What can the 74 Hawaii victims do to help health officials? Be your own junior epidemiologist.
Sitting in my hotel room on the shores of Waikiki in the remnants of tropical storm Darby, has given me time – perhaps too much – to think about this outbreak – especially after meeting with a few of the families.
The Hawaii Department of Health (HDOH) is investigating a cluster of 74 hepatitis A infections on Oahu. Onset of illness has ranged between June 12 and July 14. Sick individuals were likely exposed to the fecal human virus through food, drink or personal exposure two to six weeks prior to the onset of symptoms – so the likely exposure period is May 1 through July 1.
HDOH staff are conducting interviews with the cases in an effort to identify the source of infection. HDOH reports that identifying the source of infection continues to be a challenge because of the long incubation period of the disease and the difficulty patients have in accurately recalling the foods consumed and locations visited during the period when infection could have taken place.
All of the cases are residents of Oahu with the exception of two individuals who now live on the islands of Hawaii and Maui, but were on Oahu during their exposure periods.
On the 74 sickened, one was an employee of a Taco Bell on Oahu and one was an employee of a Baskin-Robbins on Oahu. They both worked prior to the onset of illness and during the peak exposure period. This has caused additional community concern that the outbreak may spread to Taco Bell and Baskin-Robbins patrons.
So, what can the 74 outbreak victims do to help health officials find the common link? Here are some suggestions that I am sure HDOH officials are already using:
Be cooperative – hepatitis A illnesses can last two to six months and victims are certainly not feeling their best, but their cooperation is vital.
Think about what you ate or drank. That may well not be too productive – trying to recall what you ate or drank several weeks ago is difficult – I can hardly recall what I ate or drank a few days ago – however, try.
Focus on where you have been eating and drinking in the two to six weeks prior to becoming ill – at home or out. Check your calendar, phone records and social media like Facebook and Twitter.
Review your credit and debit card purchases as well as any accounts you have at grocery stores or restaurants.
Ask friends, co-workers or family what they might recall that you did during that same time.
Keep in contact with HDOH. Its resources are stretched and it needs your support and assistance.
With the help of the 74 – hopefully, not more – HDOH will solve this mystery and stop the spread of this potentially deadly virus.
Disease Outbreak Control Division
1250 Punchbowl Street, Room 443
Honolulu, HI 96813
Tel: (808) 587-6845
Fax: (808) 586-8347
Bill Marler testified before Congress in support of the Food Safety Modernization Act, asking the government and the food industry to put him out of business.
From about 2011 though the summer of 2015 business was slower for The Food Safety Law Firm, which meant on average less people were sickened by the food they ate. For some time I thought the food industry was actually “Putting me out of Business.”
However, the Centers for Disease Control and Prevention released its FoodNet report this week with the stats on nine pathogens in 10 states for 2016 — comparing 2013-2015[1] — and the new numbers are not great. They confirm why we seem busier lately.
In 2016, FoodNet identified 24,029 infections, 5,512 hospitalizations, and 98 deaths in the United States caused by the nine pathogens.
The pathogens covered in the report are Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia.
Compared with 2013-2015, the 2016 incidence of Campylobacter infection was significantly lower at 11 percent less when including only culture-confirmed infections. Incidence of STEC infection was significantly higher for confirmed infections, posting a 21 percent increase.Similarly, the incidence of Yersinia infection was significantly higher, with confirmed infections increasing 29 percent.
Incidence of confirmed Cryptosporidium infection was also significantly higher in 2016 compared with 2013–2015 with the CDC reporting a 45 percent increase.
Among 7,554 confirmed Salmonella cases in 2016, serotype information was available for 6,583, representing 87 percent of the cases. The most common serotypes were Enteritidis with 1,320 cases or 17 percent; Newport with 797 cases or 11 percent, and Typhimurium with 704 cases or 9 percent. The incidence in 2016 compared with 2013-2015 was significantly lower for Typhimurium (18% decrease; CI = 7%–21%) and unchanged for Enteritidis and Newport.Among 208, or 95 percent, of speciated Vibrio isolates, half, or 103, were V. parahaemolyticus. There were 35, or 17 percent, that were V. alginolyticus, and 26, or 13 percent that were V. vulnificus.
Among 1,394 confirmed and serogrouped STEC cases, 36 percent, or 503 cases, were STEC O157. Another 64 percent, or 891 STEC cases, were non-O157. Among 70 percent, or 586 cases of non-O157 isolates, the most common serogroups were O26 with 190 cases, O103 with 178 cases, and O111 with 106 cases. Compared with 2013-2015, the incidence of STEC non-O157 infections in 2016 was significantly higher (26% increase; CI = 9%–46%) and the incidence of STEC O157 was unchanged.
We are still seeing a significant downturn in E. coli cases linked to red meat, but are seeing cases in products like flour and soy nut butter, that leave all a bit perplexed. We are also seeing less cases linked to leafy greens generally. Our growth areas seem to be imported food products and restaurant-related outbreaks.
The entire food chain, both foreign and domestic, as well as government, academia and consumers, clearly have more to do to drive me into retirement.
[1] FoodNet conducts active, population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia for 10 sites covering approximately 15% of the U.S. population.
Editor’s note: Bill Marler is publisher of Food Safety News and a founding member of the Seattle law firm MarlerClark LLP, PS.
I can hear a bit of silence in the board rooms of America.
Monday the U.S. Supreme Court declined to hear the appeals of Austin “Jack” DeCoster and his son, Peter DeCoster, without comment.
In April 2015 U.S. District Judge Mark Bennett sentenced the DeCosters to prison, saying they knew or should have known about the risks posed by the presence of Salmonellain and around millions of egg-laying hens. However, he allowed the DeCosters to stay free while they appealed the sentences, which they argued were unconstitutional and unreasonably harsh. The 8th U.S. Circuit Court of Appeals upheld the sentences in July 2016 and stayed any action until the U.S. Supreme Court appeal was resolved.
Now the DeCosters will now both face three-month jail sentences stemming from a Salmonella outbreak caused by their Iowa egg farms in 2010.
The Salmonella outbreak ran from May 1 to Nov. 30, 2010, and prompted the recall of more than half a billion shell eggs, the largest recall of its kind in history. And, while there were 1,939 confirmed infections, statistical models used to account for Salmonella illnesses in the U.S. suggest that the eggs may have sickened more than 62,000 people.
The family business, known as Quality Egg LLC, had already pleaded guilty to one federal felony count of bribing a U.S. Department of Agriculture egg inspector and to two federal misdemeanors associated with the outbreak. It agreed that the LLC would pay a $6.8-million fine and the DeCosters would be fined $100,000 each, for a total of $7 million.
I am not sure if the Supreme Court read Bill Neuman’s New York Times article from September 2010, “An Iowa Egg Farmer and a History of Salmonella.” However, he should. Here are some of the highlights/lowlights:
“DeCoster’s frequent run-ins with regulators over labor, environmental and immigration violations have been well cataloged. But the close connections between DeCoster’s egg empire and the spread of Salmonella in the United States have received far less scrutiny.”
“Farms tied to DeCoster were a primary source of Salmonella enteritidis in the U.S. in the 1980s, when some of the first major outbreaks of human illness from the bacteria in eggs occurred, according to health officials and public records. At one point, New York and Maryland regulators believed DeCoster eggs were such a threat that they banned sales of the eggs in their states. ‘When we were in the thick of it, the name that came up again and again was DeCoster Egg Farms,’ said Paul A. Blake, who was head of the Enteric Diseases Division at the Centers for Disease Control and Prevention in the 1980s, when investigators began to tackle the emerging problem of Salmonella and eggs.”
