintained to prevent the spread of E. coli in pools and at water parks. 

In 1998, an E. coli O157:H7 outbreak was traced to an infected toddler who played in a pool at the White Water Water Park outside Atlanta, Georgia. Although the pool was chlorinated, the chlorine concentration and contact time was presumably insufficient to kill the E. coli resulting from fecal contamination by the toddler, and other children who were in the pool ingested E. coli bacteria while playing in the pool. Twenty-six culture-confirmed E. coli cases were identified during the outbreak, and 40 percent of children under five years of age with recognized E. coli infections were diagnosed with hemolytic uremic syndrome (HUS).

In 2005, thousands of people fell ill with cryptosporidiosis, a gastrointestinal illness that causes diarrhea and vomiting, after visiting the spraypark at the Seneca Lake State Park in New York State.  By the time the public health investigation had concluded, at least 3,900 people in New York had reported becoming ill with cryptosporidiosis after taking part in recreational activities at the spraypark, which is located near Geneva. Cryptosporidium was found in two water storage tanks that supplied the 11,000-square-foot spraypark.  Since that time, the spraypark has undergone a renovation for its water storage devices. 

When municipal water sources become contaminated, systems must be flushed to ensure all bacteria has been eliminated from the system, and chlorine levels high enough to kill any bacteria, parasites, or viruses must be introduced.

In 2008, the Colorado Department of Public Health and Environment (CDPHE) reported that 417 people became ill with Salmonella after drinking water from the Alamosa municipal water system, and one resident died. The Centers for Disease Control and Prevention (CDC) and CDPHE confirmed the presence of Salmonella in five out of six water samples taken from various areas around Alamosa, and laboratory results confirmed the presence of Salmonella in the water system, which was flushed in a three-stage water treatment process beginning March 25.

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Wegman's grocery chain (73 stores in five states--MD, PA, NJ, NY, and VA) issued a recall yesterday for all fresh Anaheim peppers sold in its produce departments due to concerns of possible Salmonella contamination.  The recall involves all Anaheim peppers sold at Wegman's since June 11, 2009.  The FDA is currently investigating, and we have received no word, yet, whether there are any illnesses associated with the contaminated peppers.

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I'm no longer surprised when we get word of an outbreak associated with some new, seemingly innocuous food item.  Cookie dough for Christ's sake.  Elissa Elan reported this week that Dunkin Doughnuts learned that its supplier of instant non-fat dried milk and whey protein (Plainview Milk Products Cooperative of Plainview, Minn) had detected Salmonella on some of its equipment used to produce the products. 

Good catch.  Salmonella, or any pathogen, on equipment is bad news for consumers.  In some situations, it's even worse than a single contaminated food item because, while a single contaminated item will pass through the production process and likely sicken a few, a contaminated piece of equipment may contaminate every food item that passes through it.  This means lots of people get sick, sometimes over long periods of time, which can frustrate public health efforts to determine how people are becoming ill. 

Hopefully the problem at Dunkin, or Plainview Milk Products, is taken care of.  Dunkin certainly did the right thing by immediately stopping the sale of any of its products with a Plainview ingredient until the problem there can be fixed. 

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The FDA announced a recall of milk products on its website yesterday:

Plainview Milk Products Cooperative, Plainview, Minn., is voluntarily recalling instant nonfat dried milk, whey protein, fruit stabilizers, and gums (thickening agents) that it has manufactured over the past two years, because they might be contaminated with Salmonella.

Fortunately, no illnesses have yet been linked to the recall.   The recall was initiated when the FDA inspected the Plainview facility and "found that some of the equipment was contaminated with Salmonella."  The FDA was inspecting the plant as a result of testing done by the USDA that found Salmonella in a company product not intended for retail sale.

Hopefully, the recall was announced in time to avoid human illness.   The sequence of events is an excellent example of why companies shouldn't be fighting tooth and nail against increased inspection and testing.   If the USDA and the FDA had not uncovered both contaminated product and equipment, it would have been much more likely that ongoing contamination of product, and therefore human illness would have eventually resulted. This recall can only rightly be viewed as the less expensive outcome for both the company, and consumers.

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We are in the midst of another sprouts recall.    Sprouts from Kowalke Organics from Culver City, California are being pulled from shelves over potential contamination with Salmonella.    According to the LA Times:  "Mike Matthews, Kowalke’s owner, told the Associated Press that only one package -- with the sell-by date of June 21 -- tested positive for salmonella, so far."   There is not yet confirmation of illness associated with this latest recall.  Still, Mr. Matthews comment brings up again how misleading statements like this can be.

A perfect example is last summer's E. coli O157:H7 outbreak traced to lettuce.  Health officials gathered overwhelming  epidemiological evidence to implicate the product.   The producer, though, kept crowing to the press about how none of the lettuce tested from its plant tested positive.  Of course, health officials were forced to point out that the product tested was CURRENT PRODUCT, i.e. the product in the plant at the time the outbreak was recognized.   Thank goodness there wasn't STILL contaminated product on hand.  The product actually implicated in the outbreak was long gone, and could not be tested.

In outbreaks involving perishable items, such as produce, finding product produced and packaged at a time that coincides with product implicated in an outbreak is very unusual.  Think about this very plausible, but hypothetical, time line.   Produce goes out, lets say lettuce, processed on July 1.   It hits the shelves on July 5.   On July 7 its purchased, and then consumed two days later on July 9.  The incubation period for E. coli O157:H7 generally runs 2 days to a week.   So let's say the consumer has onset of symptoms on July 12.  By July 14, the consumer is sick enough to go to the doctor.  If we are lucky, a stool culture is ordered the first day of medical care.  Results return 48 hours later, and now it is July 16.   A good health department is notified of the illness, and interviews the consumer for a food history immediately.  It's now July 17.  Before health officials are testing product, there usually need to be multiple illnesses that suggest a product as a culprit.  Even assuming the best time line, it is probably nearly three weeks from processing to the opportunity to test product.  By then, product processed on July 1 has been consumed or discarded.

So, the next time you hear a produce supplier tell you that "none of our product has tested positive," bear this in mind.  Such proclamations are essentially worthless at best, and more likely misleading.

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In the midst of yet another sprouts recall (see Bill's recent blog-post), I received an email from a concerned sprout grower.  I will freely admit that I feel for the people, and the businesses, involved in the manfacture or sale of food products (intrinsically risky or not) who are not the immediate source of a recalled or contaminated product.  This person had the following to say about his/her company's sprout growing processes:

Alfalfa sprouts are healthy and contain a potload of vitamins. This re call involves a small grower with a few customers, here is the touchy part, you are recommending people do not eat them when there are many professional growers like ourselves who grow safe sprouts following the FDA Growing Guidelines.

We are inspected by the FDA, State and other persons. Accurate records are provided, kept and verified of the following, seed specifically grown for human consumption, handled properly, tested for salmonella and E Coli 0 157h7, then sanitized by the grower, rinsed and planted, after 48 hours, a sample of the irrigation water from all drums is tested for salmonella and E Coli 0157h7, with a Hold and Release Program, nothing gets delivered until we receive negative results.  Our sprouts are tested safe.  Now, why is there contaminated product out there from sprouters who are supposed to be following the same guidelines? Ask them.

At the risk of stating the obvious, my response to this particular grower is (1) keep up the good work because it will, hopefully, inure to the benefit of both yourself and your industry and (2) keep in mind that much good will, hopefully, soon come to sprout growers if they keep the perspective that this is an industry-wide issue/problem, not one that's confined to a bad apple or two.  With the multiple outbreaks or recalls that have happened just this year--to say nothing of the last decade--viewing this issue/problem as "somebody else's" will do no good.  It will only inhibit research and development and, as a result, keep Marler Clark in business.  

Ground beef is a case in point.  Bill Marler posted in December 2007 about the return of E. coli O157:H7.  See E. coli O157:H7--It's Back, with A Vengeance.   For present purposes, the important point is not that E. coli and ground beef have enjoyed an incredible resurgence; its that the industry managed to corral the contamination problem for many years prior to 2007.  This happened only because the industry recognized that E. coli O157 was an industry-wide problem, not one associated only with a few rogue grind operations. 

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For any of you out there audacious enough to still consume raw sprouts (click here for a recent discussion of the problem), today's announcement from the California Department of Public Health (CDPH) provides yet another example of why eating raw sprouts is simply not worth the risk.  CDPH announced this afternoon that consumers should not eat certain Kowalke Organics alfalfa sprouts due to possible Salmonella contamination.

Mike's Produce, Inc., doing business as Kowalke Family Sprouts of Culver City, is voluntarily recalling the following products with sell-by dates from June 18 to 30:

* Kowalke Organics Alfalfa Sprouts - 4 oz., 8 oz., 1 pound and 5 pound packages
* Kowalke Organics Dinner Salad - 6 oz. package
* Kowalke Organics Onion Mix - 4 oz. package

Kowalke Family Sprouts has initiated this voluntary recall after receiving notification that a surveillance sample tested positive for Salmonella. These products were distributed primarily to grocery stores in Southern California including Gelson's and Whole Foods.

No illnesses have been reported from these products to date.  "Consumers, especially young children, the elderly and people with weakened immune systems are susceptible to serious infection when exposed to Salmonella," Horton said.

"Today's warning is part of our ongoing efforts to ensure the safety of foods sold in California."
Salmonella is 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. Consumers who have eaten this product and are experiencing the above symptoms should consult their health care provider.

CDPH continues to advise consumers about the risk of consuming raw sprouts. Sprouts have been linked to previous foodborne outbreaks. Conditions required for sprout growing are ideal for rapid bacterial growth. Additionally, green leaf sprouts, such as alfalfa sprouts, are usually eaten raw with no additional treatment, such as cooking to eliminate bacteria that can cause disease.

Consumers who wish to reduce their risk of foodborne illness may want to consider avoiding sprouts.

Consumers who purchased these products should immediately discard them or return them to the point of purchase for a refund. Consumers with questions may contact Kowalke Family Sprouts at (310) 636-1924.

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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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Although not really a good defense in the arenas of law or common sense, I was struck by how quickly Nestle suggested that the consumers sickened by eating their contaminated cookie dough were themselves at fault for ignoring the recommendation on the label that the cookies be “bake before consuming.” What most struck me as most odd (and indefensible) about Nestle’s suggestion that the consumer was to blame, is how incongruous it is for Nestle to say that its product was too dangerous to be eaten raw when it manufactures its cookie dough with pasteurized eggs. Prior to this outbreak, few (if any) would have argued that the risk of eating raw cookie dough, to the extent that it was risky at all, came from anything other than the risk of Salmonella poisoning due to the presence of raw eggs. But Nestle had plainly chosen to eliminate that risk. And my guess is that they did so specifically because they knew (and encouraged) people to eat the cookie dough while it was raw, a guilty pleasure of lots and lots of people.

With this in mind I decided to look at some of the research on the consumption of raw cookie dough. Not surprising (to me), the perception of raw cookie dough as being unsafe is not only based primarily on the presence of raw eggs, and thus Salmonella, that is the SOLE basis for the perceived risk. Look at this question posed as part of a survey of school children that attempted to determine the knowledge of food safety risks:

TRUE or FALSE:
It is okay to eat raw cookie dough—(1) Anytime. The raw eggs will not hurt you. (2) Only if the cookie dough is store bought. (3) Only if the cookie dough is homemade. (4) Never. Raw cookie dough puts you at risk for Salmonellosis.

(See Richards 2008, below). Plainly, this question presupposes not only that Salmonella is the primary risk created by cookie dough, but that raw eggs solely creates the risk. Thus, no doubt, the food safety educators who did this survey would have been thrilled if the students vowed to only eat raw cookie dough so long as it was made with pasteurized eggs.

The other thing that is odd (and indefensible) about Nestle’s stated defense is that most people of relatively good health, who are not too young or old, and with a non-compromised immune system, eat raw cookie dough, even if made with unpasteurized eggs, and not face a significant risk of illness—certainly not a serious one. That is why, if you look at many of the studies that I have included in bibliography below, it will become quickly apparent that the food safety education that is being aimed at the elderly and immune-compromised is solely aimed at avoiding the risk of a Salmonella infection caused by exposure to raw eggs in cookie dough.  These citations also ably demonstrate that no one would have previously said that a person eating raw cookie dough faced a risk of being infected with a pathogen as deadly as E. coli O157:H7.  For Nestle  to suggest otherwise is like someone saying that you should wear a seatbelt when driving because meteor might crash into your car. 

