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

As lawsuits commence, the Dupage County Health Department continues to receive reports of illness linked to the Lombard, Illinois Subway restaurant that is at the epicenter of a major shigella outbreak.  Spokesperson David Hass recently stated that lab tests have confirmed 21 illnesses in the outbreak.  At least seven people have been hospitalized. 

We have been contacted by 12 families now seeking representation due to illness amongst family members.  Of those, several have been confirmed by stool tests as outbreak cases, but many have not.  The reality of any foodpoisoning outbreak, no matter the bacteria and no matter the food vehicle, is that many more people than simply the confirmed cases were sickened. 

In fact, some estimates indicate that the number of people sickened in foodpoisoning outbreaks is actually 20 or even 30 times the number of "confirmed cases."  These additional "cases" of illness may not have had a stool sample tested; they may not have had medical attention at all; or they may have received antibiotics prior to submitting the stool test.  Whatever the case, they are no less outbreak cases than the "confirmed cases." 

How many people are actually ill in the Lombard, Subway outbreak?  The math is a little scary.  21 X 30 equals . . . a lot of sick people.

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The Dupage County Health Department announced on March 4, 2010 that it "is investigating the cause of a cluster of gastrointestinal illnesses primarily among customers of a Subway restaurant located at 1009 E. Roosevelt Road in Lombard. Restaurant ownership and corporate representatives have been cooperating with health officials, and the Lombard restaurant has been closed pending further results of the investigation.

We have been contacted by ten families that are likely victims of the outbreak.  We will file suit tomorrow on behalf of a young boy who ate a shigella-contaminated sandwich at the restaurant in late February and suffered a severe gastrointestinal illness as a result.  Fortunately the is recovering, but he has a ways to go. 

Many of the people we have spoken with have done what most ordinary Americans would do when suffering from a severe case of foodpoisoning, a primary symptom of which is, of course, diarrhea:  they went to the drugstore, or more likely had a friend or family member go for them, and purchased either Imodium or Lomotil in an attempt to get the diarrhea to stop. 

We are JD's not MD's, but many physicians will strongly discourage the use of these over-the-counter drugs while ill with a case of foodpoisoning, or virtually any kind of infectious diarrhea.  In fact, also in its March 4 press release, the Dupage County Health Department stated:

Persons who exhibit any of the symptoms of shigellosis are advised to contact their physician to arrange for appropriate testing and treatment, as indicated. Before using antidiarrheal agents such as loperamide (Imodium®) or diphenoxylate with atropine (Lomotil®), contact your physician, since antidiarrheal agents can prolong illness in persons with shigellosis, and should be avoided.

The reason is that drugs that are designed to prevent diarrhea actually inhibit the passage of disease-causing bacteria in stool.  This is one of the body's many natural defense responses to things (e.g. bacteria, viruses, parasites, etc.) that it recognizes as foreign.  It is thus a necessary, though uncomfortable, process.  The best advice, as the Dupage County Health Department notes, is to talk to your doctor. 

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Shigella is indeed a very frequent cause of foodborne illness.  It is estimated, in fact, that more than 17,000 people become infected by Shigella every year in the USA.  The routes of transmission are typically food and person-to-person contact, which is why Shigella is a frequent cause of outbreaks at daycare centers. 

What is Shigella? 

Shigella is a family of bacteria that can cause sudden and severe diarrhea (gastroenteritis) in humans. Shigellosis – the illness caused by the ingestion of Shigella bacteria – is also known as bacillary dysentery. It can occur after ingestion of fewer than 100 bacteria (American Public Health Association [APHA], 2000), making Shigella one of the most communicable and severe forms of the bacterial-induced diarrheas (Gomez et al., 2002). Shigella thrives in the human intestine and.