“Records released by Congressional investigators last week suggest that tougher oversight of Mr. DeCoster’s Iowa operations might have prevented the outbreak, which federal officials say is the largest of its type in the nation’s history, with more than 1,600 reported illnesses and probably tens of thousands more that have gone unreported.”
“According to the records, Mr. DeCoster’s farms in Iowa conducted tests from 2008 to 2010 that repeatedly showed strong indicators of possible toxic salmonella contamination in his barns. Such environmental contamination does not always spread to the eggs, and it is unclear what actions Mr. DeCoster took in response. However, when the Food and Drug Administrationinspected the farms after the recalls, officials found unsanitary conditions and the presence of Salmonella enteritidis in barns and feed.”
“The first enteritidis outbreak recognized by public health officials came in July 1982, when about three dozen people fell ill and one person died at the Edgewood Manor nursing home in Portsmouth, N.H. Investigators concluded that runny scrambled eggs served at a Saturday breakfast were to blame. They traced the eggs to what the Centers for Disease Control reports referred to as a large producer in Maine; interviews with investigators confirmed that it was Mr. DeCoster’s former operation. Eggs from the same farms were also suspected in a simultaneous outbreak that sickened some 400 people in Massachusetts.”
“In 1987, a deadly outbreak at Coler Memorial Hospital on Roosevelt Island occurred. Investigators determined that mayonnaise made from raw eggs had caused the outbreak. They traced the eggs to Mr. DeCoster’s Maryland farms. On a July night in 1987, scores of elderly and chronically ill patients at Bird S. Coler Memorial Hospital in New York City began to fall violently sick with food poisoningfrom eggs tainted with salmonella. ‘It was like a war zone,’ said Dr. Philippe Tassy, the doctor on call as the sickness started to rage through the hospital. By the time the outbreak ended more than two weeks later, nine people had died and about 500 people had become sick. It remains the deadliest outbreak in this country attributed to eggs infected with the bacteria known as Salmonella enteritidis.”
“After two more outbreaks were linked to DeCoster eggs the following year, New York banned Mr. DeCoster from selling eggs in the state. He was forced to agree to a rigorous program of salmonella testing on his farms in Maine and Maryland. Michael Opitz, a poultry expert retired from the University of Maine, said that the testing found that a Maine breeder flock owned by Mr. DeCoster was infected, meaning that hens there could be passing the bacteria to their chicks, which might grow up to lay tainted eggs. Widespread contamination was also found in laying barns.”
Austin “Jack” DeCoster, left, and his son Peter DeCoster will each have to serve a three-month sentence for their roles in the 2010 Salmonella outbreak traced to their eggs.
“In 1991, tests revealed more salmonella contamination at one of Mr. DeCoster’s farms in Maryland. The state quarantined the eggs, allowing them to be sold only to a plant where they could be pasteurized to kill bacteria. Mr. DeCoster challenged the order and a federal judge ruled that Maryland could not block him from shipping eggs to other states. He was still barred from selling the eggs in Maryland, and in 1992, a state judge found that he had violated the quarantine by selling eggs to a local store; Mr. DeCoster was given a suspended sentence of probation and a token fine.”
“Soon after interstate shipments resumed in 1992, eggs from the Maryland farm caused a salmonella outbreak in Connecticut, according to a 1992 memo from the Maryland attorney general’s office. Federal regulators insisted that Mr. DeCoster decontaminate his barns. Dr. Roger Olson, the former state veterinarian of Maryland, said that Mr. DeCoster complained about the cost of testing and the quarantine and insisted there was little risk associated with his eggs.”
And, then there was 2010. I think Jack and Peter need some time away to think about this.
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Although the United States is know world-wide as having one of the safest food supplies, there have been instances where some of the foods most commonly consumed in our country have resulted in tragedy.
Jack-in-the- Box E. coli Outbreak – 1992 – 1993
708 ill, 171 hospitalized and 4 dead
An outbreak of E. coli O157:H7 was linked to the consumption of hamburgers from the Jack-in-the-Box Restaurant chain. Cases were reported from the states of Washington (602 cases/144 hospitalizations/3 deaths), Idaho (14 cases/4 hospitalizations/no deaths), California (34 cases/14 hospitalizations/1 death), and Nevada (58 cases/9 hospitalizations/no deaths). A case control study implicated the chain’s hamburgers resulting in a multistate recall of the remaining hamburgers. Only 20 percent of the product remained at the time of the recall; this amounted to 272,672 hamburger patties. Subsequent testing of the hamburger patties showed the presence of E. coli O157:H7. The strain of E. coli O157:H7 found in ill people matched the strain isolated from uncooked hamburger patties. The outbreak illustrated the potential for large, foodborne illness outbreaks associated with restaurant chains receiving shipments of contaminated food. At the time, many clinical laboratories in the United States were not routinely culturing patients’ stool for E. coli O157:H7 by using the correct culture medium. Additionally, many local and state health departments were not actively tracking and investigating E. coli O157:H7 cases.
Pennsylvania State health officials first learned of a hepatitis A outbreak when unusually high numbers of hepatitis A cases were reported in late October 2003. All but one of the initial cases had eaten at the Chi Chi’s restaurant at the Beaver Valley Mall, in Monaca, PA. Ultimately, at least 565 cases were confirmed. The victims included at least 13 employees of the Chi Chi’s restaurant, and residents of six other states. Three people died as a consequence of their hepatitis A illnesses. More than 9,000 people who had eaten at the restaurant, or who had been exposed to ill people, were given a post-exposure injection as a prevention against developing hepatitis A. Preliminary analysis of a case-control study indicated fresh, green onions were the probable source of this outbreak. The investigation and tracebacks by the state health department, the CDC, and the FDA, confirmed that the green onions had been grown in Mexico.
On Sept. 13, 2006, public health officials in Wisconsin, Oregon and New Mexico noted E. coli O157:H7 infections with matching pulsed-field gel electrophoresis (PFGE) patterns. These illnesses were associated with eating fresh, bagged spinach produced by Dole Brand Natural Selection Foods. By Sept. 26 that year, infections involving the same strain of E. coli O157:H7 had been reported from 26 states with one case in Canada. A voluntary recall was issued by the company on Sept. 15. E. coli O157: H7 was isolated from 13 packages of spinach supplied by patients in 10 states. Eleven of the packages had lot codes consistent with a single manufacturing facility on a particular day. The PFGE pattern of all tested packages matched the PFGE pattern of the outbreak strain. The spinach had been grown in three California counties –Monterey, San Benito and Santa Clara. E. coli O157:H7 was found in environmental samples collected near each of the four fields that provided spinach for the product, as designated by the lot code. However, E. coli O157:H7 isolates associated with only one of the four fields, located on the Paicines Ranch in San Benito County, had a PFGE pattern indistinguishable from the outbreak strain. The PFGE pattern was identified in river water, cattle feces and wild pig feces on the Paicines Ranch, the closest of which was less than one mile from the spinach field.
Peanut Corporation of America Salmonella Outbreak – 2008 – 2009
714 ill, 171 hospitalized and 9 dead
Beginning in November 2008, CDC’s PulseNet staff noted a small and highly dispersed, multistate cluster of Salmonella Typhimurium isolates. The outbreak consisted of two pulsed-field gel electrophoresis (PFGE) defined clusters of illness. Illnesses continued to be revealed through April 2009, when the last CDC report on the outbreak was published. Peanut butter and products containing peanut butted produced at the Peanut Corporation of America plant in Blakely, GA, were implicated. King Nut brand peanut butter was sold to institutional settings. Peanut paste was sold to many food companies for use as an ingredient. Implicated peanut products were sold widely throughout the USA, 23 countries and non-U.S. territories. Criminal sanctions were brought against the owners of PCA.