Consequently, I think Nestle probably should restate its position, that is, if it wants to appear anything else but insensitive and oblivious. The presence of E. coli O157:H7 in raw cookie dough was never the risk that the recommendation of “bake before consuming” was intended to prevent. If Nestle had wanted to warn against that risk, the recommendation should have been: Danger: This Product May Kill You If Not Handled With Extraordinary Care.

Partial Bibliography for the Discussion Above:

Julie Albrecht, Food Safety Knowledge and Practices of Consumers in the U.S.A., Int’l Jnl. of Consumer Studies, 19(2), pp. 119-34 (2007) (documenting that a low percentage of people perceived eating cookie dough as a health risk, and that those that did perceive it as a risk did so because of presence of raw eggs in the dough).

Julie A. Albrecht & Alice Henneman, Handling Eggs Safely at Home, Nebraska Cooperative Extension Publication, NF91-33 (1991) (warning that “Eggs in cookie dough and cake batter are raw and dough and batter should not be eaten”)

Marcus Comer, Food Safety for Healthy Families: Evaluation of Program Effectiveness, 40(4) (Aug. 2002) (discussing a “heated debate” among students as to whether eating cake batter or cookie dough was dangerous, and finding that students “held to the belief that eating [it] would not make a person sick and stated that they would continue the practice”).

Cynthia Dols, et al., Preventing Food and Water-borne Illnesses, American Jnl. of Nursing, 101(6), 24AA-24KK (June 2001) (stating that the teaching of immune-compromised patients about food safety risks should include a warning that “during preparation, foods should not be tasted until they are thoroughly cooked (including raw cookie dough)” because of the presence of raw eggs).

Joye Gordon, et al., Risk Perception, Attitudes, Knowledge and Safe Food Handling Behavior Among Those 65 Years and Older, Proceedings of the 20th Annual Conference of Association for International Agricultural Extension Education, Ireland,(2004) 20, 724-734,

I. Hapala & C. Probart, Food Safety Knowledge, Perceptions, and Behaviors Among Middle School Students, Journal of Nutrition Education and Behavior, 36 (2), 71-76 (study finding that, among middle school students surveyed, only 46% reported not seldom eating food items containing raw eggs, with raw cookie dough being used as the example).

Katherine MacComas, Psychological Factors Influencing People’s Reactions to Risk Information, Joint Institute for Food Safety and Applied Nutrition, Food Safety Risk Analysis Clearinghouse, Presentation, (1999) (making point that “When deciding whether to eat raw cookie dough, an individual may choose between the pleasure of eating the dough versus the risks of contracting salmonella poisoning), at http://www.foodrisk.org/exclusives/RC_tutorials/

Jennifer Richards, et al., Validation of an Interdisciplinary Food Safety Curriculum Targeted at Middle School Students and Correlated to State Educational Standards, Jnl. of Food Science Education, 7(3), 54-61 (2008) (study that analyzed self-reported food behaviors of middle school students, including asking them if: “It is okay to eat raw cookie dough,” with the choices of answers being—anytime. The raw eggs will not hurt you; only if the cookie dough is store bought; only if the cookie dough is homemade; never. Raw cookie dough puts you at risk for salmonellosis.”).

Tionni Wennrich, et al., Food Safety Knowledge and Practices of Low Income Adults in Pennsylvania, Food Protection Trends, 23(4), 326, at 332 (2003) (documenting that the “foods prepared with raw eggs, such as raw cookie dough, were the most commonly eaten high-risk food by survey respondents”).

Mary Wilson, et al., Survey of Food Safety Behaviour in Nevada Child Caregivers, Int’l Jnl. of Food Safety, Nutrition and Public Health, 1(2), 116-26 (2008) (finding that people from two rural regions had a higher preference, by 11 and 16%, for eating raw cookie dough, compared to people from two other regions).

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They may seem harmless and look cute, but juvenile turtles carry the risk of Salmonella transmission.  Recently, police in Baltimore seized dozens of tiny turtles from vendors who were selling the animals illegally.  The sale of turtles with shells under 4 inches in length has been illegal since 1975.   According to the CDC,

This size was chosen because small children are more likely to treat smaller turtles as toys and put them in their mouths. The ban by the U.S. Food and Drug Administration (FDA) has prevented an estimated 100,000 cases of salmonellosis each year in children. Despite this ban, such turtles are available from pet stores, flea markets, street vendors, and online stores.

The CDC has also issued a report  of a  2007-2008  outbreak of Salmonella linked to turtles. 

 

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We sometimes hear food poisoning dismissed (usually by those who are being blamed with causing it, not those suffering from it) as "just a little diarrhea."  Here is yet more evidence that such a characterization has no basis in reality.  Web MD is reporting today that Salmonella and Campylobacter infections triple the risk of Inflammatory Bowel Disease for at least 15 years.  Web MD is reporting the results of a study conducted by Henrik Nielsen, MD, of Denmark.

According to the report, Inflammatory Bowel Disease "typically refers to Chron's disease and ulcerative colitis."  Both of these disorders can cause chronic bloody diarrhea and abdominal pain. 

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Echoing the praise in my blog post yesterday, a Minnesota Star Tribune editorial is praising Minnesota health officials and calling for more foodborne illness surveilance.  The editorial relates the story of one of the nine tragic and pointless deaths confirmed as resulting from the PCA Salmonella outbreak.   

As with many of the deaths and illnesses in the outbreak, the 72 year old woman described in the story was sickened well after many of the early cases in the outbreak had been reported.    A better funded, better prepared, and better integrated national foodborne illness surveilance program would have prevented many of  these deaths and illnesses.  It would also havesaved the industry hundreds of millions of dollars.  The editorial correctly concludes that " Lives will be saved if scientists across the nation can replicate Minnesota scientists' stellar ability to rapidly spot patterns in data, the key to detecting outbreaks and their sources. "

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Minnesota Senator Amy Klobuchar held a press conference today to announce new proposed leglisation to "promote a more rapid and effective national response to outbreaks of foodborne sickness." 

According to Klobuchar, the new act would, among other things:

• Enhance the  Centers for Disease Control's  (CDC)  foodborne disease surveillance system.
• Direct CDC to provide more support to state health agencies, including promoting "best practices" in food safety investigations.
• Establish a “Food Safety Centers of Excellence.”

This last prong of the legislation owes its origins to Minnesota's own "Team D" [D for diarrhea].  Team D is a group of foodborne illness investigators from Minnesota agencies that have been previously praised here and elsewhere for being the first, and sometimes only, health officials to recognize foodborne illness outbreaks.    Among the outbreaks where Team D took the lead were the Salmonella Saintpaul outbreak in 2008, and the PCA Salmonella outbreak announced this February.

As for the content of the legislation, its good to see an emphasis on increased surveilance.   Of course, preventing illnesses in the first place is always the first choice.  Still, the overwhelming majority of foodborne illness in the U.S. goes unreported, and therefore un-investigated.  There are lessons to learn and improvements to make with every investigated outbreak.   Until we stop foodborne illness outbreaks altogether, we are best served to rezognize those that do occur, so that we can stop making the same mistakes over and over again.

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The House Energy and Commerce Committee is out with a discussion draft of “the Food Safety Enhancement Act of 2009.”

Given who’s signed on to this one, it’s probably the one to watch.  Sponsors include Chair Emeritus John D. Dingell, Chairs Henry A. Waxman, Frank Pallone, and Bart Stupak, and Reps. Diana DeGette and Betty Sutton.

The new draft is based on the food reforms contained in H.R. 759, the Food and Drug Administration Globalization Act of 2009, introduced in January by Reps. Dingell, Stupak and Pallone. Favored bills get heard quickly, and this one gets its first hearing next week, on Wednesday, June 3rd.

"As evidenced by the recent widespread contaminations in our food supply, including E.coli in spinach, salmonella in peppers and the most recent outbreak of salmonella in peanut butter, it is clear that we must act now," said Rep. Pallone, Chair of the Health Subcommittee. "This draft builds on legislation introduced earlier this year and will empower the FDA with the resources and authorities it needs to ensure that our food is safe to eat. I look forward to continuing to work with my colleagues and the administration to move this crucial piece of legislation forward

"Our 10 food safety hearings in the Subcommittee on Oversight and Investigations have highlighted the need for an overhaul of our food safety laws," said Rep. Stupak, Chair of the Oversight and Investigations Subcommittee. "The American people deserve a Food and Drug Administration that has both the funding and the regulatory authority needed to protect our food supply and hold the food industry accountable. President Obama and the new FDA leadership have expressed a commitment to food safety reform and I look forward to working with them to return FDA to the gold standard in protecting the public health."

A detailed summary of the draft follows below.

 

• Creates an up-to-date registry of all food facilities serving American consumers: Requires all facilities operating within the U.S. or importing food to the U.S. to register with the FDA annually.
• Generates resources to support FDA oversight of food safety: Requires registered facilities to pay an annual registration fee of $1,000 in order to generate revenue for food safety activities at the FDA; requires registered facilities to pay for FDA’s costs associated with re-inspections and food recalls; allows FDA to charge a fee to domestic firms requesting export certificates for exported food.
• Prevents food safety problems before they occur: Requires all facilities operating within the U.S. or importing food to the U.S. to implement safety plans that identify and protect against food hazards. FDA would have the authority to specify minimum food safety plan requirements and to audit food safety plans.
• Requires safety plans for fresh produce: Directs FDA to issue regulations for ensuring the safe production and harvesting of fruits and vegetables.
• Increases inspections of food facilities: Sets a minimum inspection frequency for all registered facilities. High-risk facilities would be inspected at least once every six to 18 months; low risk facilities would be inspected at least once every 18 months to three years; and warehouses that store food would be inspected at least once every three to four years. Refusing, impeding, or delaying an inspection is prohibited.
• Improves traceability of food: Enhances FDA’s ability to trace the origin of tainted food in the event of an outbreak of foodborne illness. FDA would be required to issue regulations that require food producers, manufacturers, processors, transporters, or holders to maintain the full pedigree of the origin and previous distribution history of the food and to link that history with the subsequent distribution history of the food; and to establish an interoperable record to ensure fast and efficient traceback (current law permits facilities to hold a record in any format — paper or electronic — making efficient tracing of foods difficult for FDA). Prior to issuing such regulations, FDA would be required to conduct a feasibility study, public meetings, and a pilot project.
• Enhances the safety of imported food: As an additional layer of protection, FDA can require food to be certified as meeting all U.S. food safety requirements by the government of the country from which the article originated or by certain qualified third parties. Third party certifying entities must meet strict requirements to protect against conflicts of interest with the firm seeking certification.
• Expands laboratory testing capacity: Requires FDA to establish a program to recognize laboratory accreditation bodies and to accept test results only from duly accredited laboratories. Gives FDA the ability to require laboratories to send test results to FDA.
• Provides strong, flexible enforcement tools: Provides FDA new authority to issue mandatory recalls of tainted foods. Strengthens criminal penalties and establishes civil monetary penalties that FDA may impose on food facilities that fail to comply with safety requirements.
• Creates fast-track import process for food meeting security standards: Permits FDA to develop voluntary security guidelines for imported foods. Importers meeting the guidelines would receive expedited processing.
• Enhances the safety of infant formula: Enhances FDA’s ability to assure the safety of new infant formulas before they go on the market.
• Advances the science of food safety: Directs the Secretary to include food in an active surveillance system to assess more accurately the frequency and sources of human illness. The Secretary is also directed to identify industry and regulatory approaches to minimize hazards in the food supply.
• Enhances FDA’s ability to block unsafe food from entering the food supply: Strengthens FDA’s authority to administratively detain unsafe food products. Grants FDA “quarantine” authority under which the agency may restrict or prohibit the movement of unsafe food products from a particular geographic area.
• Directs FDA to assess the use of carbon monoxide in certain foods: Requires FDA to conduct a safety review of the use of carbon monoxide in meat, poultry, and seafood products.
• Enhances transparency of GRAS program: Requires posting on FDA’s website of documentation submitted to FDA in support of a “generally recognized as safe” (GRAS) notification.
• Requires country-of-origin labeling and disclosure: Requires all processed food labels to indicate the country in which final processing occurred. Requires food manufacturers to identify the country of origin for all ingredients on their websites. Requires country-of-origin labeling for all produce.

The draft also requires all importers of food to register annually and sets up a system of unique identification numbers for all regulated facilities. Further, it protects whistle-blowers and gives FDA the power to subpoena records and locate inspectors overseas.