Past Shigella Outbreaks and Litigation:

• Lombard, Illinois Subway Outbreak (2010): Last week, a shigella outbreak was discovered at a Lombard, Illinois Shigella.  On Friday, it was announced that four more cases of shigellosis were confirmed Friday, bringing the total number of confirmed cases caused by the outbreak at the restaurant to 12, health department spokesman Dave Hass said. Of those 12 cases, seven have required hospitalization. Six of those who were hospitalized have been released, Hass said.
• San Diego Filiberto's Outbreak (2006):  On September 1, 2006, the San Diego County Health and Human Services Agency (SDHHS) and the San Diego County Department of Environmental Health announced that they were working together to investigate an apparent Shigella outbreak among customers who had eaten at the University Avenue Filiberto’s. The restaurant was closed on August 31, and according to a news release issued by SDHHS , at least ten people had become ill with apparent Shigella infections after eating at Filiberto’s in late August, three of whom were hospitalized.
• Airline Food Outbreak linked to Gate Gourmet (2004):  In September, 2004, health agencies from several U.S. states, as well as international health agencies, began reporting persons ill with Shigella sonnei infections. An epidemiological investigation conducted by the Hawaii Department of Health, in collaboration with other health agencies, revealed that a cluster of persons ill with a genetically identical strain of Shigella had traveled by air from Honolulu, Hawaii during August 22 through 24, 2004. The investigation established that food from airline caterer Gate Gourmet, Inc.’s Honolulu, Hawaii location was a common link between airlines and the cluster of persons ill with Shigella.  Gate Gourmet, Inc.’s Honolulu facility came under fire after an inspection by the Food and Drug Administration for numerous federal food safety violations in April, 2005. Investigators found pests and vermin, food stored at temperatures over fifty degrees higher than what is considered safe, and a ‘pink slimy substance’ in the washing machine.
• Colorado Doubletree Hotel (2003):  The Colorado Department of Public Health and Environment (CDPHE) received reports of a Shigella outbreak on September 9, 2003. Interviews confirmed that multiple people had been ill during or following their stay at the Doubletree Hotel in Westminster, Colorado. CDPHE notified the Foodborne and Diarrheal Diseases Branch of the federal Centers for Disease Control and Prevention (CDC) of a cluster of diarrheal illness among guests of the hotel. On September 12, CDC staff left Atlanta for Denver, to assist the CDPHE and Tri-County Health Department in their investigation of the outbreak.  Two separate large groups of hotel guests were identified; one group consisted of a wedding party; the second group consisted of a World War II veterans reunion, with attendees from a number of different states. Members of both groups, as well as a random sample of hotel guests, were contacted and interviewed; in all, 132 people.Ten individuals were diagnosed with culture-confirmed cases of Shigella sonnei infections.  On September 18, following positive stool tests from three food handlers, additional interviews of 25 kitchen staff were conducted. A kitchen chef cultured positive; he had worked September 4-6, had illness onset of September 8, and continued to work September 9-13.
• Royal Fork Shigella Outbreak (2001):   An employee at a Mt. Vernon, Washington restaurant was determined to be the source of a Shigella outbreak. The Skagit County Health Department confirmed nine illnesses linked to food served at Royal Fork.
• Senior Felix Outbreak (2000):  In January, 2000, a multi-state outbreak of shigellosis was traced to 5 Layer Fiesta Dip (“bean dip”) manufactured by Senor Felix Gourmet Mexican Foods. Over 335 people Washington, California, Oregon, Idaho, New Mexico, Arizona, and Alaska had confirmed or suspected cases of Shigella traced to the dip.

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The DuPage County Illinois Health Department has reported that four more cases of shigellosis were confirmed Friday, bringing the total number of confirmed cases caused by the outbreak at the Subway restaurant in Lombard to 12. Of those 12 cases, seven have required hospitalization. Six of those who were hospitalized have been released. The restaurant at 1009 E. Roosevelt Road in Lombard remains closed as investigators try to determine the cause of the outbreak.

In mid-October of 1999, an unusually high number of hepatitis A cases were reported among individuals residing in Northeast Seattle and Snohomish County, Washington. Public health officials conducted an epidemiologic survey that included questions about whether case-patients had eaten at fast food restaurants and grocery stores prevalent in the North Seattle area. By November 5, 1999, 18 of 21 persons confirmed positive with hepatitis A in King County after October 15, 1999 were found to have eaten at one of two Subway Sandwich outlets during the two to six week period prior to the onset of symptoms. During this same time period, the SHD determined that at least six persons with hepatitis A had eaten at one of the two implicated Subway outlets.

An environmental investigation resulted in the finding that neither of the implicated Subway outlets had a written hand washing policy, and that employees were not required to document their knowledge of proper hand washing technique. Having confirmed that the Subway outlets were, in fact, the outbreak’s common source, health department officials issued a press release that stated, in part, that: “An ongoing investigation by Public Health suggests that many [hepatitis A] infections are associated with consuming food from one of two Subway Salads and Sandwiches outlets during the month of September. . . .”