A multistate outbreak of Listeria monocytogenes involving five distinct strains was associated with consumption of cantaloupe grown at Jensen Farms’ production fields near Granada, CO. A total of 147 ill people were reported to the CDC. Thirty-three people died, and one pregnant woman miscarried. Seven of the illnesses were related to pregnancy –three newborns and four pregnant women. Among 145 ill people with available information, 143 – 99 percent – were hospitalized. Source tracing of the cantaloupes indicated that they came from Jensen Farms, and were marketed as being from the Rocky Ford region. The cantaloupes were shipped from July 29 through Sept. 10, 2011, to at least 24 states, and possibly distributed elsewhere. Laboratory testing by the Colorado Department of Public Health and Environment identified Listeria monocytogenes bacteria on cantaloupes collected from grocery stores and from ill persons’ homes. Laboratory testing by FDA identified Listeria monocytogenes matching outbreak strains in samples from equipment and cantaloupe at the Jensen Farms’ packing facility in Granada, Colorado. Criminal sanctions were brought against the two owners of Jensen Farms.
Andrew and Williamson Cucumber Salmonella Outbreak – 2015
907 ill, 204 hospitalized and 6 dead
On September 4, 2015 the CDC announced an outbreak of Salmonella Poona linked to consumption of cucumbers grown in Mexico and imported by Andrew & Williamson Fresh Produce. On March 18, 2016 the outbreak was declared to be over. A total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states. Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Two hundred four ill people were hospitalized and six deaths were reported. Salmonella infection was not considered to be a contributing factor in two of the 6 deaths. Epidemiologic, laboratory, and traceback investigations identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.
My friend, Darin Detwiler, let me post this for him tonight for tomorrow:
Today marks the 25th anniversary of the day the last of four young children died during the landmark 1993 Jack in the Box E. coli outbreak.
Riley Edward Detwiler
I learned about the reality of this foodborne pathogen on Riley’s deathbed. When he was only a few months old, I justified being out to sea on a Navy submarine by telling myself that I was making the world a safer place for him, and I thought that I would spend the rest of my life making up lost time with him when he was older.
Riley would now be older than I was during that outbreak. I never got to see him grow older than he appears in the few photos and videos from so long ago. Over the years since his death, however, I have seen news of recalls and outbreaks and deaths on a far too regular basis. I have also seen much improvement in food safety.
We have gained new federal food safety regulations and policies at the USDA and, most recently at the FDA. We have witnessed advancements in science and data collection and even a whole new “culture of food safety.” We have training, certifications, university programs, conferences, magazines, books, and even movies that serve to inform and motivate new generations of food safety experts.
Many of the changes in food safety policies came about through the hard work of victims, families, advocacy groups and industry leaders. Statistics and charts alone achieve little without victim’s voices. Facts rarely motivate policymakers as much as seeing the faces and stories. I am very proud of their efforts. I am also proud to have stood with them and before them, trying to prevent other parents from looking at their family table with one chair forever empty due to preventable illnesses and deaths from foodborne pathogens.
One thing that hits me hard lately is how the faces and stories of victims from mass shootings are seemingly not enough to bring about change in terms of gun control. While no new policies will bring back the dead, they would bring hope and an increased safety for others. I am saddened by the thought that so many parents will live with the belief that their child’s death did not result in some element of change.
Perhaps the reasons matter not as to why parents worry about making the world a safer place for their children. Too many homes in this country include a chair forever empty at a family table due to reasons that could and should have been prevented.
Answer: They are all in Kentucky where a hepatitis A outbreak has been ongoing for months. With 272 people infected with Hepatitis A in Kentucky, restaurants must offer hepatitis A vaccines to employees – its common sense. – Full Report
To view a larger version of this map, please click on it.
A McDonald’s Corp. employee in Kentucky could have potentially spread hepatitis A to customers, according to local health officials, igniting a new health scare for the fast food giant.
Officials at the Madison County health department are warning people that they may have been infected by the food handler, who was working at a restaurant in the town of Berea, south of Lexington, on March 23.
An employee at the Applebee’s on Dixie Highway has been diagnosed with hepatitis A, the Louisville Department of Health said in a series of Tweets on Friday night.
The implicated Applebee’s is located at 4717 Dixie Highway.
Anyone who ate at that Applebee’s between March 23 and April 12 should get a hepatitis A vaccine, the health department said.
The Ashland-Boyd County Health Department is investigating a case involving a food preparation worker at a Texas Roadhouse who has been diagnosed with hepatitis A.
The window of possible exposure for customers and staff at the Texas Roadhouse restaurant is March 20 through April 12. The restaurant is located in the 500 block of Winchester Road.
If you have been exposed, there is a two-week window to receive the hepatitis A post-exposure vaccine. After those two weeks have passed, the vaccine may not be effective in preventing the virus.
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First off, yes, 2018 seems to be – and we are just 1/2 way into it – a very Big, Bad year for foodborne illnesses.
Second, I am not sure why.
It could be better surveillance by state, local and national health authorities utilizing cutting edge tools such as PFGE and WGS. It could be a lack of support for inspectors. It is certainly possible that it is more imports with a greater supply chain with a great chance for contamination or temperature abuse. It also could be more mass produced fresh, ready to eat foods without a “kill step.”
It also could be none of those things, but it seems to me to be more than just random events. Here are some of the highlights of 2018:
E. coli
Romaine Lettuce – 218 sick in US and Canada with 96 hospitalizations and 5 deaths.
Cyclospora
McDonald’s Salads – 163 sick with 3 hospitalizations.
Del Monte Vegetable Trays – 237 sick with 7 hospitalizations.
Salmonella
Jimmy John’s Sprouts – 10 sick.
Kratom – 199 sick with 50 hospitalizations.
Fareway/Triple T Chicken Salad – 265 sick with 94 hospitalizations and 1 death.
Go Smile Coconut – 14 sick with 3 hospitalizations.
Rose Acre Shell Eggs – 45 sick with 11 hospitalizations.
Caito Cut Melons – 70 sick with 34 hospitalizations.
Kellogg’s Honey Smacks – 100 sick with 34 hospitalizations.
Hy-Vee Pasta Salad – 21 sick with 5 hospitalizations.
Raw Turkey – 90 sick with 40 hospitalizations.
Vibrio parahaemolyticus
Venezuelan Crab Meat – 12 sick with 4 hospitalizations.
And, we are only 1/2 way through the year.
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An additional 87 ill people from 16 states were included in this investigation since the last update on Nov. 15. States with newly reported illnesses include: Michigan, Mississippi, and West Virginia.
As of Dec. 12, there are 333 people infected with the outbreak strain of Salmonella Newport. They have been reported from 28 states. Their illnesses started on dates ranging from Aug. 5 through Nov. 9. One-third of the patients have been hospitalized. No deaths have been reported.
Epidemiologic, laboratory, and traceback evidence indicates that ground beef produced by JBS Tolleson Inc. is a likely source of this outbreak.
On Oct. 4 this year, JBS Tolleson Inc. recalled approximately 6.9 million pounds of beef products that may be contaminated with Salmonella Newport. On Dec. 4 JBS Tolleson Inc. recalled an additional 5.2 million pounds of beef products.
Personally, as I said to theLos Angeles Times some time ago, “I think that anything that can poison or kill a person should be listed as an adulterant [in food].”
Ignoring Salmonella in meat makes little, if any, sense. Even after the Court’s twisted opinion in Supreme Beef v. USDA, where it found Salmonella “not an adulterant per se, meaning its presence does not require the USDA to refuse to stamp such meat ‘inspected and passed’, ” our government’s failure to confront the reality of Salmonella, especially antibiotic-resistant Salmonella, is inexcusable.