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It never ceases to amaze me, particularly after the last few years and all the high-profile outbreaks that have occurred, that people still pass off "foodpoisoning" as a couple of days of diarrhea--i.e. that the victim is no worse for the wear.  There is so much that is wrong with this statement that it would be pointless to even begin assailing it with mere facts.  Instead, as I've done recently with Jacob Aggas, Kelly Cobb, and Regan Erickson, I'll tell the story of somebody who, after his Salmonella infection, would disagree wholeheartedly with the notion that "foodpoisoning" is just a couple days of diarrhea.  In fact, don't stop reading this 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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We learned over the weekend that L&M Companies was recalling whole cantaloupes sold between May 10 and May 15 in Wal-Mart Supercenter stores in North Carolina, South Carolina and South Hill, Virginia, because a cantaloupe at a farm in Mexico where L&M sources cantaloupe had tested positive for Salmonella.  The recall was initiated as a precaution, and was explained by L&M vice president of production and grower development, Mike McGee, in a written statement:

“L&M Companies takes food safety seriously and we are committed to the shoppers who buy our products everyday. We are issuing this recall because we want to ensure that even the slightest risk to public health is minimized.”

Consumers who purchase cantaloupes and other melons should be aware that several foodborne illness outbreaks have been traced to melons in the past.  In 2002, residents of several states became ill after consuming Salmonella-contaminated cantaloupe.

FOOD SAFETY TIP:  Bacteria such as Salmonella present on the fruit's surface can be transferred to the inside of the fruit as a person's knife pushes through the skin's surface and into the fruit.  Public health agencies such as the Food and Drug Administration's Center for Food Safety and Applied Nutrition have issued guidelines for preventing foodborne illness associated with cantaloupe and other hard-skinned fruits.  That includes washing the fruit and scrubbing cantaloupe rinds with a vegetable brush.

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In a bit of news that is less surprising than it should be, the AP today reports that the FDA has for the last several years failed to perform a large percentage of required audits for inspections being conducted (under contract) by the States.  According to today's report (based on documents recently released to Congress:

The Food and Drug Administration conducted only about half the state food safety audits it promised in the two years before the recent peanut salmonella outbreak, according to new documents the agency sent to Congress.

The documents show the agency did not do any of the required audits of state-run food inspections in five states during those states' budget years spanning 2007 and 2008. And the FDA was unable to say whether audits were conducted at all in 11 additional states during that time, including Georgia and Texas, where salmonella was found in two peanut plants during a wide-ranging peanut recall earlier this year.

Only 14 states saw 100 percent of the audits completed.

As you will recall, the failure of state-performed inspections was a key contribution the recent nationwide Salmonella outbreak linked to contaminated peanuts processed by the Peanut Corporation of America.  Ditto the Conagra pot pie Salmonella outbreak, and the Peter Pan peanut butter Salmonella outbreak.  Double ditto the Veggie Booty Salmonella outrbeak. 

But at least the FDA seems to starting its long overdue recovery process, taking the first step by admitting it has a problem.  As the AP story reports:

Stephen R. Mason, acting assistant commissioner for legislation at the agency, said the recent salmonella outbreak "has highlighted limitations in our current approach and has prompted internal discussions on potential enhancements to the audit program." 

An agency spokesperson, trying hard to put the best spin on things, goes on to offer the following lame rationalization:

FDA spokeswoman Susan Cruzan says the agency is "evaluating approaches" for improving the audits.

"Although FDA has not been able to fulfill the goal of conducting 100 percent of the audits expected under FDA's internal auditing policy, FDA has audited each state at least once, has good knowledge of the state programs and state inspection personnel, and works to improve the programs as needed," she said.

Having admitted the problem, one can now only hope that the FDA will move on to the crucial next step: Stop Being in Denial.

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Yesterday, the New York Times published an interesting, as well as disturbing, article on the continuing dangers of ConAgra frozen pot pies.  Specifically, despite the 2007 outbreak and all the serious illnesses it caused, the safety of the pot pies still depend on the customer cooking them correctly.  Apparently, the challenge of making the pot pies safe to eat, even if cooked to a temperature below what would constitute a "kill step," was simply too difficult.  Here is how the NY Times described the decision:

The frozen pot pies that sickened an estimated 15,000 people with salmonella in 2007 left federal inspectors mystified. At first they suspected the turkey. Then they considered the peas, carrots and potatoes.

The pie maker, ConAgra Foods, began spot-checking the vegetables for pathogens, but could not find the culprit. It also tried cooking the vegetables at high temperatures, a strategy the industry calls a “kill step,” to wipe out any lingering microbes. But the vegetables turned to mush in the process.

So ConAgra — which sold more than 100 million pot pies last year under its popular Banquet label — decided to make the consumer responsible for the kill step. The “food safety” instructions and four-step diagram on the 69-cent pies offer this guidance: “Internal temperature needs to reach 165° F as measured by a food thermometer in several spots.”

For the full article, see www.nytimes.com/2009/05/15/business/15ingredients.html

But getting a frozen-hard pot-pie to reach a uniform temperature of 165 degrees is by no means an easy thing to accomplish, as the Times article amply demonstrates. 

But attempts by The New York Times to follow the directions on several brands of frozen meals, including ConAgra’s Banquet pot pies, failed to achieve the required 165-degree temperature. Some spots in the pies heated to only 140 degrees even as parts of the crust were burnt.

A ConAgra consumer hotline operator said the claims by microwave-oven manufacturers about their wattage power could not be trusted, and that any pies not heated enough should not be eaten. “We definitely want it to reach that 165-degree temperature,” she said. “It’s a safety issue.”

A safety issue indeed.  Because if that pot pie is contaminated with a deadly pathogen, and the cooking process does not essentially pasteurize the pot pie, then eating will could be the real "kill-step" here. 

For additional discussion, please click Continue Reading.

One of the issues really missed in the Times article--although it is one missed a lot, is the question of whether the real problem here is that ConAgra wants to be able to sell the pot pies, and do so profitably, for a price of 69 cents per pie. According to the article:

The company says the outbreak and management changes prompted it to undertake a broad range of safety initiatives, including testing for microbes in all of the pie ingredients. ConAgra said it was also trying to apply the kill step to as many ingredients as possible, but had not yet found a way to accomplish it without making the pies “unpalatable.”

Its Banquet pies now have some of the most graphic food safety instructions, complete with a depiction of a thermometer piercing the crust.

Pressed to say whether the meals are safe to eat if consumers disregard the instructions or make an error, Stephanie Childs, a company spokeswoman, said, “Our goal is to provide the consumer with as safe a product as possible, and we are doing everything within our ability to provide a safe product to them.”

Yes, they are going to do "everthing within [their] ability to provide a safe product" EXCEPT, that is, to raise the price to a point that would allow them to manufacture a product that did not require that consumers pasteurize the pot pie before eating it. So, yest the problem might be with the cooking instructions.  And the problem might be with consumers not microwaving something along enough to constitute a "kill step" for the pot pie.  But the REAL problem, that no one wants to talk about is this: You get what you pay for, including safety.

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State legislators around the US, fed up with the perceived slow response of the federal government to enact stronger food safety laws, have begun sending a clear message to Washington:  if you won't protect our citizens from increasing foodborne illness outbreaks, then we will.

in a Wall Street Journal article by Jane Zhang, she highlights the numerous changes some states are making to strengthen their food safety laws and better protect their own citizens, including:

• Georgia recently enacted legislation that gives food processors 24 hours to report internal tests that find tainted products. The state's peanut industry was hit hard after a widespread salmonella outbreak was traced to a processing plant in rural Blakely, GA.

• Idaho enacted a law last month that authorizes the state to charge food services, retailers and processors a licensing fee to help pay for food-safety inspections.

• The Oregon Senate, with the support of the food industry, passed legislation in February that would let the state impose civil fines of as much as $10,000 for food-safety violations. Under current law, a food company must be convicted of a criminal violation and the fine is limited to $200.

• California lawmakers have introduced a bill aimed at strengthening food safety after a massive recall this year of pistachios from Setton Pistachio of Terra Bella Inc. that could be tainted with salmonella. Like the new Georgia law, it would require food processors to report positive tests for pathogens or harmful contaminants within 24 hours. It also would require food processors to keep detailed safety plans to prevent contamination and stepped-up testing of foods from California facilities.

Of course, these state-led efforts are leading to another potential issue: lack of uniformity for food manufacturers and distributors.  Food-industry groups say anything other than a uniform federal food-safety system will add to their costs. "It's a good thing states are trying to raise the bar and improve food safety, but it needs to be looked at carefully," said Robert Brackett, chief science officer of the Grocery Manufacturers Association, a trade group in Washington. "It should really lead to a national system."

What are your thoughts on this issue?

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I know you're dying for more.  I posed a question to Caudill Seed yesterday about why they haven't recalled their product.  Jim Prevor, the Perishable Pundit, had the same question apparently. 

Pundit:  FDA says Caudill made the decision to voluntarily withdraw from the market all the alfalfa seeds bearing six digit lot numbers that start with 032. Why a withdrawal and not a recall? What is the difference? Does a recall have a greater legal obligation, where Caudill would be agreeing to pay for companies to ship back and dispose of product, etc.?

Orwig:  The biggest difference between a recall and withdrawal is that a recall is a request from FDA because they have discovered an adulterated product. A market withdrawal is voluntary, as this one is because there is no proof, only suspicion. It is a significant difference. There is no proof; there are only problems and suspicion.

They have to have scientific proof to have a recall. There has to be an exact match. There are multiple strains of salmonella. In this instance, the only way you should have a recall is if it traces back the exact fingerprint of Salmonella Saintpaul. To justify a recall you have to have an exact match from the sick person to the seeds or product, otherwise it’s just suspicion.

My two cents:  Don't hate me for this.  I swear, I never use those acronyms that everybody but high-school kids hate like LOL and OMG.  But OMG!  (For my parents, that stands for Oh My God!, as if i was astonished at something).  Give me a break Caudill and Orwig.  You should have recalled your product long ago.  There are 228 people sick (and that's only the confirmed illnesses).  What if people continue to get sick, or even worse, die?  So you're telling me that if this outbreak balloons to 500 illnesses and ten deaths that you're still not going to recall your product unless the FDA comes up with a Salmonella positive from seeds at your building or in a bag marked O32?  Wow, that would be bold.  I wonder how long Mr. Orwig will toe this untenable line. 

Much more to come. 

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Andrew Martin of the New York Times wrote a nice article this morning on the safety of our food supply.  We represent all three individuals profiled in his article:  Heather Whybrew, Carl Ours, and Mary Tardiff.  All suffered devastating illnesses in separate outbreaks and from different pathogens.  All have unbelievable stories of suffering. 

Heather's story is unique, perhaps because she had lived through so much pain in her life even before her severe E. coli O157:H7 illness.  In November 2004, after two years of headaches, she was diagnosed with a brain tumor. Treatment for her relatively rare condition—giant cell glioblastoma—included a full craniotomy to remove the tumor from the left frontal lobe of Heather’s brain. The procedure left her partially paralyzed. She remained hospitalized at Seattle Children’s Hospital and in intensive rehabilitation from November 16 until December 24, 2004.

During her rehabilitation, Heather had to relearn many basic motor functions, including how to walk.  Relearn these skills she did, and despite her brain tumor, Heather eventually went on to college at Pacific Lutheran University.

Heather was infected by E. coli O157:H7 in the midst of finals her freshman year from contaminated lettuce served in a University Cafeteria. She would ultimately be hospitalized at St. Francis Hospital and Seattle Children's Hospital for three weeks.  During her hospitalization, Heather battled endless nausea, vomiting, and diarrhea, a bad pneumonia illness, and severe blood clots in the superficial veins of her arms.  The combined medical treatment would cost almost $114,000.  She would have to make up her final exams during the next school year.

By the time Heather had recovered to the point that she could return to school at Pacific Lutheran University, class was already well into the first semester.  Thus, as a result of her E. coli O157H7 illness, not only did Heather miss final exams her freshman year, but also she had to drop certain courses from her schedule during fall semester of her sophomore year.  She will be forced to take another year of class at Pacific Lutheran University as a result of the delays caused by her E. coli O157:H7 illness.  The cost of this additional year will be at least $36,000. 

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Here is a copy of the Morbidity and Mortality Weekly Report from the CDC addressing the recent sprout outbreak.  We have been reporting on this for weeks now (maybe months), since cases were first report in Nebraska in February.  Please take a look at this report; it provides a good summary of the anatomy of an outbreak, especially when sprouts are the vehicle. 

