Health leaders said seven people are in the hospital, and more than 30 have reported symptoms consistent with salmonellosis. Kayla Semonco and her boyfriend Parker Allred are two of those who had hospital visits are eating take-out from the restaurant.

Semonco and Allred went to Tarheel Q on June 17th, to celebrate Allred’s father’s birthday. The take-out they later ate, according to the pair, caused them and three other people to become ill in the following days.

“I have been sick for four or five days now, ” said Semonco. “I woke up this morning and was tired of being sick, so I went to the hospital to get fluids.”

Allred, traveling for a mission trip, found himself in a Pennsylvania hospital at the same time, also receiving fluids. He said he is feeling better and will be released soon

Salmonella is an enteric bacterium, meaning that it lives in the intestinal tracts of humans and other animals. Salmonella bacteria are usually transmitted to humans by eating foods contaminated with human or animal feces. Contaminated foods usually look and smell normal. They are often of animal origin, such as beef, poultry, milk, or eggs, but all foods, including vegetables, may become contaminated. An infected food handler who neglects to wash his or her hands with soap and warm water after using the bathroom may also contaminate food.

Salmonella is the second most common foodborne illness in the United States. Approximately 1.4 million cases of Salmonella occur each year with 95% of those caused by tainted food. The acute symptoms of Salmonella include the sudden onset of nausea, abdominal cramping, and bloody diarrhea and mucous over a period of days. While there is no cure, infected persons usually recover completely, although it may take months. A small number of people experience ongoing symptoms such as joint pain, which can lead to chronic arthritis.

North Carolina has seen its fair share:

Cleveland County Fair E. coli Outbreak – North Carolina (2012)

Crossroads Farm Petting Zoo E. coli Outbreak Lawsuits – North Carolina (2004)

Robeson Schools E. coli Outbreak Litigation – North Carolina (2001)

Olive Garden Hepatitis A Outbreak Lawsuit – North Carolina (2011)

Lancaster’s BBQ Salmonella Outbreak Lawsuit – North Carolina (2012)

Smiling Hara Tempeh Salmonella Outbreak Lawsuits- North Carolina (2012)

Western Sizzlin’ Salmonella Outbreak Lawsuits – North Carolina (2002)

Holiday Inn Bordeaux Salmonella Outbreak Lawsuits – North Carolina (2013)

Salmonella: Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $600 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation. Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants. The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

Last week as the news surrounding the hospitalization of an Ebola victim in Dallas, I passed through the Dallas/Fort Worth airport on my way to Austin to give a series of food safety speeches.  By the time I got home came the report of the first death in the United States.  This morning came the report of a infected health care worker at the Dallas Hospital where the original victim died last week.

The outbreak, which to date has primarily impacted West Africa – Total Cases: 8399, Laboratory-Confirmed Cases: 4655, Total Deaths: 4033 – has now clearly hit our shores.

The World Health Organization reports that it is “thought that fruit bats of the Pteropodidae family are natural Ebola virus hosts. Ebola is introduced into the human population through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as chimpanzees, gorillas, fruit bats, monkeys, forest antelope and porcupines found ill or dead or in the rainforest.”

It does make you think.

Tampa Bay Police report, shortly after dinner, Ronnie Morales felt sick and called 911. However, he was feeling so ill that his girlfriend drove him to St. Joseph’s Hospital. When they arrived his girlfriend also became ill and was rushed across the street to St. Joseph’s Women’s Hospital where they induced labor, as she was 9 months pregnant. A short time later, her daughters, 7-year-old Elyana and 6-year-old Rayna, started experiencing hallucinations and felt ill. Both children and Ronnie Morales received tracheal intubation and were hospitalized. They were released from the hospital in good condition on Wednesday, March 5th. The mother and her healthy baby boy were released Thursday, March 6th.

TPD’s Forensic investigators took possession of the food items that the family consumed prior to falling ill. They also took the family’s oven for testing. Initial test results received today from the Hillsborough County Medical Examiner’s Office determined the family consumed bottom round steak contaminated with LSD. Toxicology test on samples from the family members are pending. Results are expected in the next three weeks.

Detectives determined the family bought the meat at a Walmart located at 1501 North Dale Mabry Highway. The chain has been very cooperative with the investigation and voluntarily turned over all meat of that type that was on their shelves at that time. The Medical Examiner is currently testing that meat. TPD does not have any other similar cases. At this point, it appears this is an isolated incident. Detectives are still working to determine if a crime has occurred. The Federal and Florida Department of Agriculture along with the Hillsborough County Health Department are investigating the case with TPD detectives.