The Wisconsin Supreme Court in Kriefall v Excel called it as it saw it:
The E. coli strain that killed Brianna and made the others sick is a “deleterious substance which may render [meat] injurious to health.” There is no dispute about this. Thus, under the first part of 21 U.S.C. § 601(m)(1), meat that either “bears or contains” E. coli O157:H7 (the “deleterious substance”) is “adulterated.” That E. coli O157:H7 contamination can be rendered non-“injurious to health” by cooking thoroughly, as discussed below, does not negate this; Congress used the phrase “may render,” not “in every circumstance renders.” Moreover, if the E. coli bacteria is not considered to be “an added substance,” because it comes from some of the animals themselves and is not either applied or supplied during the slaughtering process (although we do not decide this), it cannot be said that the E. coli strain “does not ordinarily render [the meat on or in which it appears] injurious to health.” Accordingly, meat contaminated by E. coli O157:H7 is also “adulterated” under the second part of § 601(m)(1).
Now, why would Salmonella be different? According to the CDC, it is estimated that 1.4 million cases of salmonellosis occur each year in the United States. Of those cases, 95 percent are related to foodborne causes. Approximately 220 of each 1,000 cases result in hospitalization, and 8 of every 1,000 cases result in death. About 500 to 1,000 deaths – 31 percent of all food-related deaths – are caused by Salmonella infections each year.
So, where do we stand with the existing USDA/FSIS law on adulteration? Here is the law:
(m) The term “adulterated” shall apply to any carcass, part thereof, meat or meat food product under one or more of the following circumstances:
(1) if it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in case the substance is not an added substance, such article shall not be considered adulterated under this clause if the quantity of such substance in or on such article does not ordinarily render it injurious to health; …
(3) if it consists in whole or in part of any filthy, putrid, or decomposed substance or is for any other reason unsound, unhealthful, unwholesome, or otherwise unfit for human food;
(4) if it has been prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health; …
Hmmm. It is hard to read the above and not think that the words in bold equate to all E. coli and Salmonella — frankly, all pathogens in food. I know, I am just a lawyer, but don’t ya think that when food with animal feces (and a dash of E. coli O157:H7) in it is considered an adulterant, that other animal feces (with dashes of other pathogens, like Salmonella) in them, should be considered adulterated too? But, hey, that is just me. Another odd governmental fact is that the FDA does not seem to make a distinction between pathogens it considers adulterants or not. FDA’s enabling legislation – Sec. 402. [21 USC §342] of the Food, Drug & Cosmetic Act also defines “Adulterated Food” as food that is:
(a) Poisonous, insanitary, or deleterious ingredients.
(1) If it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in case the substance is not an added substance such food shall not be considered adulterated under this clause if the quantity of such substance in such food does not ordinarily render it injurious to health;
(2) If it bears or contains any added poisonous or added deleterious substance … that is unsafe within the meaning of section 406;
(3) if it consists in whole or in part of any filthy, putrid, or decomposed substance, or if it is otherwise unfit for food;
(4) if it has been prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health …
It would be interesting, and perhaps entertaining, to have House and Senate hearings focusing on what should and should not be considered adulterants in our food. I can see panels of scientists from various fields, FDA, USDA and FSIS officials, beef and produce industry representatives, and consumers discussing this. I would pay to watch it.
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This past weekend I woke up to the sad news of yet other injuries and a death linked to animal contact at a fair.
San Diego County health officials announced late Friday night that a 2-year-old child has died and three other children between 2 and 13 years old have become ill after having contact with animals at the San Diego County Fair.
The County of San Diego Health and Human Services Agency (HHSA) reported four confirmed pediatric cases of Shiga-toxin-producing E. coli linked to contact with the animals. Officials from the HHSA’s Epidemiology Program and County Department of Environmental Health are investigating the cluster of four infections, officials said.
The four children who fell ill visited the fair between June 8 and June 15 and began showing symptoms between June 10 and June 16.
Photo illustration
“Three of the four cases were not hospitalized,” county authorities said in a statement released at 10:10 p.m. Friday. “However, one of the four cases, a 2-year-old boy, was hospitalized and unfortunately died on June 24, from a complication of this disease.”
Officials at the San Diego County Fair closed public access to all animal areas, including the petting zoo, according to the statement issued by the county. The source of the E. coli bacteria remains under investigation, but all the children reportedly visited the animal areas or petting zoo or had other animal contact at the fair.
It reminded me of an op-ed I penned several years ago about banning petting zoos.
I can hear the wailing and gnashing of teeth over such an un-American suggestion.
The Centers for Disease Control and Prevention (CDC) reports the creation of yet another multiagency task force in North Carolina “to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.” Hmm, didn’t that happen after the 2004 North Carolina State Fair E. coli outbreak, which resulted in 187 illnesses, including 15 complicated by hemolytic uremic syndrome (HUS)?
This latest task force is looking into what happened at the 2011 North Carolina State Fair, held October 13-23 in Raleigh. According to the CDC, 25 cases of E. coli O157:H7infection were identified with case-patients’ illness onsets during October 16-25; median age was 26 years (range: 1-77 years). Eight case-patients (32 percent) were hospitalized; four (16 percent) experienced HUS. Once again, the only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions.
After decades of outbreaks, the CDC and a collection of state veterinarians have issued these stern warnings and suggestions about animal exhibits and petting zoos:
Photo illustration
– Wash hands after contact with animals to reduce the risk of zoonotic disease transmission.
– Do not allow food, drink, or pacifiers in animal areas.
– Include transition areas between animal areas and non-animal areas.
– Educate visitors about disease risk and prevention procedures.
– Properly care for and manage animals.
But, if history is any guide, guidelines are not working very well. Here is a sample of zoonotic outbreaks during the past decade:
2011 English Animal Farm Outbreak – Cruckley Animal Farm in Foston-on-the-Wolds, England is closing its gates permanently following an outbreak of E. coli O157:H7. The family-run farm was linked to at least six cases of the life-threatening infection as of August 2011. The owners, John and Sue Johnston, expressed sorrow at the illness and stated that “the health and safety of our visitors has always been our top priority,” thus with the news the farm was the likely source of illnesses, they decided to close.
2011 Snohomish County Petting Zoo – At least 6 people who visited the Forest Park Petting Zoo in Everett, Washington, in June 2011 became ill with E. coli O157:H7 infections. The Snohomish County Health Department investigated the E. coli outbreak and determined that there was a “clear association between disease and being in the open animal interaction area of the forest Park Animal Farm.”
2009 Utah Rodeos Outbreak – Utah state and local health officials and the CDC noted a cluster of E. coli O157:H7 cases in the summer of 2009. The illnesses were associated with attendance to rodeos, but not all the same one. The vast majority of the 14 cases (93 percent) had food histories containing ground beef, unsurprising for rodeo visitors. However, a traceback on the meat products provided at the rodeos found no contamination.
2009 Godstone Park Farm and Plan Barn E. coli Outbreak in Surrey, England – A final report of the Outbreak Control Committee of the Surrey and Sussex Health Protection Unit describes an outbreak of E. coli O157 (VTEC O157 PT21/28) occurring in August and September 2009. This was the largest documented outbreak of VTEC O157 associated with farms in the UK. Individuals became infected either through direct or indirect contact with farm livestock.
2009 “Feed the Animals” Exhibit E. coli Outbreak at the Western Stock Show – In January 2009, the Communicable Disease and Consumer Protection Divisions of the Colorado Department of Public Health noticed an increase is in the number of laboratory confirmed cases of E. coli O157. Thirty cases were identified–including nine hospitalizations and 2 cases of HUS. All the children had visited the National Western Stock Show in Denver, Colorado.