Moreover, consider now that the CDC is reporting at least 228 illnesses from 13 states (including NE, IA, SD, MI, KA, PA, MN, OH, IL, WV, FL, NC, and UT).  These outbreaks are evolving things, and more illnesses may ultimately be determined to have been confirmed in this outbreak by the time all is said and done.  But even if a hundred additional illnesses are added, that's nothing compared to the true scope and impact of this outbreak.  I've been posting for weeks that the number of likely ill people in this outbreak already exceeds a thousand, maybe many thousands.  But that's only part of the story.

There are many other victims in these outbreaks.  In fact, this is exactly what Bill Marler is speaking to the House of Lords in England about this week:  How One Peanut Company Caused 1.5 Billion Dollars in Losses.  My guess is that there are many more victims in this current sprout outbreak, in the form of both people and business losses, than the 228 people who are currently recognized as victims in the CDC report.  How many millions, hundreds of millions, billions (a little too bold??? maybe, maybe not) will the outbreak now linked to Caudill Seed cause?  Only time, and a little hard-driving discovery about what Caudill Seed knew and when they knew it, will tell.

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Last June, Brian Grubbs, of Colorado, suffered a Salmonella Saintpaul infection after consuming contaminated jalapeno peppers.  His illness was one of more than 1,200 in a nationwide outbreak.    The Grubbs purchased the peppers at their local WalMart.   Marler Clark subsequently filed suit against WalMart on Mr. Grubbs behalf.   WalMart tried unsuccessfully to have the suit thrown out, and has now identified Frontera Produce Ltd, of Texas, as the supplier of the jalapenos in question.

Brian Grubbs, and his wife Cheryl, were in Washington D.C. on April 29 to call for increased food safety in the U.S.  About 25 former foodpoisoning victims met with federal legislators to discuss the problem, and the various pieces of pending food safety legislation. 

As reported in the Cortez Journal, Ms. Grubss stated, "'The food we die for shouldn't be killing you, we don't want everyone to find out about foodborne illness like we did. We're trying to educate our community and get (legislation) passed."

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Our work at Marler Clark requires lots of travel . . . sometimes even overseas.  Looks like it might be time to up my intake of spaghetti carbonnara and red wine so that I'm ready to roll when it comes time to take a closer look at the Italian company selling the sprout seeds that are now responsible for a major Salmonella outbreak in the US associated with alfalfa sprouts.  Of course, there are a number of reasons why we might do this . . . not least of which is to find out exactly what, or who, Caudill Seed was relying on for the safety of the product that it was selling.

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I guess you've got to be in this business to get frustrated when people think of foodborne disease as being akin to "an upset stomach" or what everybody calls "the flu."  That, or you've got to be unlucky enough to have known or loved somebody who developed hemolytic uremic syndrome or some other horrible manifestation of foodborne disease. 

Betty Desjarlais was a perfect example of somebody in good health whose Salmonella illness quickly killed her.  Read a brief summary of Betty's illness and her untimely death.  This is not a frequent result in Salmonella cases, but it serves well to illustrate the risks that we really do face . . . which is particularly alarming when you consider the true scope of these outbreaks--e.g. the recent sprouts outbreaks.  There are many more people who are sick than the 150 or so illnesses that investigating health authorities include in their tallies of confirmed cases.

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There is plenty of information out there on (1) what sprout and seed companies should be doing to reduce or eliminate the risk that they sell contaminated food to customers, and (2) what sprout sellers should be doing now, in the context of the Salmonella Saintpaul outbreak linked to sprouts/sprout seeds.  With absolutely no effort at sarcasm, that is truly all well and good.  But what about YOU?  What should you do when you have eaten a contaminated product?

My guess is that the sprout sellers of the world aren't reading this blog.  If they are, and they're doing it for ideas on how to improve the safety of their product, that's a little scary.  So this post is dedicated to the victims.  First, from a medical standpoint, doctors and moms across the country stress the importance of staying hydrated.  Second, it is important to have a doctor monitor your progress, or lack thereof.  Symptoms like a high fever, reduced urine production, nose bleeds, etc., may not seem too alarming in a vacuum, but they can signify the onset of devastating conditions, among them hemolytic uremic syndrome and sepsis.  Finally, it is always a good idea to encourage your doctor to run a stool test.  Now your doctor may or may not think that this is warranted in your individual circumstances, but it is extremely important in certain medical situations, and it is critical in helping to stop the spread of disease if you're involved in an outbreak.  The truth of the matter is that any investigating health authorities in an outbreak will not have the benefit of knowing your involvement (and your individual circumstances may be quite important in the outbreak investigation) unless you have a stool sample that tests positive for the outbreak bacteria or virus.  Important steps, all.

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Sprouts have gotten a bad rap recently, and I suspect that the sprout market will have that much-maligned feeling for many months to come.  In this day and age, with all the channels of communication available to health departments (federal and state) around the country, and all the detective work that we do here at Marler Clark, outbreaks simply do not go unnoticed.  Which brings me to my point.  If you're a sprout devotee whose simply not going to be deterred by the recent Salmonella outbreaks and recalls linked to your favorite risky food, maybe you should read this article and take it's advice to follow the developing outbreaks on Twitter.  That way, particularly if you're going to continue to eat sprouts and you live in . . . well, almost anywhere between the Rocky Mountains and the Eastern Seaboard, you can at least have the most up-to-date information before eating any Salmonella contaminated sprouts.

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The Salmonella-sprouts outbreak that we formerly reported was linked to illnesses in Michigan has grown.  Health officials from multiple states (Michigan, Minnesota, Ohio, Pennsylvania, South Dakota, Utah and West Virginia) report at least 31 confirmed illnesses, which means that the number of actual illnesses in the outbreak is probably over one hundred.  The FDA is on the case (see Bill's recent post), as are the health departments of many states.  Interestingly, the strain of Salmonella involved in this sprout outbreak is the same (Salmonella Saintpaul) as that involved in the CW Sprouts outbreak.   The common link is thought to be the seeds.

Some ideas:

§ Seeds for sprout production must be grown under good agricultural practices. Purchasers of seed should request verification from their supplier that appropriate practices were followed.

§ Seeds for sprouting should be treated with one or more treatments (such as 20,000 ppm calcium hypochlorite) that have been approved for reduction of pathogens in seeds or sprouts. Some treatments can be applied at the sprouting facility while others will have to be applied earlier in the seed production process. However, at least one approved antimicrobial treatment should be applied immediately before sprouting.

§ Microbiological testing of spent irrigation water from each production lot for Salmonella, E. coli O157:H7 (or EHEC), and Listeria monocytogenes. There is a potential that pathogens may survive antimicrobial treatments, even if used properly, so testing becomes the last chance to detect contaminated lots. Because testing for pathogens can be done with irrigation water as early as 48 hours into what is generally a 3 to 10 day growing period, producers who plan accordingly can obtain test results before shipping product without losing product shelf-life. Testing, whether done by the producer or contracted out, should be done by trained personnel, in a qualified laboratory, using validated methods.

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Steve Meyerowitz is, apparently, the Sproutman.  Although I disagree with his analysis of the numbers--i.e. Sprouts have caused a hell of a lot more foodborne illnesses than 2,000 in the last 40 years--it's good to see an industry man who recognizes the risks associated with his product, and who cares enough about consumer health to advocate that his fellow sprout devotees do all they can, by way of researching and developing new pasteurization methods, to reduce risks. 

Nonetheless, I am not a convert, and I never will be.  I feel too much for those sickened and hospitalized in the recent outbreaks and recalls linked to sprouts.  Let us not forget that there are over 120 people in Nebraska, Iowa, South Dakota, and Kansas (not to mention the sprouts/listeria recall or the Calco, Inc sprouts advisory), and a bunch in Michigan, who (1) probably didn't know the risks associated with sprouts and (2) wouldn't have thought it could happen to them anyway. 

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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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We have filed two lawsuits on behalf of two victims of the Salmonella Saintpaul outbreak linked to sprouts manufactured by CW Sprouts, a Nebraska Company.  For information about the outbreak, click here.  Keep in mind, studies have shown that the actual number of victims in any given outbreak is many times more than the number of culture-confirmed "cases"--i.e. by stool or blood test.  Some people don't seek medical attention, but are no less infected by the bacterium or virus; and some, like one of our clients in Colorado, are sick enough to have their intestines spilled out onto the operating table but their stool tests are negative.  Bottom line, you are no less a victim of an outbreak merely because your stool sample is not positive for Salmonella, E. coli O157:H7, hepatitis A, or any other bacterium or virus associated with foodpoisoning, assuming you have an epidemiological relationship to the outbreak.  Bottom line in the CW Sprouts outbreak, there may be hundreds sick across the midwest due to Salmonella-contaminated sprouts.

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It never ceases to amaze many clients of ours at Marler Clark how foods that seem so healthy can pose so much risk of foodborne disease.  Lettuce and E. coli O157:H7???  Many victims were shocked, not to mention badly injured, when baby spinach was the cause of yet another outbreak of E. coli O157:H7 and other pathogens associated with leafy greens during the 2006 spinach outbreak. 

Sprouts are another case in point.  We've all had them, and most of us have never been sick from them, but there are hundreds of victims across the mid-west who cannot say the same thing.  Here is an interesting article on how sprouts are grown and harvested, and why they are such a risky food to eat, especially for young children, the elderly, or the immune compromised. 

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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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On January 5, Mark's Quality Meats, Inc. of Detroit, Michigan, recalled over 13,000 pounds of ground beef and steak products that were produced in late December after E. coli contamination was identified through lab testing.  In announcing the recall, the Food Safety and Inspection Service stated that no illnesses have been reported in connection with the recall.  According to the Detroit Free Press: 

Michael Layne, a spokesman for Mark’s Quality Meats, said some of the meat has been consumed, but the products that weren’t have been removed from the restaurants, brought back to the company’s facility and destroyed. About 200 restaurants had received meat from the company, he said.

Meanwhile, public health officials are investigating to determine the source of Salmonella outbreaks in Pennsylvania and Montana.  The Pennsylvania outbreak has been traced to foods prepared by a restaurant, and the Montana outbreak is still under investigation, although the strain of Salmonella isolated from Montana patients is likely linked to the strain causing illness in Texas and Pennsylvania. 

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The U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) issued a public health alert today after a joint investigation by state public health officials and the Centers for Disease Control and Prevention identified ground beef as the source of a multi-drug-resistant strain of Salmonella.  At least 38 people in Arizona, California, Hawaii, Nevada, and New Mexico became ill with Salmonella Newport infections after consuming the ground beef between September 19 and November 5, 2007.

FSIS stated in its public health alert:

This alert is being issued after an exhaustive and continuing investigation whereby FSIS could not identify specific establishments, lots and products that would be subject to a recall. FSIS has no reason to believe that these products are still available for sale in commerce.

Consumers that may have purchased these fresh ground beef products between Sept. 19 and Nov. 5, 2007, and stored them in the freezer should look for and discard or destroy these products if they find them. . . .

This particular strain of Salmonella is resistant to many commonly prescribed drugs, which can increase the risk of hospitalization or possible treatment failure in infected individuals.

Antimicrobial Resistance in Salmonella Bacteria

Antimicrobial resistance in bacteria is an emerging and increasing threat to human health. Physicians should be aware that antimicrobial resistance is increasing in foodborne pathogens and that patients who are prescribed antibiotics are at increased risk for acquiring antimicrobial resistant foodborne infections. In addition, “[i]increased frequency of treatment failures for acute illiness and increased severity of infection may be manifested by prolonged duration of illness, increased frequency of bloodstream infections, increased hospitalization or increased mortality.”

The use of antimicrobial agents in the feed of food animals is estimated by the FDA to be over 100 million pounds per year. Estimates range from 36% to 70% of all antibiotics produced in the United Sates are used in a food animal feed or in prophylactic treatment to prevent animal disease. The use of antibiotics is thought to promote growth and to prevent disease in beef, pork, and poultry production as well as on fish farms and some fruit and vegetable farms.

According to the National Antimicrobial Resistance Monitoring System (NARMS), Campylobacter has been recovered from 47% of chicken breasts tested in recent studies. In the same NARMS studies, five mulit-drug resistant strains of Salmonella Newport were recovered from ground beef, ground turkey and pork chops. According to the report, “[a]ntimicrobial resistance among these foodborne bacteria is not uncommon and often associated with the use of antimicrobial agents in food animals.” Ceftriaxone-resistant Salmonella has also been reported (Fey et al., 2000). The emergence of multidrug-resistant Salmonella typhimurium in the United States is another example of a drug-resistant bacteria spreading from animals to humans (Glynn et al., 1998).