It is estimated that over 40 persons became ill as a result of eating contaminated food sold at the two Subway outlets implicated in the September 1999 hepatitis A outbreak. One child developed acute liver failure and required a transplant; many others were hospitalized with severe symptoms.

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Illnesses continue to be reported in the Shigella outbreak tied to the Subway restaurant in Lombard, Illinois.   Restaurant based Shigella outbreaks, though, are nothing new.  Sometimes, the results can be tragic.  In the fall of 2000, Shigella sickened hundreds, and left one person dead, in an outbreak at a Mexican restaurant in Northern California. 

The outbreak was investigated by health officials with the State of California.  The Division of Communicable Disease Control Branch reported that:

Between October 19 and 24, approximately 221 individuals became ill after eating at the Viva Mexico restaurant in Redwood City, CA. One death occurred in a female who ate at Viva Mexico on October 19. Symptoms included fever, vomiting, abdominal cramps, diarrhea (sometimes bloody) and dehydration. Seventy persons were culture confirmed with Shigella Sonnei. Analysis of data from a case-control study completed by San Mateo County Communicable Disease Control staff of all patients, completed by San Mateo County Communicable Disease Control staff of all patients, revealed a statistically significant association with salsa served at the table.

As is often the case, an environmental assessment of the restaurant uncovered conditions that may have contributed to the outbreak. 

An environmental assessment was conducted by sanitarians with San Mateo County Environmental Health on October 24. Due to multiple violations of the California Uniform Retail Food Facility Law, the restaurant was closed by San Mateo County sanitarians on October 24, 2000.

Additionally, the environmental assessment made by the county health made the following observations:

• no soap in the women’s restroom;
• no sanitizer on the premises;
• on site thermometer was reading temperatures 10°F off;
• improper cooling of foods – meet, poultry, and beans – with core temperatures from 50-70°F after 18 hours of cooling;
• cross contamination of foods – meat residue on knives used to cut produce.

As long as restaurants fail to heed sanitation principles, illnesses will result.

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When an outbreak happens at a restaurant, as opposed to an outbreak from a food item sold in grocery stores, the cause is frequently that one of the restaurant's employees was ill and contaminated food.  Often, other employees in the restaurant become sick as well, which can cause the problem of illness amongst customers to increase exponentially.  This is surely the case in the 2003 Salmonella javiana outbreak linked to Chili's restaurant in Vernon Hills, Illinois.  See Analysis of the Chili's Chicago-area Salmonella outbreak. 

The Shigella outbreak at Subway in Lombard, Illinois may also have been because of ill employees.  The Dupage County Health Department has not released any findings yet because its efforts have been aimed primarily at stopping the outbreak, and making sure that the restaurant is in shape to operate again.  Currently, there are at least 12 confirmed illnesses in the outbreak, with seven hospitalizations. 

The legal requirements in the State of Illinois related to ill employees are quite clear.  Section 750.500(a) of the Illinois administrative code states:

No person, while affected with a disease in a communicable form that can be transmitted by foods or who is a carrier of organisms that cause such a disease or while afflicted with a boil, or infected wound, or an acute respiratory infection, shall work in a food service establishment in any capacity in which there is a likelihood of such person contaminating food or food-contact surfaces with pathogenic organisms or transmitting disease to other persons.

Whether sick employees were a cause of the Lombard Subway Shigella outbreak remains to be determined for sure.  But its always a good guess in a restaurant outbreak situation. Other interesting legal requirements for Illinois restaurants appear at the Dupage County Health Department site.  Certain requirements sure to be the subject of much discovery in lawsuits surrounding the outbreak are:  The personal cleanliness of restaurant personnel, employee training, and manager training and certification. 

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The Chicago Tribune reported last night on a developing Shigella outbreak linked to a Lombard, Illinois Subway restaurant:

A Subway restaurant in Lombard has been closed by the DuPage County Health Department after several customers contracted gastrointestinal illnesses, officials said Thursday.

Health Department officials said in a statement that eight cases of shigellosis, an infectious disease caused by a bacterium called shigella, have been confirmed. Four people were hospitalized, according to the statement.

The Health Department said the restaurant at 1009 E. Roosevelt Road has been closed pending additional results of an investigation. Owners of the restaurant and representatives of Subway's corporate offices were cooperating with health officials, according to the statement.