2007 Petting Zoo E. coli O157:H7 Outbreak in Pinellas County, FL – In May and June 2007, seven Florida children were infected with E. coli O157:H7. Six of the children had visited a Day Camp petting zoo, and the seventh was a sibling. Two of the children were hospitalized, all seven recovered. The petting zoo was closed on the recommendation of the health department.
2005 Big Fresno Fair Petting Zoo E. coli Outbreak – At least six children were infected with E. coli O157:H7 – one gravely – visiting the petting zoo at the 2005 Big Fresno Fair. One child was 2 years old at the time of her visit to the petting zoo. She developed HUS and was hospitalized for months. Her kidneys were severely damaged and a series of strokes left her with impaired movement and vision.
2005 Campylobacteriosis Outbreak Associated with a Camping Trip to a Farm – In June 2005, King County Public Health was notified that a several children on a school trip had been ill with diarrhea, abdominal pain and fever following the trip. Campylobacter was isolated from the stool of one ill individual, and later in the week, two more cases of campylobacteriosis were reported in persons who had been on the same camping trip, held at a private farm.
2005 Florida State Fair, Central Florida Fair, and Florida Strawberry Festival E. coli Outbreak – The AgVenture Farms E. coli O157:H7 outbreak was first recognized after two separate HUS case reports were reported to the Florida Department of Health in mid-March. The two cases (a 5-year-old girl and a 7-year-old boy) both reported hav
ing visited a fair with a petting zoo (AgVenture) a few days prior to becoming ill. The two children did not have any other common risk factors. A total of 22 confirmed, 45 suspect and 6 secondary cases were reported.
2003 Fort Bend County Fair E. coli Outbreak – Rosenberg, TX – In 2003, 25 people (fair visitors and animal exhibitors) became ill with HUS and one case of a related disease, thrombotic thrombocytopenic purpura. All seven laboratory-confirmed cases had an indistinguishable PFGE pattern, which matched 10 isolates obtained from environmental samples taken from animal housing areas.
2002 E. coli Outbreak at a Petting Zoo in Zutphen, The Netherlands – A young child developed a Shiga toxin 2 producing strain of Escherichia coli (STEC) O157 infection after visiting a petting zoo in Zutphen, The Netherlands. The STEC strains were isolated from the fecal samples from goats and sheep on the farm and were indistinguishable from the human patient isolate.
2002 Lane County, Oregon, Fair E. coli Outbreak – The Oregon Department of Human Services (Oregon, 2002) initially documented a patient with bloody diarrhea, who attended the Lane County Fair held during August 2002. Epidemiologists identified 82 ill persons, 22 who were hospitalized, and 12 with HUS. This is the largest E. coli O157:H7 outbreak recorded in Oregon.
2002 Wyandot County, OH, Fair E. coli Outbreak – The Ohio Wyandot County Health Department received a report of an E. coli O157 outbreak in September 2001 (CDC memorandum, February, 2002). A total of 92 cases were identified, including 27 laboratory-confirmed E. coli O157 infections. Two cases were diagnosed with hemolytic uremic syndrome. Eighty-eight cases reported attending Wyandot County Fair before becoming ill.
2001 Lorain County, OH, Fair E. coli Outbreak – The Department of Health and Human Services, Public Health Services (CDC memorandum, February, 2002) reported that 23 cases of E. coli O157:H7 infection were associated with the attendance at the Lorain County Fairgrounds in September 2001. Additional cases were identified as likely due to secondary transmission from attendees at the fairgrounds. An investigation associated illness with environmental contamination at the Cow Palace.
2001 Ozaukee County, WI, Fair E. coli Outbreak – The Ozaukee County Public Health Department and Wisconsin Department of Health and Family Services (2001) investigated an outbreak of E. coli O157:H7 associated with animals at the Ozaukee County Fair in August 2001. A total of 59 E. coli O157:H7 cases were identified in this outbreak, with 25 laboratory confirmed cases (25 “primary cases” and 34 probable cases).
2001 E. coli Outbreak at a Petting Zoo in Worcester, PA – An article published by WebMD Medical News on April 23, 2001 (Bloomquist, 2001), reported an outbreak of E. coli O157:H7 among visitors to the Merrymead Farm petting zoo in Worcester, Pennsylvania. In all, 16 children who had visited the zoo contracted E. coli, and it was suspected that another 45 people became ill from the bacteria. The report indicated that one week after visiting the zoo, one of the children came down with violent stomach cramps and was hospitalized.
2000 Cryptosporidiosis Outbreak at a Farm in Wellington, New Zealand – An outbreak of Cryptosporidiosis was linked to a two-day farm educational event in the Wellington region of New Zealand. Twenty-three cases were laboratory-confirmed. The route of infection was most likely from an infected animal.
2000 E. coli Outbreak at a Dairy Farm– Crump et al (2002) discussed an outbreak of E. coli O157:H7 among visitors to a dairy farm in Pennsylvania in September 2000. A case control study among the visitors was conducted to identify the risk factors of infection, along with a household survey to determine the rates of diarrheal illness. The total number of confirmed or suspected E. coli O157:H7 cases was 51. The median age among the patients was four. Eight of the cases developed hemolytic uremic syndrome (HUS).
2000 Snohomish County, WA, Petting Zoo E. coli Outbreak – The Snohomish Health District, Communicable Disease Department (June, 2000) reported five cases of bacterial diarrhea caused by E. coli O157:H7 in children in Snohomish County in May 2000. Three of the children visited a petting zoo several days before they became sick. The fourth child did not visit the petting zoo, but lived on another farm where cattle were raised.
2000 Medina County, OH, Fair E. coli Outbreak – A cluster of E. coli O157:H7 isolates was observed in Medina County, Ohio, in August of 2000. In the case-control investigation, 43 culture confirmed E. coli O157:H7 cases were identified. The environmental investigation suggested that contamination of a section of the water distribution system supplying various vendors was the likely exposure.
So, what do you think should be done?
For more information on outbreaks and prevention measures, visit Fair-Safety.Com
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This is not meant as a criticism of my friends at the FDA or the good people at LGMA – California and Arizona – or at Western Growers, United Fresh or PMA. But seriously, since leafy green E. coli O157:H7outbreaks spiked in the early 2000’s, is anyone surprised by the following conclusion by the FDA (only that it was not said out loud sooner).
Also, the has long reported that tracebacks on all three outbreaks have identified a common grower in Salinas. However, that grower has remained unnamed – so much for transparency.
FDA considers adjacent or nearby land use for cattle grazing as the most likely contributing factor associated with these three outbreaks. While the agency could not confirm a definitive source or route(s) of contamination of the romaine fields, the Agency considers the indirect transmission of fecal material from adjacent and nearby lands from water run-off, wind, animals or vehicles to the romaine fields, or to the agricultural water sources used to grow the romaine, as possible routes of contamination.
According to a report by the FDA released Thursday, in November and December 2019 there were three E. coli O157: H7 foodborne illness outbreaks. One outbreak sickened 167 and was in part linked to Ready Pac Bistro® Chicken Caesar Salad and Fresh Express Leafy Green Romaine. The romaine lettuce came from the Salinas growing region. The second outbreak sickened 11 and was linked in part to the Evergreen’s restaurant chain and was again linked to romaine lettuce from the Salinas growing region. The third outbreak sickened 10 and was linked to Fresh Express Sunflower Crisp Chopped Salad Kits from romaine lettuce grown in the Salinas growing region.