The use of antibiotics in feed for food animals, on animals prophylactically to prevent disease, and the use of antibiotics in humans unnecessarily must be reduced. European countries have reduced the use of antibiotics in animal feed and have seen a corresponding reduction in antibiotic-resistant illnesses in humans.

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California health officials and the Food and Drug Administration are warning customers who purchased basil imported by Top Line Specialty Produce that the product could be contaminated with Salmonella. The warning came after testing revealed some of the basil, which was imported from a farm in southern Baja California, Mexico, was contaminated.

The San Francisco Chronicle reported on the recall:

5,500 pounds of basil grown in Mexico and sold in the United States was recalled because of fears it may be infected with salmonella, a spokesman for the importer said Thursday.

The basil was imported from a farm in Mexico's southern Baja California region on Dec. 5 and sold to food distributors in Southern California, Texas and Illinois the following day, said Alberto Martinez, a spokesman for Los Angeles-based importer Top Line Specialty Produce.

The Southern California distributor sold the basil to restaurants and other food service customers, but it was unknown whether the other distributors sold to food service customers or retailers, he said.

While many dried spices are irradiated to prevent illness, fresh spices, such as basil and parsley, have been identified as the source of foodborne illness outbreaks in the past.

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Ediets.com provided some good tips on safer eating this morning in an article titled, "13 Foods That Could Kill".  The thirteen foods the column focuses on are:

Lettuce: because lettuce has been identified as the source of several E. coli and other foodborne illness outbreaks.  In 2006, Dole spinach was the source of a large E. coli outbreak, and lettuce was the source of outbreaks at Taco Bell and Taco John's restaurants.  Ediets.com states, "All raw fruits and vegetables can harbor disease-causing bacteria. Thoroughly wash any raw produce under cold running water before eating it. If appropriate, use a small scrub brush to remove any visible dirt. This is true even for organic fruits and vegetables."

Water: because contaminated water can harbor bacteria, viruses, and parasites, it is important to ensure your drinking water, as well as water in pools or at sprayparks, has been properly treated to eliminate the possibility of contamination.  According to Ediets.com, "The Environmental Protection Agency (EPA) recommends that private water supplies be tested at least once a year for: nitrates, total dissolved solids and coliform bacteria, the presence of which (although it is generally harmless) may indicate other contamination. You may need to test more frequently and for more potential contaminants if a problem is suspected."

Raw sprouts: Because sprout seeds can be contaminated with foodborne pathogens that cause food poisoning, raw sprouts should be avoided.  Raw sprouts have been associated with E. coli and Salmonella outbreaks.  Ediets encourages consumers to cook sprouts thoroughly to kill bacteria.

Unpasteurized juice, milk or cheese: Because unpasteurized juices and "raw" dairy products do not go through a "kill step" before they are served, bacteria, viruses, or parasites could be present in the products.  Several E. coli outbreaks have been traced to raw juices, including a 1996 E. coli outbreak traced to apple juice and subsequent Salmonella outbreaks traced to orange juice.  outbreaks have been traced back to raw milk, including E. coli outbreaks that resulted in children being hospitalized for kidney failure.  Edites.com states, "Make sure you always purchase the pasteurized versions of your favorite products. Pasteurization kills bacteria. When you go to a juice bar, make sure the juices being served are pasteurized. Unpasteurized products have been linked to salmonella, E. coli and Listeria -- all of which can lead to death."

Moldy peanuts:  Because moldy peanuts, wheat chereals, and corn can produce aflatoxins.  Ediets.com encourages people to check these products for any signs of discoloration or mold, as, "Alfatoxins have been found to cause liver cancer in animal species."

Raw or undercooked shellfish: Because shellfish, such as clams and oysters, can be contaminated with micro-organisms such as vibrio or viruses such as norovirus.  Raw oysters should be avoided.  Ediets.com states:  "Any animal protein consumed raw or undercooked has an increased potential for causing illness."

Swordfish, shark, king mackerel and tilefish: Because these fish have been associated with high levels of methyl mercury, which can cause brain damage in unborn and young children.  According to Ediets.com, "The Food and Drug Administration (FDA) and the EPA advise young children, women who are planning to become pregnant and pregnant or nursing women not to eat these fish."

Caesar salad: Because many recipes for Caesar salad dressing call for raw eggs, and eggs can carry Salmonella, Campylobacter jejuni, and other foodborne pathogens. Ediets.com encourages you to ask your server or host if Caesar salad dressing contains raw eggs because, "Many restaurant or homemade recipes call for raw eggs in Caesar salad."

Wild mushrooms: Because several species of mushrooms contain deadly poisons.  According to Ediets.com, "Portabella and shiitake lovers have no reason to worry. Just don’t go scavenging in your backyard. Only eat mushrooms you’ve purchased in the grocery store."

Raw, homemade cookie dough. Because, again, raw eggs can contain potentially deadly foodborne pathogens.  Ediets.com says, "We're not talking about the prepackaged kind that many of us prefer to nibble on straight from the tube or tub. We're talking about homemade batter that's made with eggs."

Rare hamburger. Because ground beef can be contaminated with E. coli, Salmonella, and other bacterial pathogens that cause food poisoning.  All ground beef products and hamburgers should be cooked to 160 degrees fahrenheit.  Ediets.com provides the advice to, "Always use a food thermometer to ensure you've cooked the beef to a safe temperature. Avoid any restaurant entrée labeled "tartare" – it's raw."

Turkey and stuffing. Because stuffing cooked inside a turkey or chicken has a reduced likelihood of reaching a hot enough temperature to kill Salmonella, Campylobacter, or other "bugs".  Ediets explains, "The bird cooks both from the outside and the inside. When you stuff the bird, it reduces the heat penetration. Your best bet is to cook the turkey and stuffing separately. If you do choose to cook them together, make sure the temperature reaches at least 180 degrees Fahrenheit in the innermost part of the thigh while the center of the stuffing inside the turkey reaches 165 degrees."

Shakes and eggs. Because, as pointed out earlier, raw eggs can carry Salmonella or Campylobacter jejuni.  Protein shakes can be made with p asteurized eggs, but unless they're pasteurized, avoid raw eggs.  Ediets warns, "Once again, you're putting yourself at risk for salmonella when you consume raw eggs. Also, beware of sunny side up or runny eggs. The rule of thumb is to cook the egg until both the yolk and the white are firm."

More about food poisoning can be learned at www.foodborneillness.com. 

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E. coli, Salmonella, and botulism were all featured in the news today:

In Hutchinson, Kansas, the Hutchinson News reported that a five-year-old girl from Sterling, Kansas, has been put on dialysis.  She became ill with an E. coli infection and hemolytic uremic syndrome.  She is in critical condition after 18 days in the hospital.  As reported by the Hutchinson News:

Aubrey Anderson, 5, continued to undergo daily dialysis treatments lasting three to five hours each at Wesley Medical Center, said her father, Bill Anderson, who is principal of Sterling High School.

"Aubrey's hemoglobin was down a little today, which is not good," Anderson said in an e-mail. "Her platelets, however, have reached a 'normal' level and the doctor feels that they will not decrease again, and that is encouraging. Her toxicity level is down from yesterday, but they would like to see it come down farther."

In Omaha, Nebraska, the Omaha World Herald reported that ConAgra has resumed the production of Banquet and private label pot pies - one of two ConAgra products identified earlier this year as the source of a nationwide Salmonella outbreak.  According to the World Herald:

ConAgra Foods Inc. said Wednesday that it had enhanced its food safety procedures and resumed making frozen Banquet and private-label pot pies, which the company recalled last month after they were linked to salmonella illnesses.

The company said it would ship the pot pies to stores beginning in December, and they should be back on store shelves as soon as January.

And in Roanoke, Virginia, a relative of a doctor who passed away this week - allegedly of botulism poisoning - spoke with the Roanoke Times.  While testing has not been completed, the relative stated that health authorities are investigating the possibility that the doctor's death was caused by botulism.

Kwang Kim, the doctor’s younger brother, said the family is still awaiting laboratory results to confirm the death was caused by botulism. They expect those results Thursday, he said.

Kwang Kim said the state health department approached the family last week about the doctor’s illness. Dr. Kim’s husband, George Makarie, is also ill and was still hospitalized Wednesday morning, Kwang Kim said. He said he doesn’t know if Makarie’s illness is also related to botulism.

The Centers for Disease Control and Prevention (CDC) estimates that 76 million foodborne illness cases occur in the United States every year. This amounts to one in four Americans becoming ill after eating foods contaminated with such pathogens as E. coli O157:H7, Salmonella, Hepatitis A, Campylobacter, Shigella, Norovirus, and Listeria.

On an annual basis, approximately 325,000 people are hospitalized with a diagnosis of food poisoning, and 5,000 die. The annual dollar costs of foodborne illnesses—in terms of medical expenses and lost wages and productivity—range from $6.5 to $34.9 billion.

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This week's food safety infosheet from the International Food Safety Network focuses on proper cooking temperatures for food. 

We've learned more about proper cooking temperatures in recent weeks since ConAgra recalled chicken and turkey pot pies for Salmonella contamination.  Microwave temperatures vary, and using a food thermometer to measure a food's internal temperature and determine food safety is important since consumers are the last line of defense when cooking at home.

The iFSN "barf blog" post titled, "Cooking a Frozen Pot Pie in a Microwave" is a good demonstration of why food thermometers are useful tools in the kitchen.

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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 CDC's publication, Morbidity and Mortality Weekly Report, contains a report on an outbreak of Salmonella Oranienburg that was determined to have originated from fruit salad served in health care facilities in the Northeastern United States and Canada in 2006.  While public health officials were unable to determine which fruit ingredient in the salads was the source of the outbreak, they did note the following:

Fruits such as cantaloupe and honeydew melon previously have been associated with salmonellosis outbreaks in the United States. During 1973--2003, a total of 11 cantaloupe-associated salmonellosis outbreaks were reported to CDC. Reported outbreaks were associated both with whole melons contaminated in growing fields and with precut melons. Cut fruit can be contaminated during processing when rind is removed and fruit is sliced. Furthermore, because the inner flesh of melons contains nutrients that can support microbial growth, improper refrigeration of cut fruit can cause bacteria proliferation.

The public health officials conducting the investigation into the Salmonella outbreak performed a case-control study, interviewing outbreak- and non-outbreak patients and found:

A case was defined as culture-confirmed S. Oranienburg infection with the outbreak strain and illness onset from June 15 to July 31. Forty-one cases of S. Oranienburg with the outbreak strain occurred in 10 U.S. states and one Canadian province: Massachusetts (12), New Hampshire (nine), New York (four), Pennsylvania (three), Vermont (three), Kentucky (two), Maine (two), Maryland (two), Connecticut (one), New Jersey (one), and Ontario, Canada (two). Date of illness onset ranged from June 15 to July 25 (Figure). The median age of patients was 59 years (range: 8 months--96 years); 31% of cases were in persons aged >70 years. Twenty-eight (68%) patients were female. Symptoms reported by patients included diarrhea (74%) (i.e., three or more loose stools in a 24-hour period), abdominal cramps (52%), fever (39%), vomiting (23%), and bloody diarrhea (16%). Seven (17%) patients were hospitalized as a result of their Salmonella infections. No deaths were reported.

Among the 41 cases, 30 (73%) occurred among persons who worked, stayed, or ate in a health-care facility during the 7 days preceding illness onset, including 10 already-hospitalized patients, 10 residents of a long-term--care facility, nine employees of health-care facilities, and one visitor who had eaten in a hospital cafeteria. The interviews with 33 of the 41 patients suggested that illness was associated with eating fruit salad in a health-care facility; 23 (70%) reported eating fresh fruit salad, 19 (83%) of whom had eaten fresh fruit salad in a health-care facility.

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Kraft has announced that the company is because they have the potential to be contaminated with Salmonella.  The company issued a press release regarding the outbreak yesterday detailing the specifics of the recall, and stated:

The potential for contamination was noted after testing by the U.S. Food and Drug Administration that detected the presence of Salmonella in some packages of Baker’s Premium White Chocolate Baking Squares (6 oz.). The company is aggressively investigating the source of the problem.

Products with best when used by dates of 31 MAR 2008 XCZ, 01 APR 2008 XCZ, 02 APR 2008 XCZ, and 03 APR 2008 XCZ are all subject to recall.

Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis – the disease caused by Salmonella – is the second most common bacterial foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95 percent of those cases are related to foodborne causes.

Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 deaths - 31 percent of all food-related deaths - are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

Salmonella infection occurs when bacteria are ingested, typically from food derived from infected animals, but infection can also occur by ingesting the feces of an infected animal or person. Food sources include raw or undercooked eggs/egg products, raw milk or raw milk products, contaminated water, meat and meat products, and poultry. Raw fruits and vegetables contaminated during slicing have been implicated in several foodborne outbreaks, as have foods contaminated by food handlers who did not adhere to proper hygienic standards and practice proper handwashing techniques.

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It sounds like the plot for a scary B-movie: Germs go into space on a rocket and come back stronger and deadlier than ever.

Except it really happened.

The germ: Salmonella, best known as a culprit of food poisoning.

The trip: Space Shuttle STS-115, September 2006.

The reason: Scientists wanted to see how space travel affects germs, so they took some along -- carefully wrapped -- for the ride.

The result: Mice fed the space germs were three times more likely to get sick and died quicker than others fed identical germs that had remained behind on Earth.

The researchers found that 167 genes had changed in the salmonella that went to space.

Why?

"That's the $64 million question," Nickerson said. "We do not know with 100 percent certainty what the mechanism is of space flight that's inducing these changes."

The results of the salmonella study are reported in yesterday's edition of Proceedings of the National Academy of Sciences.

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A Salinas Valley spinach grower recalled bagged spinach products today after Salmonella was detected in some of the company's products.  Metz Fresh of King City, California, released the following information about the recall, which was published in the Westfall Daily News:

The recalled spinach was distributed throughout the 48 states and Canada and sold in both retail and food service packages. It covers 8,118 cases of spinach, although the company said more than 90 percent of that was on hold and would not be released.

The recall covers 10- and 16-ounce bags, as well as 4-pound cartons and cartons that contain four 2.5-pound bags, with the following tracking codes: 12208114, 12208214 and 12208314.

Last year over 200 people became ill with E. col O157:H7 infections, and four people died after eating contaminated Dole spinach.

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California almond growers have asked for an extension on a rule requiring all almonds sold commercially to be pasteurized.  The California Almond Board has asked the USDA to push back the date of required pasteurization to march 1, 2008.  The Board is arguing that almond farmers have not had enough time to validate their processes and update their machinery. 

The San Diego Tribune reported on the Almond Board's request:

The largest organization of almond growers is asking the government for a six-month delay before enforcing a new rule requiring all California almonds to be pasteurized, saying farmers can't adjust in time to meet the original deadline.

In January, the U.S. Department of Agriculture announced it would require virtually all almonds to be pasteurized by Sept. 1, following Salmonella outbreaks in 2001 and 2004 that were traced to raw almonds.

The California Almond Board posted the following on its website:

Why was a food safety plan necessary?

In the past 5 years, the almond industry experienced two food safety incidents in which raw almonds were recalled due to the presence of Salmonella. While contamination in almonds is not common, the industry determined that aggressive measures were necessary to prevent any other occurrences. Research was needed to develop more effective, practical technologies for reducing potential contaminants in almonds. It was also important for the entire industry to adopt these food safety measures in order to provide the safest and highest quality product possible for consumers. The “Action Plan” accomplishes both of these goals.

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ConAgra announced today that the company will re-open the plant where Salmonella-contaminated peanut butter was produced.  The plant was closed in February after it was identified as the source of a Salmonella outbreak that had sickened hundreds of people who ate contaminated Peter Pan and Great Value peanut butter.  From Forbes.com:

The Omaha-based company said it was planning to reopen its Sylvester, Ga., plant after spending at least $15 million on renovations that include repairing the roof, installing new equipment and creating a design to better separate raw materials and the finished product.

"Right now we're in the final stages of getting everything ready to produce Peter Pan peanut butter there," said Stephanie Childs, a company spokeswoman.

The plant was shut down in February after health officials linked the Peter Pan and Great Value peanut butter to a salmonella outbreak. More than 600 people in 47 states reported becoming ill, and the company faces lawsuits in several states.

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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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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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Newsinferno.com added a post titled, "CDC, FDA, ConAgra or Peter Pan himself, Who’s to Blame for the Underreporting of Sickening and Potentially Deadly Salmonella & E-Coli Food Poisoning Cases?" which offers an interesting discussion on foodborne illness outbreaks.  

The federal agency responsible for insuring food safety was also been taken to task for its role in the incident. In April 2007, the Washington Post published documents proving that the FDA, as well as ConAgra, knew of contamination problems at the plant as far back as 2004. The agency took few corrective measures, assuming that ConAgra would address the situation itself. ConAgra apparently did little to nothing to fix the problem.

And this was not the first time the FDA knew about food safety problems but did little to correct them. The Post article also cited evidence that the agency had been aware of problems with contaminated spinach and other California greens as far back as 1995. In the fall of 2006, hundreds of people were sickened and three were killed after contracting e-coli from contaminated California Spinach.

Critics say that under-funding and a lack of trained inspectors at the FDA have left the nation’s food supply in a perilous condition. A congressional fact sheet published by Henry Waxman (D-Calif) in 2006 said funding for the FDA fell short by $135 million. The number of scientists employed by the FDA’s food division dropped from 1,000 to 800 in the past three years. This decrease in personnel and the ongoing budget cuts have overwhelmed the agency, greatly impacting its ability to watch over the food supply. The results of this shortfall are apparent — according to the CDC, contaminated foods cause 325,000 hospitalizations and 5,000 deaths each year.

Maybe Newsinferno.com will post about the recent E. coli outbreaks traced to ground beef and include USDA in its next analysis.

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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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California, Nevada, Oregon, and Washington health officials are warning that alfalfa sprouts sold by Salad Cosmo USA Corp., a California company, may be contaminated with Salmonella.  Routine testing revealed Salmonella contamination in alfalfa sprout seeds at Salad Cosmo, and the company instituted a voluntary recall of the products.  An article in the San Jose Mercury News identified the recalled products as, "two-and-a-half-ounce plastic containers and one-pound plastic bags of sprouts labeled Salad Cosmo Alfalfa Sprouts with the production codes of 0519 to 0526."

Dozens of foodborne illness outbreaks have been traced to sprouts.  In 2000, Bill Marler called on the FDA to require a warning label on sprouts after a California Salmonella outbreak was traced to contaminated sprouts. 

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According to news reports, Whole Foods is recalling 16-ounce jars of 365 Organic Everyday Value Sesame Tahini for possible Salmonella contamination.  So far, no Salmonella illnesses in connection with the recalled product have been reported.

From www.about-Salmoenlla.com:

The acute symptoms of Salmonella gastroenteritis include the sudden onset of nausea, abdominal cramping, and bloody diarrhea with mucous. The onset of symptoms usually occurs within 6 to 72 hours after the ingestion of the bacteria.1 The infectious dose is small, probably from 15 to 20 cells. There is no real cure for a Salmonella infection (or salmonellosis), except treatment of the symptoms. For most strains of Salmonella, the fatality rate is less than one percent.

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 rehydration, often with intravenous fluids. Treatment with antibiotics is not usually necessary, unless the infection spreads from the intestines, or otherwise persists, in which case the infection can be treated with ampicillin, gentamicin, trimethoprim/sulfamethoxazole, or ciprofloxacin. Some Salmonella bacteria have become resistant to antibiotics, however, and this has occurred possibly as a result of the use of antibiotics to promote the growth of feed animals.

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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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An article on HOI.com titled, "E. coli and Friends," gives a good description of several foodborne pathogens featured at www.foodborneillness.com.  Reporter Jen Christensen profiles E. coli, Salmonella, Campylobacter, and Listeria, and describes how health officials determine which pathogen is responsible for illness:

Tracking Down the Culprits

When stomach symptoms occur, people tend to attribute the cause to a “bug” rather than food. Clues suggesting a possible foodborne pathogen include severe symptoms and having more than one person is affected – especially if the symptoms occur in several families. A physician may contact the local health department to determine if other cases have been reported. In addition, stool samples may be sent to a lab for testing.

It can take quite a bit of detective work to track down a source of foodborne illness. Not everyone who eats a contaminated food product gets sick (typically the very young, very old, patients with chronic medical conditions and those with weak immune systems are most susceptible). The severity of symptoms may also vary.

Health officials gather data on patient characteristics, how long they have been sick and places they may have visited days before the onset of illness. Hopefully, common traits will begin to emerge, such as “everyone ate at the same restaurant” or “ate the same food.” Suspect food items may be tested for the presence of bacteria or toxins. As more clues emerge, experts may be able to narrow down or pinpoint the source of the problem. In some cases (as with the peanut butter/salmonella link recently), an investigation may lead to an extensive recall of a particular food item.

The E. coli Reference Center at Penn State University is the nation’s largest repository for E. coli strains, holding more than 70,000 strains collected over the last 40 years. The bacteria are frozen to enable researchers to study and track changes or genetic mutations that may make the illness more difficult to treat. Older samples are stored at room temperature in “slants,” or test tubes containing a solid growth medium to preserve the culture. The lab can also test a current sample for the bacteria and look for genes associated with those causing the most serious illness.

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The Food and Drug Administration announced a recall of Archer Farms four-cheese risotto after random sampling of the product tested positive for Salmonella contamination.  The product was sold in Target stores nationwide.  From the FDA press release:

Archer Farms Four Cheese Risotto, Code "Best If Used By 16JUL2008AA" was sold nationwide through Target stores. The Archer Farms Four Cheese Risotto flavor has been pulled from Target stores while the FDA and Aulcorp Food Marketers Inc. continue their investigation as to the source of the contamination.

The Archer Farms Four Cheese Risotto is packaged in a 6 oz. (170g) Paperboard Box with a mustard yellow banner which identifies this item as the Four Cheese flavor.

A consumer alert also went out after routine sampling turned up positive for Salmonella contamination in raw milk distributed in Dekalb County, Illinois.  As reported by WFIR:

The state public health director is issuing a warning to customers of the Brian and Barbara Hill Dairy Farm located in Maple Park.

During a routine inspection a sample tested positive for the bacteria. No illnesses have been reported but if you've purchased milk there since March 27Th, throw it away.

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According to an article titled, "Move over, milk -- almonds are headed for pasteurization," published in the San Francisco Chronicle, all almonds sold in the United States are to be heat treated or fumigated with chemicals that will kill pathogenic bacteria like Salmonella in the near future. 

The Chronicle's Carol Ness reports:

"Pasteurization" is the California almond industry's response to two salmonella outbreaks, traced to almonds, that sickened a total of about 130 consumers -- and resulted in lawsuits -- in 2001 and 2004.

Starting Sept. 1, under industry-written rules adopted March 30 by the U.S. Department of Agriculture, almost all almonds sold in the United States will have to be treated, either with short blasts of steam or dry heat, or with a carcinogenic chemical that's used to make bowling balls and foam seat cushions as well as insecticide.

Marler Clark represented victims of the 2004 outbreak traced to almonds sold world-wide. 

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Reports from the Albany Times Union indicate that students on a school trip to Spain became ill with Salmonella food poisoning in the last days before flying back to the United States.  The paper reported that at least 24 students and chaperones who went on the trip to Spain became ill with symptoms of Salmonella infections either just before leaving the country, on the plane ride home, or after arriving back in the United States.  Two students were hospitalized, but are expected to recover from their illnesses, and most students are well on the way to recovery.

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Bill Marler is traveling to Washington, DC today to support victims of three recent foodborne illness outbreaks as they give testimony before the House Committee on Energy and Commerce's Subcommittee on Oversight and Investigations.  Marler provided written testimony for the subcommittee, highlighting eight steps he feels could greatly improve food safety. 