Researchers from Weill Cornell Medical College have added to the growing body of evidence that multiple sclerosis may be triggered by a toxin produced by common foodborne bacteria. The presented their research at the 2014 ASM Biodefense and Emerging Diseases Research Meeting.

Multiple sclerosis (MS) is an inflammatory disease of the central nervous system characterized by blood brain (BBB) permeability and demyelination, a process in which the insulating myelin sheaths of neurons are damaged.   The disease is thought to be triggered in a genetically susceptible individual by a combination of one or more environmental factors. The environmental trigger of MS, however, is still unknown.  According to the National Multiple Sclerosis Society, the condition affects approximately 400,000 Americans and is, with the exception of trauma, the most frequent cause of neurological disability beginning in early to middle adulthood.

“We provide evidence that supports epsilon toxin’s ability to cause BBB permeability and show that epsilon toxin kills the brain’s myelin producing cells, oligodendrocytes; the same cells that die in MS lesions,” says Jennifer Linden of Weill Cornell Medical College, who presented the research.  “We also show that epsilon toxin targets other cells types associated with MS inflammation such as the retinal vascular and meningeal cells.  Epsilon toxin may be responsible for triggering MS.”

Epsilon toxin is produced by certain strains of Clostridium perfringens, a spore-forming bacterium that is one of the most common causes of foodborne illness in the United States. The U.S. Centers for Disease Control and Prevention estimates that non-epsilon toxin producing C. perfringens strains  cause nearly a million cases of foodborne illness each year.

Previous studies have suggested that C. perfringens, and in particular epsilon toxin, may play a role in triggering MS.  Late last year Linden and her colleagues discovered C. perfringens type B (a strain that is not known to infect humans and produces the epsilon toxin) in a 21-year-old woman who was experiencing a flare-up of her MS. To further test their hypothesis Linden and her colleagues studied the behavior of the toxin in mice, specifically which cells it targeted.

They discovered that the toxin did target the brain cells associated with MS pathology.  But that was not all they found.

“Originally, we only thought that epsilon toxin would target the brain endothelium cells and oligodendrocytes; we just happened to notice that it also bound to and killed meningeal cells.  This was exciting because it provides a possible explanation for meningeal inflammation and subpial cortical lesions exclusively observed in MS patients, but not fully understood,” says Linden.

They also tested samples of local foods for the presence of C. perfringens and the toxin gene.  Of the 37 food samples, 13.5% were positive for bacteria and 2.7% were positive for the epsilon toxin gene.

Linden says these findings are important, because if it can be confirmed that epsilon toxin is indeed a trigger of MS, development of a neutralizing antibody or vaccine directed against epsilon toxin might stop the progression of the disease or prevent it from even developing.

According to Food Safety Magazine, NSF International’s Applied Research Center (ARC) has released the 2013 NSF International Household Germ Study, revealing that many common kitchen items harbor unsafe levels of E. coli, Salmonella, Listeria, yeast and mold. NSF International scientists point to a number of contributing factors — including improper food storage, handling, preparation and cleaning — which may help explain why more than 20% of foodborne illness outbreaks result from food consumed in the home.

The NSF microbiologists conducting the germ study analyzed 14 common kitchen items for the presence of four different types of microorganisms: E. coli, Salmonella, yeast and mold, and Listeria. The study found that many of these common kitchen appliances and tools used to prepare food do indeed harbor pathogens that can cause foodborne illness:

• Refrigerator vegetable compartment: Salmonella, Listeria, yeast and mold

• Refrigerator meat compartment: Salmonella, E. coli, yeast and mold

• Blender gasket: Salmonella, E. coli, yeast and mold

• Can opener: Salmonella, E. coli, yeast and mold

• Rubber spatula: E. coli, yeast and mold

• Food storage container with rubber seal: Salmonella, yeast and mold

It is NSF’s hope that the information gained from this study will further underscore the importance of properly maintaining and cleaning these items, especially those that we don’t always think to disassemble and clean such as the blender gasket.

Perception vs. Reality: Are We Unknowingly Making Ourselves and Others Sick?

Importantly, while germ study volunteers correctly identified items that they thought would harbor the most germs, they are not always cleaning them sufficiently to prevent illness. The following is a list of the items that were perceived by volunteers to be the “germiest” versus the actual “germiest” items (ranked from highest to lowest in germ count):

Perceived:

1. Microwave keypad

2. Can opener

3. Refrigerator meat compartment

4. Refrigerator vegetable compartment

5. Flatware storage tray

6. Knife block

7. Pizza cutter

8. Rubber spatula

9. Refrigerator insulating seal

10. Ice dispenser

Reality:

1. Refrigerator water dispenser

2. Rubber spatula

3. Blender

4. Refrigerator vegetable compartment

5. Refrigerator ice dispenser

6. Refrigerator meat compartment

7. Knife block

8. Food storage container with rubber seal

9. Can opener

10. Refrigerator insulating seal

Germs found on these everyday kitchen appliances and tools can easily come in direct contact with food, especially raw produce, meat, poultry, seafood and ready-to-eat food. The study identified where the germs are located in the average home kitchen and, more importantly, how people can better protect against foodborne illness. The key is to be aware of where the ‘hot spots’ are in your home and clean correctly and regularly to help prevent germ accumulation.