During the course of these investigations, the FDA determined that:
Each of these three outbreaks was caused by distinctly different strains of E. coli O157:H7 as determined by whole-genome sequencing (WGS) analysis;
Outbreak 1 strain of E. coli O157: H7 was found in two different brands of fresh-cut salads containing romaine lettuce in 2019;
Traceback investigations of multiple illness sub-clusters and supply chain information identified a common grower with multiple ranches/fields, which supplied romaine lettuce during the timeframe of interest to multiple business entities associated with Outbreaks 1, 2 and 3;
The Outbreak 1 strain of E. coli O157:H7 was detected in a fecal-soil composite sample taken from a cattle grate on public land less than two miles upslope from a produce farm with multiple fields tied to the outbreaks by the traceback investigations.
Other STEC strains, while not linked to outbreaks 1,2, or 3, were found in closer proximity to where romaine lettuce crops were grown, including two samples from a border area of a farm immediately next to cattle grazing land in the hills above leafy greens fields and two samples from on-farm water drainage basins.
See picture above right – cows on hillside, leafy greens below. People say what about shit and hillsides?
The FDA has made the following recommendation (not mandates):
In light of the findings of these investigations, FDA recommends that growers of leafy greens:
Emphasize/Redouble efforts around Prevention
Assess growing operations to ensure implementation of appropriate science and risk-based preventive measures, including applicable provisions of the FSMA Produce Safety Rule and GAPs.
Adjacent Land Use – Assess and mitigate risks associated with adjacent and nearby land uses, including grazing lands and animal operations regardless of size. Prevent contamination from uphill adjacent cattle grazing lands, such as by produce farms increasing buffer zones if fields are adjacent to cattle grazing lands (based on assessment); and adding physical barriers such as berms, diversion ditches, and vegetative strips
Agricultural Water – Ensure that all agricultural water is safe and of adequate sanitary quality for its intended use. Assess and mitigate risks related to land uses near or adjacent to agricultural water sources that may contaminate agricultural water. Ensure that any agricultural water treatment is validated, verified, and in accordance with all applicable Federal, State, Local, and other regulations
Improve Traceability
Increase digitization, interoperability, and standardization of traceability records, which would expedite traceback and prevent further illnesses.
Broader, more consistent implementation of voluntary source labeling on packaging or point of sale signs, or by other means to help consumers and retailers more readily identify product during an outbreak or recall.
Improve Root Cause Analysis
Perform a root cause analysis when a foodborne pathogen is identified in the growing environment, in agricultural inputs (e.g., agricultural water or soil amendments), in raw agricultural commodities or in fresh-cut ready-to-eat produce.
CNN reported this week that Coca-Cola is shutting down the juice and smoothie brand Odwalla at the end of July. Coca-Cola purchased the brand in 2001.
Coca-Cola made the call “given a rapidly shifting marketplace and despite every effort to support continued production,” John Hackett, president of Coca-Cola’s Minute Maid business unit, which includes the company’s juice brands, said in a statement e-mailed to CNN Business.
Coca-Cola had been assessing Odwalla’s business for the past several years, according to a company spokesperson, who added that the decision to discontinue the brand is not directly related to the coronavirus pandemic. Health-conscious consumers are less interested in smoothies than they used to be, she explained.
“This decision was not made lightly,” he added.
Forgive me if I do not “lightly” shed a tear for anyone but the child that died in 1996, and several others who were stricken with acute kidney failure, after consuming Odwalla’s unpasteurized apple juice. I represented many of those sickened and left with life-long complications.
In October of 1996, the Seattle-King County Department of Public Health linked 13 cases of E. coli O157:H7 to unpasteurized apple juice sold by Odwalla. The FDA subsequently announced a recall of all Odwalla juices containing raw apple juice.
The E. coli outbreak eventually included 65 confirmed victims in the western United States and British Columbia. More than a dozen victims developed hemolytic uremic syndrome (HUS) from their infections (acute kidney failure). One Colorado toddler died.
During the course of the litigation, we uncovered that Odwalla had attempted to sell its juice in 1996 to the U.S. Army – no, not as a biological weapon – but to be sold in base grocery stores to our men and women service members and their families. The Army rejected the product – because it was not fit for military consumers. This letter tells that story:
Despite being told by the Army that it would not buy Odwalla’s product, Odwalla continued to ignore the warnings and to not test its product, because it did not want to document that it was in fact unsafe.
Odwalla kept selling the product to pregnant women and children until it poisoned too many people to be ignored.
The Court ordered the disclosure of Odwalla’s emails:
Odwalla paid out 10’s of millions of dollars in settlements to the victims of its pathogenetic juice.
In 1998, Odwalla was indicted and held criminally liable for the 1996 E. coli outbreak. The company pled guilty to 16 federal criminal charges and agreed to pay a $1.5 million fine.
Good riddance to bad rubbish.
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I can hear a bit of silence in the board rooms of America.
Monday the U.S. Supreme Court declined to hear the appeals of Austin “Jack” DeCoster and his son, Peter DeCoster, without comment.
In April 2015 U.S. District Judge Mark Bennett sentenced the DeCosters to prison, saying they knew or should have known about the risks posed by the presence of Salmonellain and around millions of egg-laying hens. However, he allowed the DeCosters to stay free while they appealed the sentences, which they argued were unconstitutional and unreasonably harsh. The 8th U.S. Circuit Court of Appeals upheld the sentences in July 2016 and stayed any action until the U.S. Supreme Court appeal was resolved.
Now the DeCosters will now both face three-month jail sentences stemming from a Salmonella outbreak caused by their Iowa egg farms in 2010.
The Salmonella outbreak ran from May 1 to Nov. 30, 2010, and prompted the recall of more than half a billion shell eggs, the largest recall of its kind in history. And, while there were 1,939 confirmed infections, statistical models used to account for Salmonella illnesses in the U.S. suggest that the eggs may have sickened more than 62,000 people.
The family business, known as Quality Egg LLC, had already pleaded guilty to one federal felony count of bribing a U.S. Department of Agriculture egg inspector and to two federal misdemeanors associated with the outbreak. It agreed that the LLC would pay a $6.8-million fine and the DeCosters would be fined $100,000 each, for a total of $7 million.
I am not sure if the Supreme Court read Bill Neuman’s New York Times article from September 2010, “An Iowa Egg Farmer and a History of Salmonella.” However, he should. Here are some of the highlights/lowlights:
“DeCoster’s frequent run-ins with regulators over labor, environmental and immigration violations have been well cataloged. But the close connections between DeCoster’s egg empire and the spread of Salmonella in the United States have received far less scrutiny.”
“Farms tied to DeCoster were a primary source of Salmonella enteritidis in the U.S. in the 1980s, when some of the first major outbreaks of human illness from the bacteria in eggs occurred, according to health officials and public records. At one point, New York and Maryland regulators believed DeCoster eggs were such a threat that they banned sales of the eggs in their states. ‘When we were in the thick of it, the name that came up again and again was DeCoster Egg Farms,’ said Paul A. Blake, who was head of the Enteric Diseases Division at the Centers for Disease Control and Prevention in the 1980s, when investigators began to tackle the emerging problem of Salmonella and eggs.”
“Records released by Congressional investigators last week suggest that tougher oversight of Mr. DeCoster’s Iowa operations might have prevented the outbreak, which federal officials say is the largest of its type in the nation’s history, with more than 1,600 reported illnesses and probably tens of thousands more that have gone unreported.”
“According to the records, Mr. DeCoster’s farms in Iowa conducted tests from 2008 to 2010 that repeatedly showed strong indicators of possible toxic salmonella contamination in his barns. Such environmental contamination does not always spread to the eggs, and it is unclear what actions Mr. DeCoster took in response. However, when the Food and Drug Administrationinspected the farms after the recalls, officials found unsanitary conditions and the presence of Salmonella enteritidis in barns and feed.”