They are:

1. There exist two “best practices” in meat that should be extended to produce. Following the Jack in the Box crisis, the head of the USDA’s Food and Safety Inspection Service took a regulatory and systems approach to food safety. That “hero” was Michael Taylor. Taylor declared that raw ground beef that is contaminated with E. coli would be classified and treated as “adulterated” within the meaning of the Federal Meat Inspection Act. Taylor also introduced a mandatory Risk Management System. The required meat processors to adopt comprehensive precautions. Those included carcass washes, citric acid sprays, steam pasteurization and air-exchange systems. Following Taylor’s example, we must serve notice to produce and other food processors that E. coli, salmonella, etc. will be classified and treated as adulterants. In addition, the same kind of comprehensive Risk Management System must be established and implemented. Penalties must be criminal and civil. When these best practices are adopted, firms will have to certify that not only they, but that every aspect of their supply chain, also are in compliance. Branding can and should reflect this certification of both the firms and their suppliers. This would be a new kind of “Seal of Approval.” This “Seal of Approval” can also apply to such issues as the location of produce fields near animal farms, what kinds of procedures are used, and the method of irrigation as well as the type of water used.
2. We need the same kind of food safety champion that Taylor was. This person would be a highly visible symbol of our commitment. Along these lines, it is useful to consider consolidating responsibility in one federal-level agency. That would be the central point for communication about best practices and the point of contact for state and local regulators and health departments.
3. The track record of business for issuing warnings and recalls rapidly isn’t good. The federal and state governments should have authority to recall food products. That means increased funding, particularly at the state level. Most outbreaks are regional, not national.
4. Produce an E. coli vaccine for cows. I would say that the lion’s share of produce problems result from this contaminant passed on through cow feces.
5. The nation requires education about the benefits of irradiation of all mass-produced food including produce. Resistance to this practice seems to be rooted in public perception, not science.
6. Attention has to be paid to the vulnerability of our food supply system to acts of terrorism. Denial and lack of common sense seem to dominate thinking at all levels – business and federal and state government.
7. Why haven’t we applied our economic and political muscle to imposing more stringent regulations on food imports? This is a central trade issue that has been neglected.
8. There’s an urgent need to improve the resources available to foodborne disease victims. At the top of the list are the out-of-pocket medical costs. Those are usually not immediately or even eventually reimbursed by medical insurance if victims have coverage. By time compensation comes from litigation, individuals are sometimes heavily in debt. Next on the list is the expense of missing work. Marler Clark has been encouraging food processors and retailers to provide this help as a gesture of goodwill.

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According to HealthDay News, capsules of dried rattlesnake meat -- a Hispanic folk remedy purported to cure a host of health problems including acne, impotence, AIDS and cancer -- can be contaminated with a potentially lethal strain of salmonella bacteria, a U.S. infection control expert warns. 

John James, a microbial epidemiologist at Children's Hospital in Denver, said the life-threatening strain of bacteria -- Salmonella arizonae -- in capsules of dried rattlesnake meat caused a child to become seriously ill. The child survived.  Salmonella arizonae is commonly found in snakes and lizards.

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The Chicago Sun-Times reported that the Kane County, Illinois, health department was encouraging consumers to avoid unpasteurized milk and cheese because the source of a Salmonella outbreak that has been ongoing was likely unpasteurized dairy products.  According to the Sun-Times article, "They issued a public warning about queso fresco or queso cotija cheese, adding that they found Salmonella in dairy purchased at Aurora's El Paso Carniceria Chico."

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Here is an update from the FDA site about the peanut butter salmonella outbreak.

"The Centers for Disease Control and Prevention (CDC) has identified 290 people from 39 states who have gotten sick from Salmonella Tennessee, the Salmonella type associated with this outbreak. Forty six (46) patients are known to have been hospitalized and there have been no reported deaths.

The 39 states with reported illness are: Alaska, Alabama, Arkansas, Arizona, California, Colorado, Connecticut, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Massachusetts, Maryland, Maine, Michigan, Minnesota, Missouri, Mississippi, Montana, Nebraska, New Jersey, North Carolina, New Mexico, New York, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Virginia, Vermont, Washington, Wisconsin and West Virginia."

If you believe you are part of the Salmonella outbreak that was traced to Peter Pan and Great Value peanut butter, here are a few suggestions:

1. If you or a family member are still sick, please seek medical treatment.

2. If you do seek medical treatment, please ask that a stool culture be done to try and confirm that you have been sickened by salmonella. A stool culture is the only way to confirm that you have been sickened by the Salmonella bacteria. The lack of a positive stool culture, however, will not preclude a claim. We expect that a majority of claimants will not have a positive stool culture.

3. You should contact you local health department about your concerns and to relate information about your family members’ illnesses. Please make note of your peanut butter label, the brand, and the product code found on the lid—“2111” is the implicated product. Also note when and where you purchased it. This information will help the health department’s investigation.

4. If you have any left over peanut butter, please put the entire jar in a plastic bag and place it in a cool spot. Do not return the lid to ConAgra as we will need it to prove your claim. Please let your local health department know that you have it. They may offer to test it. If not, we will arrange to have it tested.

5. If any family member is currently sick, please be sure to attend to careful hygiene. Frequent hand washing can help reduce the risk of spreading infection among family members.

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Marler Clark is investigating potential Salmonella claims on behalf of 150 families who have contacted us in regards to the Salmonella outbreak that was traced to contaminated peanut butter (see the Salmonella blog for more information about hte outbreak.

What  to do if you became ill with Salmonella food poisoning after eating peanut butter:

1. If you or a family member are still sick, please seek medical treatment.

2. If you do seek medical treatment, please ask that a stool and urine culture be done to try and confirm that you have been sickened by salmonella. A positive culture is the only way to confirm that you have been sickened by the Salmonella bacteria.

3. You should contact you local health department about your concerns and to relate information about your family members’ illnesses. Please make note of your peanut butter label, the brand, and the product code found on the lid—“2111” is the implicated product. Also note when and where you purchased it. This information will help the health department’s investigation.

4. If you have any left over peanut butter, please put the entire jar in a plastic bag and place it in a cool spot. Please let your local health department know that you have it. They may offer to test it. If not, we will arrange to have it tested.

5. If any family member is currently sick, please be sure to attend to careful hygiene. Frequent hand washing can help reduce the risk of spreading infection among family members.

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Today Show food reporter and MSNBC columnist Phil Lempert recently published an article about preventing E. coli and Salmonella infections. 

Top tips to prevent salmonella and E. coli:

• Always wash hands, dishes, utensils and counter surfaces often while preparing and cooking all foods
• When preparing or cooking raw meats, poultry or other foods, clean surfaces and hands with hot soapy water and use paper towels and discard immediately
• Never use the same plate, tray or utensils for the cooked meat that you use for the raw meat
• Separate raw meat, poultry, and seafood from other foods in your refrigerator
• Always cook all foods thoroughly. Meats, poultry, pork and especially ground meats, should be cooked until the juices run absolutely clear.

To read the full article, click here.

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A potentially deadly form of food poisoning may not always be caused by something you ate. Researchers from the Centers for Disease Control and Prevention report exposure to infected rodents may also cause salmonellosis.

The medical detective story began with the identification of a specific form of the infection in hamsters sent by a pet distributor in Minnesota to the University of Minnesota Veterinary Diagnostic Laboratory in St. Paul. Further investigation found many hamsters carried by the same distributor were suffering from an illness suggestive of salmonellosis, and researchers subsequently matched the exact bacterial strain to 28 patients who came down with the disease.

Researchers interviewed 22 of the "food-poisoning" victims, and 13 reported exposure to pet hamsters, mice, or rats. Six were hospitalized with the infection, which is especially serious because it is resistant to some drugs designed to treat it. The bacterial strain was subsequently cultured from the pet mouse of one patient and from seven hamsters found in pet stores.

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Consumer Reports has run extensive tests for bacteria and found 83 percent of the chicken tested harbored the kinds of bacteria that are the leading causes of food poisoning.

Leighton Kunkle has nerve damage in his hands and feet from Guillain-Barré syndrome, a side effect of food poisoning caused by the bacteria campylobacter. He believes he got sick from eating undercooked chicken in a restaurant.

Consumer Reports tested chicken purchased nationwide to see if it contained the bacteria campylobacter or salmonella -- the two leading bacterial causes of food poisoning. According to government figures, they sicken close to 3.5 million Americans a year and kill more than 700.

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As the FDA investigates an outbreak of illnesses that may be related to Salmonella typhimurium bacteria in produce, the U.S. Food and Drug Administration is reminding consumers of steps they can take to keep their food safe.

Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons often experience fever, diarrhea (which may be bloody), nausea, vomiting, and abdominal pain. In rare circumstances, infection can result in the organism getting into the bloodstream and producing more severe illnesses.

Based on information currently available from the U.S. Centers for Disease Control and Prevention (CDC), the investigation shows a peak in cases of illness in September. This suggests that the outbreak is no longer ongoing. The agency believes that contaminated food products that caused the illnesses have at this point been consumed, destroyed or thrown out because they are perishable. Therefore, FDA does not believe a consumer warning about produce on store shelves is warranted at this time.

FDA is working closely with states and CDC to identify the most likely food item(s) that caused the current outbreak. If and when a food item is identified, FDA will investigate where the product came from and what may have gone wrong during its production, packing or distribution that could have led to contamination with Salmonella.

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The Rutherford-Polk-McDowell District Health Department has confirmed three salmonella cases in Polk County recently. Helen White, RN, PHN Supervisor at Rutherford-Polk-McDowell District Health Department, said all three cases involve Polk County High School students but no connection among them has yet been established.

Officials are still in the surveying stage, she said, and have not yet determined where salmonella was contracted or if the cases are related. More cases of salmonella are possible as other students have reported experiencing similar symptoms without going to a physician.

White says the health department has worked well with the N.C. Department of Health and Human Services and the Polk County School system to test and monitor students.

Officials asked students what and where they ate as far back as 72 hours prior to developing symptoms.

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Classic Salads of Salinas, CA is voluntarily recalling 4lb., 2lb. and 10 oz. Baby Spinach and 4lb., 3lb., 1.5lb., Spring Mix, because it has the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain 12 to 72 hours after infection. 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.

Baby Spinach/Spring Mix was distributed nationwide, as well as Canada and Japan, to foodservice, institutions and distributors.

Classic Salad's Baby Spinach and Spring Mix are packed in clear plastic bags with a stamped Lot Code number of 1502XXX indicating that it was processed on July 24th, 2006. Master cartons bear the "Classic Salads", "Classic Choice", "Classic Greens", "Sir Lancelot", "Taste of the Valley", "US Fresh" and "Valley Gold" labels and a Pallet ID Number is stamped in black ink on the exterior of the carton that is unique to each pallet. Baby Spinach pack sizes include: 4lb., 2x2lb., 12x10oz. Spring Mix pack sizes include: 5x3lb., 4x3lb., 3lb., 3x1lb., 2x1.5lb., 12x7oz.

Outbreaks associated with lettuce or spinach, specifically the "pre-washed" and "ready-to-eat" varieties sold under various brand and trade names, are by no means a new phenomenon.

In October 2003, 13 residents of a California retirement center were sickened and 2 died after eating E. coli-contaminated "pre-washed" spinach.

In September 2003, nearly 40 patrons of a California restaurant chain became ill after eating salads prepared with bagged, "pre-washed" lettuce.

In July 2002, over 50 young women were stricken with E. coli at a dance camp after eating "pre-washed" lettuce, leaving several hospitalized, and 1 with life-long kidney damage.

The Center for Science in the Public Interest found that of 225 food-poisoning outbreaks from 1990 to 1998, nearly 20 percent (55 outbreaks) were linked to fresh fruits, vegetables or salads.

It is clear that the risks associated with E. coli O157:H7 AND Salmonella and lettuce were well known to the industry prior to this recall. For the last several years, the FDA had been aggressively trying to get the industry to address serious ongoing deficiencies it saw as creating a serious risk to consumers. Apparently, the industry has not responded.

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Keith Nunes of MeatPoultry.com reports that some commercial poultry processors have begun using a bacterial culture developed at the University of Arkansas (U.A.) that may reduce the levels of pathogenic Salmonella and Campylobacter in live poultry. The probiotic is helping processors increase the safety of food products and poultry science researcher Billy Hargis believes his research team can do more.

"We have not bothered to patent this specific culture because we don't think this is the best we can do," said Mr. Hargis, who is working on the Food Safety Consortium project in the U.A. Division of Agriculture. "We think we can find better cultures. This is just the best we have found so far. We think we can make it more effective."

The culture is unique because unlike previous cultures that have been tested, this is a "defined culture" -- entirely derived from a single defined group of bacteria.

"They're known organisms, specific isolates that are well characterized," Mr. Hargis said.

The federal Food and Drug Administration does not allow undefined cultures to be used in competitive exclusion, so the defined cultures produced by Mr. Hargis' research group fill a need for industry.

"Our cultures are different because they can be truly defined and they can be reproduced from specific isolates that are stored back in the freezer," he said. "Then they can be propagated virtually forever."

At the poultry production farm level, the probiotic culture has been administered to chicks through drinking water and by spray application. In addition to cutting down on pathogens in the live poultry, the culture also has been found in experiments to be effective in increasing the birds' weight, lowering production costs and reducing environmental contamination in poultry houses.