The CDC reports as of July 25, 2013, CDC has been notified of 321 cases of Cyclospora infection in residents of multiple states and one city, including Iowa, Nebraska, Texas, Florida, New York City, Wisconsin, Georgia, Missouri, Arkansas, Connecticut, Minnesota, New Jersey, and Ohio. Illinois and Kansas have also notified CDC of one case each that may have been acquired out of state but in the United States.

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded Cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.  See, www.outbreakdatabase.com for past outbreaks related to Cyclospora cayetanensis.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America.

Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that Cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, and loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with Cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with Cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since Cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for Cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for Cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with Cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure.

Washing fresh fruits and vegetables at home may help to remove some of the organisms, but Cyclospora may remain on produce even after washing.

The U.S. Department of Agriculture’s Food Safety and Inspection Service announced over the weekend that about 188,000 pounds of chicken imported from Chile is being recalled for potential dioxin contamination.

After the Chilean Ministry of Health found dioxin in chicken products, FSIS said it instructed importers to hold product from the country at the point of re-inspection. U.S. authorities believe 188,522 pounds of chicken may be affected and of that 126,082 is currently being held.

“The agency is investigating the distribution of the remaining 62,440, pounds and verifying if additional shipments are involved,” read the weekend announcement. “FSIS may expand the public notification and will take necessary and appropriate action after analyzing updated information received from the government of Chile.”

The agency said it had conducted an analysis of the Chilean test results and “determined that the risk to consumers is negligible,” but that the agency is continuing to track down where the product was distributed.

FSIS said it was issuing a public notification to “make the public aware of the situation” and the agency is not formally announcing a recall because “the establishment most directly associated with producing the adulterated product has recalled product and USDA works with its counterparts to conduct effectiveness checks in U.S. In this case, the Chilean Ministry of Health initiated a recall of this product.”

The Washington State Department of Agriculture (WSDA) has revoked the food-processing license of Chu Minh Corp., which produces tofu and other soy products, after several inspections found on-going sanitation problems with the Seattle business.

In addition to revoking the company’s license to process food, WSDA also assessed a civil penalty of $17,800 against the company and required all products at the facility to be destroyed. Notices about the license revocation are being sent to all retail outlets and restaurants that have purchased or carry Chu Minh products.

As a result of these actions, the company cannot process any food at this location. Chu Minh has 10 days to appeal and request agency reconsideration of the order, but it cannot operate as a food processing operation during that appeal period.

This enforcement action follows several visits to Chu Minh where WSDA inspectors consistently found problems with unsanitary conditions, poor sanitation practices by employees, pest infestations and a general failure to protect food products from contamination.

During the most recent inspection on March 6, inspectors noted many of the same problems observed during earlier inspections.

WSDA’s Food Safety and Consumer Services Division typically tries to work with businesses to correct problems when violations of the state food production and handling requirements are discovered. When these education efforts fail to improve conditions, WSDA has the authority to suspend licenses or assess civil penalties.

In this case, WSDA had twice issued orders to suspend Chu Minh Corps.’ processing license. Both times, the company signed settlement agreements in which they promised to meet food-processing requirements. The most recent agreement was in October 2012.

However, the continued violations of food processing standards and the failure to fully pay earlier fines associated with previous violations led to the decision to revoke Chu Minh’s food processing license.

Consumers who purchased Chu Minh products are advised to dispose of them. For questions, contact WSDA’s Food Safety and Consumer Services Division at foodsafety@agr.wa.gov or 800-843-7890.

Bumble Bee Foods, LLC, has issued a voluntary recall on specific codes of 5-ounce Chunk White Albacore and Chunk Light Tuna products. The recall has been issued because the products do not meet the company’s standards for seal tightness.  These products were distributed for retail sale nationwide between January 17, 2013 and February 28, 2013.  For full listing: http://www.fda.gov/Safety/Recalls/ucm342592.htm

Tri-Union Seafoods LLC is voluntarily recalling a limited amount of Chicken of the Sea brand 5-ounce cans of chunk white albacore tuna in water.The seams on the lids of the cans do not meet the standard for seam quality. The specific product being recalled is Chicken of the Sea Brand 5-ounce chunk white albacore tuna in water sold at retail nationwide in single cans between February 4, 2013 and February 27, 2013.  For full listing: http://www.fda.gov/Safety/Recalls/ucm342650.htm

Cans that do not meet seam standards could result in product contamination by spoilage organisms or by pathogens, which could lead to illness if consumed.