“The first enteritidis outbreak recognized by public health officials came in July 1982, when about three dozen people fell ill and one person died at the Edgewood Manor nursing home in Portsmouth, N.H. Investigators concluded that runny scrambled eggs served at a Saturday breakfast were to blame. They traced the eggs to what the Centers for Disease Control reports referred to as a large producer in Maine; interviews with investigators confirmed that it was Mr. DeCoster’s former operation. Eggs from the same farms were also suspected in a simultaneous outbreak that sickened some 400 people in Massachusetts.”
“In 1987, a deadly outbreak at Coler Memorial Hospital on Roosevelt Island occurred. Investigators determined that mayonnaise made from raw eggs had caused the outbreak. They traced the eggs to Mr. DeCoster’s Maryland farms. On a July night in 1987, scores of elderly and chronically ill patients at Bird S. Coler Memorial Hospital in New York City began to fall violently sick with food poisoningfrom eggs tainted with salmonella. ‘It was like a war zone,’ said Dr. Philippe Tassy, the doctor on call as the sickness started to rage through the hospital. By the time the outbreak ended more than two weeks later, nine people had died and about 500 people had become sick. It remains the deadliest outbreak in this country attributed to eggs infected with the bacteria known as Salmonella enteritidis.”
“After two more outbreaks were linked to DeCoster eggs the following year, New York banned Mr. DeCoster from selling eggs in the state. He was forced to agree to a rigorous program of salmonella testing on his farms in Maine and Maryland. Michael Opitz, a poultry expert retired from the University of Maine, said that the testing found that a Maine breeder flock owned by Mr. DeCoster was infected, meaning that hens there could be passing the bacteria to their chicks, which might grow up to lay tainted eggs. Widespread contamination was also found in laying barns.”
Austin “Jack” DeCoster, left, and his son Peter DeCoster will each have to serve a three-month sentence for their roles in the 2010 Salmonella outbreak traced to their eggs.
“In 1991, tests revealed more salmonella contamination at one of Mr. DeCoster’s farms in Maryland. The state quarantined the eggs, allowing them to be sold only to a plant where they could be pasteurized to kill bacteria. Mr. DeCoster challenged the order and a federal judge ruled that Maryland could not block him from shipping eggs to other states. He was still barred from selling the eggs in Maryland, and in 1992, a state judge found that he had violated the quarantine by selling eggs to a local store; Mr. DeCoster was given a suspended sentence of probation and a token fine.”
“Soon after interstate shipments resumed in 1992, eggs from the Maryland farm caused a salmonella outbreak in Connecticut, according to a 1992 memo from the Maryland attorney general’s office. Federal regulators insisted that Mr. DeCoster decontaminate his barns. Dr. Roger Olson, the former state veterinarian of Maryland, said that Mr. DeCoster complained about the cost of testing and the quarantine and insisted there was little risk associated with his eggs.”
And, then there was 2010. I think Jack and Peter need some time away to think about this.
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Although the United States is know world-wide as having one of the safest food supplies, there have been instances where some of the foods most commonly consumed in our country have resulted in tragedy.
Jack-in-the- Box E. coli Outbreak – 1992 – 1993
708 ill, 171 hospitalized and 4 dead
An outbreak of E. coli O157:H7 was linked to the consumption of hamburgers from the Jack-in-the-Box Restaurant chain. Cases were reported from the states of Washington (602 cases/144 hospitalizations/3 deaths), Idaho (14 cases/4 hospitalizations/no deaths), California (34 cases/14 hospitalizations/1 death), and Nevada (58 cases/9 hospitalizations/no deaths). A case control study implicated the chain’s hamburgers resulting in a multistate recall of the remaining hamburgers. Only 20 percent of the product remained at the time of the recall; this amounted to 272,672 hamburger patties. Subsequent testing of the hamburger patties showed the presence of E. coli O157:H7. The strain of E. coli O157:H7 found in ill people matched the strain isolated from uncooked hamburger patties. The outbreak illustrated the potential for large, foodborne illness outbreaks associated with restaurant chains receiving shipments of contaminated food. At the time, many clinical laboratories in the United States were not routinely culturing patients’ stool for E. coli O157:H7 by using the correct culture medium. Additionally, many local and state health departments were not actively tracking and investigating E. coli O157:H7 cases.
Pennsylvania State health officials first learned of a hepatitis A outbreak when unusually high numbers of hepatitis A cases were reported in late October 2003. All but one of the initial cases had eaten at the Chi Chi’s restaurant at the Beaver Valley Mall, in Monaca, PA. Ultimately, at least 565 cases were confirmed. The victims included at least 13 employees of the Chi Chi’s restaurant, and residents of six other states. Three people died as a consequence of their hepatitis A illnesses. More than 9,000 people who had eaten at the restaurant, or who had been exposed to ill people, were given a post-exposure injection as a prevention against developing hepatitis A. Preliminary analysis of a case-control study indicated fresh, green onions were the probable source of this outbreak. The investigation and tracebacks by the state health department, the CDC, and the FDA, confirmed that the green onions had been grown in Mexico.
On Sept. 13, 2006, public health officials in Wisconsin, Oregon and New Mexico noted E. coli O157:H7 infections with matching pulsed-field gel electrophoresis (PFGE) patterns. These illnesses were associated with eating fresh, bagged spinach produced by Dole Brand Natural Selection Foods. By Sept. 26 that year, infections involving the same strain of E. coli O157:H7 had been reported from 26 states with one case in Canada. A voluntary recall was issued by the company on Sept. 15. E. coli O157: H7 was isolated from 13 packages of spinach supplied by patients in 10 states. Eleven of the packages had lot codes consistent with a single manufacturing facility on a particular day. The PFGE pattern of all tested packages matched the PFGE pattern of the outbreak strain. The spinach had been grown in three California counties –Monterey, San Benito and Santa Clara. E. coli O157:H7 was found in environmental samples collected near each of the four fields that provided spinach for the product, as designated by the lot code. However, E. coli O157:H7 isolates associated with only one of the four fields, located on the Paicines Ranch in San Benito County, had a PFGE pattern indistinguishable from the outbreak strain. The PFGE pattern was identified in river water, cattle feces and wild pig feces on the Paicines Ranch, the closest of which was less than one mile from the spinach field.
Peanut Corporation of America Salmonella Outbreak – 2008 – 2009
714 ill, 171 hospitalized and 9 dead
Beginning in November 2008, CDC’s PulseNet staff noted a small and highly dispersed, multistate cluster of Salmonella Typhimurium isolates. The outbreak consisted of two pulsed-field gel electrophoresis (PFGE) defined clusters of illness. Illnesses continued to be revealed through April 2009, when the last CDC report on the outbreak was published. Peanut butter and products containing peanut butted produced at the Peanut Corporation of America plant in Blakely, GA, were implicated. King Nut brand peanut butter was sold to institutional settings. Peanut paste was sold to many food companies for use as an ingredient. Implicated peanut products were sold widely throughout the USA, 23 countries and non-U.S. territories. Criminal sanctions were brought against the owners of PCA.