Health officials said most people infected with the bacterium develop a gastrointestinal illness, including diarrhea, vomiting, fever and stomach cramps one to two days after being exposed to it.

Illness can pass from one infected person to the next and can also be acquired from eating contaminated food.

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The National Institutes of Health (NIH) has awarded a group of researchers $2.87 million for preclinical development of an oral drug to treat Shigella and C. difficile.

Shigella is a bacterium that belongs to a small group of pathogens (including E. coli O157:H7 and Cryptosporidium) that can infect the gut after the ingestion of relatively few organisms, and can cause sudden and severe diarrhea (gastroenteritis) in humans. About 25,000 laboratory-confirmed cases of shigellosis are reported each year in the U.S. Many cases go undiagnosed and/or unreported, however, and the CDC estimates that 450,000 total cases of shigellosis occur in the United States every year.

Clostridium difficile (C. difficile) is a spore-forming, gram-positive anaerobic bacillus that produces two toxins: toxin A and toxin B. These toxins typically cause gastrointestinal disease, often with severe complications.

The new research will focus on Ceragenin™ technology, which is a class of antimicrobial compounds that mimic functions of the body’s own innate immune system. The technology was invented by Paul B. Savage, Ph.D., professor at BYU.

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Two children in Zanesville, Ohio that both attend the same daycare have tested positive for Shigella.  The Zanesville Times Recorder reports:

Health officials are investigating a shigella outbreak after two children who attend Rufus Putnam Daycare tested positive for the infectious disease. One is a 2-year-old girl and the other is a 3-year-old girl.

"We've had two positive cultures of Shigella bacteria. Both are children at a day-care center. There are 79 children at the center so we got concerned," said Vicki Whitacre, medical director of the health department.

Approximately 15 people connected to the daycare have had a diarrheal illness, and all are being tested by health officials.  Shigella is a bacterium that belongs to a small group of pathogens (including E. coli O157:H7 and Cryptosporidium) that can infect the gut after the ingestion of relatively few organisms, and can cause sudden and severe diarrhea (gastroenteritis) in humans.

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Mike the Mad Biologist wrote a post titled, "Shigella, Children, and Antibiotic Resistance, in which he cites a study by the Centers for Disease Control and Prevention. The CDC study emphasized the fact that some strains of Shigella, a bacterium that is sometimes foodborne and can lead to serious illness and even death in children and populations with compromised immune systems, have become resistant to antibiotic treatment. From Mike the Mad Biologist's Post:

In the developed world, shigellosis, a diahrreal disease caused by the bacterial species Shigella, typically isn't considered dangerous, even though it makes about 450,000 ill in the U.S. To shorten the length of illness and to reduce potential infection of other people, antibiotics are typically prescribed, usually cotrmoxazole or ampicillin. However, recent shigellosis outbreaks are cause for concern (italics mine):

Surveillance data for antimicrobial resistance among all S. sonnei isolates received by NARMS during 1999--2003 indicated that 80% of the isolates were resistant to ampicillin and 47% to TMP/SMX [cotrimoxazole]; 38% were resistant to both drugs (6). In the two outbreaks described in this report, resistance to both ampicillin and TMP/SMX was 89%, complicating shigellosis treatment in these communities.

Mike the Mad Biologist points out that hand washing can prevent Shigella infection, and that a national approach to preventing future outbreaks is necessary, since, "bacteria and viruses really don't care about state boundaries." See the Shigella blog for more information about Shigella outbreaks.

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Courier Staff Writer Amy Ehrnreiter reports that Barney Phillips of Bedford, Kentucky, plans to set up the foundation in memory of his son, Patrick, who died at age 5 on June 13 of shigella.

Patrick loved Spiderman and wanted to be a superhero. A foundation established in his memory may help carry on Patrick's ambitions.

It wasn't until this week they learned the cause of his death was shigella, an infectious disease caused by a group of bacteria. Those infected experience severe diarrhea, fever and stomach cramps up to 24 hours after exposure to the bacterium, according to the Web site of the federal Centers for Disease Control and Prevention.

The disease, which is not commonly fatal, affected most of the Phillips family. Barney Phillips' wife, Sarah Phillips, and their other two children, Josh, 4, and Vicki, 2, also displayed symptoms of shigella.

Barney Phillips thinks the family was exposed to the bacteria at a fast-food restaurant while in Indianapolis at a "Reconciling the Kingdom" convention June 8.

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