Pictures of some of the recalled products:

In 2011, Congress enacted the FDA Food Safety Modernization Act (FSMA), recognizing the unique challenges faced by FDA in the area of food safety in the 21st century. FSMA directs FDA to build a new food safety system based on the public health principle of comprehensive prevention, an enhanced focus on risk-based resource allocation, and partnerships across the public and private sectors to minimize hazards from farm to table.  In addition, Section 305 of FSMA calls on FDA to develop a comprehensive plan to expand the technical, scientific, and regulatory food safety capacity of foreign governments and their respective food industries in countries that export foods to the United States (the “Plan”). This Plan meets the Section 305 requirement, and does so by incorporating FSMA’s principles of comprehensive prevention, risk-based resource allocation, and partnering.

This Plan provides a strategic framework for FDA’s international food safety capacity-building activities. It outlines goals, objectives, and key actions that will provide a framework for the FDA in setting priorities and managing international food safety capacity building programs.

The Plan will also enable all stakeholders to see the breadth of food safety capacity-building efforts on the part of FDA.   It charts a direction for how FDA will prioritize its capacity-building efforts based on risk, coordinate with other partners to avoid duplication of efforts, and to broaden the reach of technical assistance and capacity-building efforts.   FDA will use data to develop strategies, allowing the agency to make decisions about capacity-building based on identifiable needs, while also allowing the agency to measure the impact of its efforts.

The plan addresses the six elements required by Section 305 of FSMA by incorporating them into four key goals and objectives, as supplemented by additional themes. The Plan’s key goals and objectives are:

  • Ensure efficiency across the FDA Foods and Veterinary Medicine Program
  • Increase effectiveness through evidence-based decision making
  • Support the exchange of information between FDA and other foreign government agencies or other entities
  • Enhance technical assistance and capacity-building in food

Building International Capacity with Respect to Food Safety

About 48 million people (1 in 6 Americans) get sick, 128,000 are hospitalized, and 3,000 die each year from foodborne diseases, according to recent data from the Centers for Disease Control and Prevention. This is a significant public health burden that is largely preventable.

The FDA Food Safety Modernization Act (FSMA), signed into law by President Obama on January 4, 2011 enables FDA to better protect public health by strengthening the food safety system. It enables FDA to focus more on preventing food safety problems rather than relying primarily on reacting to problems after they occur. Specifically, the legislation significantly enhances FDA’s ability to oversee the millions of food products that come into the United States from other countries each year. An estimated 15 percent of the U.S. food supply is imported, including 60 percent of fresh fruits and vegetables and 80 percent of seafood.

The law gives FDA important new tools to hold imported foods to the same standards as domestic foods. With these new tools, FDA can better ensure that imported products meet U.S. standards and are safe for U.S. consumers.

Full Text of the Law Relating to International Capacity Building

FDA’s International Food Safety Capacity-Building Plan

Section 305 of FSMA requires FDA to develop a comprehensive plan to expand technical, scientific and regulatory food safety capacity of foreign governments and their respective food industries in countries from which foods are exported to the United States. Further, FDA is required to develop the capacity-building plan in consultation with certain stakeholders, including representatives of the food industry, officials from other federal agencies, foreign government officials, non-governmental organizations that represent the interests of consumers, and other stakeholders. The capacity-building plan shall include, as appropriate:

  1. Recommendations for bilateral and multilateral arrangements and agreements, including providing for responsibilities of exporting countries to ensure food safety;
  2. Provisions for secure electronic data sharing;
  3. Provisions for mutual recognition of inspection reports;
  4. Training of foreign governments and food producers on U.S. requirements for safe food;
  5. Recommendations on whether and how to harmonize requirements under the Codex Alimentarius; and
  6. Provisions for multilateral acceptance of laboratory methods and testing and detection techniques.

View FDA’s International Food Safety Capacity-Building Plan (PDF: 5.7MB), February 2013.

Public Meeting

FDA hosted a one-day public meeting entitled “International Capacity Building with Respect to Food Safety” on June 19, 2012 in Washington, DC. The purpose of this public meeting was to provide interested persons a forum to learn about FDA’s current thinking on the international capacity building plan and offer an opportunity for the public to provide comments. See more information on the upcoming public meeting.