"Our premise has been that if we can do something that provides an economic advantage in addition to reducing food borne pathogens, then we might see more rapid adoption of the technology," Mr. Hargis said. "We've had quite a bit of commercial adoption in the past year. We have several companies that are using the product at least intermittently."

In addition to seeking ways to perfect the probiotic culture, Mr. Hargis also wants to pursue more study of its ability to reduce carcass contamination. Some experiments have shown such reductions, but more data are needed.

"Salmonella does not occur by spontaneous generation in a processing plant," Mr. Hargis said. "It comes in with the live animals. I think it's a pretty good bet that reducing Salmonella in live animals will end up reducing Salmonella in food because that's where it comes from. Our focus now is to make the culture better and find other isolates that are more effective."

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According to the New Mexico Environment Department, since 2002, reported cases of Salmonella in New Mexico have decreased from 338 cases to 288 cases through 2004, the most recent year for which data is available. That decrease represents a drop in the incidence of Salmonella of about 14.8 percent to 15.1 cases per 100,000 people. The New Mexico Environment Department (NMED), which regulates the food service industry, has been working to increase awareness of food-borne illnesses by emphasizing regulatory public health issues during inspections, providing free food handling and preparation training classes throughout the state, working in conjunction with the Department of Health to assist investigating food-borne illness outbreaks.

Nationwide, there are an estimated six million to 33 million illnesses and as many as 9,000 deaths every year due to food-borne diseases.

"Most people take food safety for granted, but over the years there have been a number of large foodborne illness outbreaks around New Mexico," NMED Secretary Ron Curry said. "Through our 23 field offices and 43 food inspectors we hope to deliver the message of food safety to restaurants and food establishments, which includes annual church cookouts and pancake fundraisers, that improperly cooked food can make you sick and can even kill."

The New Mexico Environment Department permits and inspects more than 6,700 food establishments statewide with a staff of 43 inspectors, who are also responsible for a host of other field inspections, such as septic systems and swimming pools.

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According to an I-Newswire report, many living things, from fruit flies to people, naturally produce disease-fighting chemicals, called antimicrobial peptides, to kill harmful bacteria. In a counter move, some disease-causing bacteria have evolved antimicrobial detectors. The bacteria sense the presence of antimicrobial peptides as a warning signal. This alarm sets off a reaction inside the bacteria to avoid destruction.

University of Washington ( UW ) and McGill University researchers have revealed a molecular mechanism whereby bacteria can recognize tiny antimicrobial peptide molecules, then respond by becoming more virulent. Their studies were done on the bacterium Salmonella typhimurium. The findings were published in the Aug. 12 edition of Cell.

Salmonella typhimurium can contaminate meats such as beef, pork, chicken, as well as cereals and other foods, and cause severe intestinal illness. Certain strains of the bacteria are difficult to treat, and are behind the increase of salmonellosis in people. Some food science institutes anticipate that virulent strains of salmonella will become more common throughout the food chain. Learning how this sometimes deadly organism fights back against the immune system may lead to treatments that get around bacterial resistance.

Work in this area may also suggest ways other disease-causing, Gram-negative bacteria maintain a stronghold in the midst of the body's attempts to get rid of them.

Strangely enough, the same molecules that the body sends out to help destroy salmonella inadvertently launch bacterial defenses. It is as if missiles armed, rather than demolished, the target. The body's antimicrobial peptides bind to an enzyme, PhoQ, that acts as a watchtower and interceptor near the surface of bacteria cell membranes. The peptide binding activates PhoQ, which sets off a cascade of signals. The signals turn on a large set of bacterial genes. Some of genes are responsible for products that fortify the bacterial cell surface and protect the bacteria from being killed.

The research was done in the UW laboratory of Dr. Samuel Miller, professor of microbiology and of medicine, Division of Infectious Diseases. The Miller Lab explores the molecular aspects of bacteria-induced illness, and how disease-causing bacteria interact with cells in the host they have infected, and adapt to environments inside the body, such as the airway.

The lead author of the Aug. 12 Cell article was Dr. Martin Bader, a UW senior fellow in microbiology and genome sciences. The research team, under the direction of Miller, included Dr. Sarah Sanowar of the Department of Microbiology and Immunology at McGill University; Dr. Margaret Daley, a UW senior fellow in biochemistry; Anna Schneider, a UW undergraduate majoring in mathematics and biochemistry; Uhn Soo Cho, a graduate student in biological structure; Dr. Wenqing Xu, assistant professor of biological structure; Dr. Rachel Klevit, professor of biochemistry; and Dr. Herve Le Moual on the McGill Faculty of Dentistry.

Grants from National Institute of Allergy and Infectious Diseases and from the Canadian Institutes of Health Research funded the study.

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In light of the July 8, 2005 FDA recall of unpasteurized juice produced by Orchid Island Juice Co. of Fort Pierce, Florida, Seattle attorney William Marler of Marler Clark, has called again on the FDA to completely ban the sale of all unpasteurized juices.

"It is simply outrageous that after all we've learned about the importance of pasteurizing fruit juice, especially after the Odwalla and Sun Orchard outbreaks, we still have companies selling unpasteurized juices, and the government allowing it. This must stop," said Mr. Marler.

According to the FDA, fifteen cases of infection with Salmonella enterica serotype Typhimurium have been directly linked with consumption of Orchid Island juice in Michigan, Ohio, and Massachusetts from mid-May to mid-June.

"Not only was Orchid Island exempted from using pasteurization, it also appears that the FDA may have exempted it from labeling its juice as unpasteurized. Why the FDA would allow a company to produce an unpasteurized product and allow no warning label in beyond me," Marler added.

The FDA in 1998 had set forth a labeling requirement that stated: "WARNING: This product has not been pasteurized and, therefore, may contain harmful bacteria which can cause serious illness in children, the elderly, and persons with weakened immune systems."

Prior Salmonella Outbreaks in Orange Juice

May-June, 1995: Salmonella Serovars Hartford, Gaminara and Rubislaw -- In Orlando, Florida, U.S.A., cases of Salmonella infections were reported at a Walt Disney World theme park after people drank unpasteurized orange juice. There were 63 cases from 21 states (average age 10 years old) and 22% were hospitalized. No deaths occurred. Salmonella of three different serotypes were found (Parish, 1998, Smith De Waal et al., 1999). Isolates of the three serovars from the patients, orange juice and processing environment demonstrated a link between the facility and the outbreak (Parish, 1997). Amphibians are suspected to be the source of contamination (Parish, 2000). JAMA. 1999 May 26; 281(20):1892-3.

February, 1999: Salmonella enterica -- In Adelaide, Australia there were approximately 500 laboratory confirmed cases of Salmonella infection from fresh, chilled, unpasteurized orange juice. No deaths occurred. The Knispel Fruit Juice Pty Ltd's orange juice called "Nippy's" was found to be the cause of the outbreak (Steene, 1999). Oranges from a fresh fruit packing house were the source of the contamination (Parish, 2000).

June 1999: Salmonella Muenchen -- In the summer of 1999, over 400 people became infected and one died as a result of drinking either frozen or fresh unpasteurized orange juice contaminated with Salmonella Muenchen. The product was sold by the bottle and in bulk to restaurants, hotels and other food establishments. Thus, 15 US states were involved and 2 Canadian provinces. The juice was produced by Sun Orchard Inc. in Tempe, Arizona and was labeled under a number of different brand names (Sun Orchard, Aloha, Zupan, etc.) (Steinberg, 1999). The causative organism was isolated from samples of the packaged raw juice as well as from storage vats within the packaging facility. Three other Salmonella strains were also isolated from the product at the plant in Tempe, Arizona. Import of Mexican orange juice that contained melted ice is the suspected source of contamination. This was the largest Salmonella outbreak associated with unpasteurized orange juice. JAMA. 1999; 282:726-728.

April 2000: Salmonella enteritidis -- Seventy-four confirmed cases of Salmonellosis were reported in 7 US states. No deaths occurred. California Day-Fresh Foods, who sells the unpasteurized juice as "Naked Juice" and "Ferraro's", was implicated in the outbreak. The source of contamination is unknown. Source: Press Release, Colorado Department of Public Health and Environment, April 20, 2000.

About Salmonella

Salmonella is one of the most common enteric (intestinal) infections in the U.S. The reported incidence of Salmonella illnesses are about 17 cases per each 100,000 persons.

Over 40,000 actual cases are reported and confirmed yearly in the U.S. As only about 3% of Salmonella cases are officially reported nationwide, and many milder cases are never diagnosed, the true incidence is undoubtedly much higher. It is more common in the warmer months of the year. Approximately 500 to 1,000 persons or 31% of all food-related deaths are caused by Salmonella infections in the U.S. every year.

According to the April 15, 2005 MMWR article on FoodNet data, five Salmonella serotypes accounted for 56% of all Salmonella infections, as follows: Typhimurium, (20%); Enteritidis, (15%); Newport, (10%); Javiana, (7%); and Heidelberg, (5%).

Salmonellosis

The acute symptoms of Salmonella gastroenteritis include the sudden onset of nausea, abdominal cramping, and bloody diarrhea with mucous. The onset of symptoms usually occurs within 6 to 72 hours after the ingestion of the bacteria. The infectious dose is small, probably from 15 to 20 cells. There is no real cure for a Salmonella infection (or salmonellosis), except treatment of the symptoms. For most strains of Salmonella, the fatality rate is less than one percent. Symptoms of Salmonella infection include diarrhea, abdominal cramps, fever, nausea, and/or vomiting. The diarrhea may be non-bloody, occur several times per day, and not be very voluminous, although in severe cases it may be frequent, bloody and/or mucoid, and of high volume. Fever generally occurs in the 38(degree) C to 39(degree) 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.

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Citizen-Times.com reports that the state Laboratory of Public Health has detected nearly five times as many cases of the food-borne illness Salmonella enteritidis so far this year compared to the first six months in 2004.

The lab has detected more cases of the bacterial infection this year to date than in the past three years put together for the same time period, indicating a troubling rise in S. enteritidis cases statewide.

Surrounding states are experiencing similar increases in Salmonella enteritidis. North Carolina's divisions of Public Health and Environmental Health are working with other agencies here and in those states, as well as with the U.S. Centers for Disease Control, to halt the rapid increase of S. enteritidis.

No common source has yet been identified for the North Carolina outbreak, so health officials are continuing their investigation. However, recent outbreaks of the illness in nearby states have largely been associated with eggs, as have several of North Carolina's previous outbreaks. Beef, poultry, and unpasteurized (raw) milk have also been associated with outbreaks of this type of Salmonella.

Salmonella bacteria can be found inside seemingly normal eggs. When those eggs are eaten raw or undercooked, the bacteria can cause sickness and even death. But proper handling and storage of eggs help prevent bacterial growth, and thorough cooking destroys the bacteria.

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The best defense against salmonellosis and other food-borne diseases is safe food handling. The U.S. Department of Agriculture's Food Safety and Inspection Service has been trying to get that message to consumers. But changes in the food industry and Americans' eating habits make the job challenging. An estimated 76 million cases of food poisoning occur each year in the United States; 5,000 are fatal, according to the Centers for Disease Control and Prevention.

For eating out, here are a few tips:

1. Shun any fresh-cooked food that doesn't arrive at your table piping hot. Ditto for any cold food that appears lukewarm.

2. Pass up foods containing raw eggs -- a common source of salmonella bacteria.

3. Order your food cooked to a safe internal temperature. The recommended temperature for a hamburger is 160 degrees.

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Sweetwater County Environmental Health officials have traced a Salmonella outbreak to the Sand's restaurant located on 9th Street in Rock Springs, Wyoming. At least eight patrons have become ill with Salmonella poisoning.

Resources for victims of Salmonella outbreaks are available on the Web, with sponsored sites on Salmonella and Salmonella litigation provided by Marler Clark, the Seattle law firm nationally recognized for its successful representation of victims of foodborne illness. The firm sponsors a Web site specifically about Salmonella, its symptoms, risks of infection, treatment, and news about outbreaks (see www.about-salmonella.com), as well as www.salmonellalitigation.com and www.salmonellablog.com.

We know that many people turn to the Web as their first source of information, and having represented hundreds of victims of Salmonella poisoning, we have heard time and again how helpful the information provided on this site is,

Victims suffer from intense abdominal cramping, bloody diarrhea, and nausea. Many have to be hospitalized, and most miss work. It is natural for them to want to find out more about this illness, and we are providing one of the most comprehensive resources on Salmonella that is out there on the Internet.

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