A multistate outbreak of Listeria monocytogenes involving five distinct strains was associated with consumption of cantaloupe grown at Jensen Farms’ production fields near Granada, CO. A total of 147 ill people were reported to the CDC. Thirty-three people died, and one pregnant woman miscarried. Seven of the illnesses were related to pregnancy –three newborns and four pregnant women. Among 145 ill people with available information, 143 – 99 percent – were hospitalized. Source tracing of the cantaloupes indicated that they came from Jensen Farms, and were marketed as being from the Rocky Ford region. The cantaloupes were shipped from July 29 through Sept. 10, 2011, to at least 24 states, and possibly distributed elsewhere. Laboratory testing by the Colorado Department of Public Health and Environment identified Listeria monocytogenes bacteria on cantaloupes collected from grocery stores and from ill persons’ homes. Laboratory testing by FDA identified Listeria monocytogenes matching outbreak strains in samples from equipment and cantaloupe at the Jensen Farms’ packing facility in Granada, Colorado. Criminal sanctions were brought against the two owners of Jensen Farms.
Andrew and Williamson Cucumber Salmonella Outbreak – 2015
907 ill, 204 hospitalized and 6 dead
On September 4, 2015 the CDC announced an outbreak of Salmonella Poona linked to consumption of cucumbers grown in Mexico and imported by Andrew & Williamson Fresh Produce. On March 18, 2016 the outbreak was declared to be over. A total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states. Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Two hundred four ill people were hospitalized and six deaths were reported. Salmonella infection was not considered to be a contributing factor in two of the 6 deaths. Epidemiologic, laboratory, and traceback investigations identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.
My friend, Darin Detwiler, let me post this for him tonight for tomorrow:
Today marks the 25th anniversary of the day the last of four young children died during the landmark 1993 Jack in the Box E. coli outbreak.
Riley Edward Detwiler
I learned about the reality of this foodborne pathogen on Riley’s deathbed. When he was only a few months old, I justified being out to sea on a Navy submarine by telling myself that I was making the world a safer place for him, and I thought that I would spend the rest of my life making up lost time with him when he was older.
Riley would now be older than I was during that outbreak. I never got to see him grow older than he appears in the few photos and videos from so long ago. Over the years since his death, however, I have seen news of recalls and outbreaks and deaths on a far too regular basis. I have also seen much improvement in food safety.
We have gained new federal food safety regulations and policies at the USDA and, most recently at the FDA. We have witnessed advancements in science and data collection and even a whole new “culture of food safety.” We have training, certifications, university programs, conferences, magazines, books, and even movies that serve to inform and motivate new generations of food safety experts.
Many of the changes in food safety policies came about through the hard work of victims, families, advocacy groups and industry leaders. Statistics and charts alone achieve little without victim’s voices. Facts rarely motivate policymakers as much as seeing the faces and stories. I am very proud of their efforts. I am also proud to have stood with them and before them, trying to prevent other parents from looking at their family table with one chair forever empty due to preventable illnesses and deaths from foodborne pathogens.
One thing that hits me hard lately is how the faces and stories of victims from mass shootings are seemingly not enough to bring about change in terms of gun control. While no new policies will bring back the dead, they would bring hope and an increased safety for others. I am saddened by the thought that so many parents will live with the belief that their child’s death did not result in some element of change.
Perhaps the reasons matter not as to why parents worry about making the world a safer place for their children. Too many homes in this country include a chair forever empty at a family table due to reasons that could and should have been prevented.
Answer: They are all in Kentucky where a hepatitis A outbreak has been ongoing for months. With 272 people infected with Hepatitis A in Kentucky, restaurants must offer hepatitis A vaccines to employees – its common sense. – Full Report
To view a larger version of this map, please click on it.
A McDonald’s Corp. employee in Kentucky could have potentially spread hepatitis A to customers, according to local health officials, igniting a new health scare for the fast food giant.
Officials at the Madison County health department are warning people that they may have been infected by the food handler, who was working at a restaurant in the town of Berea, south of Lexington, on March 23.
An employee at the Applebee’s on Dixie Highway has been diagnosed with hepatitis A, the Louisville Department of Health said in a series of Tweets on Friday night.
The implicated Applebee’s is located at 4717 Dixie Highway.
Anyone who ate at that Applebee’s between March 23 and April 12 should get a hepatitis A vaccine, the health department said.
The Ashland-Boyd County Health Department is investigating a case involving a food preparation worker at a Texas Roadhouse who has been diagnosed with hepatitis A.
The window of possible exposure for customers and staff at the Texas Roadhouse restaurant is March 20 through April 12. The restaurant is located in the 500 block of Winchester Road.
If you have been exposed, there is a two-week window to receive the hepatitis A post-exposure vaccine. After those two weeks have passed, the vaccine may not be effective in preventing the virus.
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First off, yes, 2018 seems to be – and we are just 1/2 way into it – a very Big, Bad year for foodborne illnesses.
Second, I am not sure why.
It could be better surveillance by state, local and national health authorities utilizing cutting edge tools such as PFGE and WGS. It could be a lack of support for inspectors. It is certainly possible that it is more imports with a greater supply chain with a great chance for contamination or temperature abuse. It also could be more mass produced fresh, ready to eat foods without a “kill step.”
It also could be none of those things, but it seems to me to be more than just random events. Here are some of the highlights of 2018:
E. coli
Romaine Lettuce – 218 sick in US and Canada with 96 hospitalizations and 5 deaths.
Cyclospora
McDonald’s Salads – 163 sick with 3 hospitalizations.
Del Monte Vegetable Trays – 237 sick with 7 hospitalizations.
Salmonella
Jimmy John’s Sprouts – 10 sick.
Kratom – 199 sick with 50 hospitalizations.
Fareway/Triple T Chicken Salad – 265 sick with 94 hospitalizations and 1 death.
Go Smile Coconut – 14 sick with 3 hospitalizations.
Rose Acre Shell Eggs – 45 sick with 11 hospitalizations.
Caito Cut Melons – 70 sick with 34 hospitalizations.
Kellogg’s Honey Smacks – 100 sick with 34 hospitalizations.
Hy-Vee Pasta Salad – 21 sick with 5 hospitalizations.
Raw Turkey – 90 sick with 40 hospitalizations.
Vibrio parahaemolyticus
Venezuelan Crab Meat – 12 sick with 4 hospitalizations.
And, we are only 1/2 way through the year.
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The RCAHD is currently investigating nine cases of hepatitis A associated with this exposure.
An employee who worked at three Famous Anthony’s restaurant locations in Roanoke has been diagnosed with hepatitis A. As a result, the Roanoke City and Alleghany Health Districts (RCAHD) announced today that anyone who visited any of these three Famous Anthony’s locations — 4913 Grandin Road, 6499 Williamson Road or 2221 Crystal Spring Ave. — from Aug. 10 through 26 only, may have been exposed.
To protect your health and prevent further spread of illness, if you meet these criteria and are not vaccinated against hepatitis A, please monitor yourself for these symptoms:
• jaundice: yellowing of the skin or the eyes,
• fever,
• fatigue,
• loss of appetite,
• nausea,
• vomiting,
• abdominal pain,
• dark urine, or
• light-colored stools.
If you develop any of these symptoms, please seek medical care and let your healthcare provider know of your possible exposure. It is also very important for people with symptoms to stay home from work, especially if they work in food service, health care or child care.
It is irresponsible for restaurants to not offer hepatitis A vaccines to employees. Or, ignore the issue, sicken your customers, and be assured, you will be sued.
A fact from the CDC: “Since the hepatitis A outbreaks were first identified in 2016, more than 39,000 cases, 24,000 hospitalizations, and 374 deaths as a result of hepatitis A virus (HAV) infection have been reported.”
True, some of the above have been the homeless or drug addicts, but how many of those work at restaurants? Where exposed at restaurants? Note: 30 percent to 40 percent of the people impacted are NOT the homeless or drug addicts.
Hardly a day passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak.
Absent vaccinations of food handlers, combined with an effective and rigorous hand-washing policy, there will continue to be more hepatitis A outbreaks. It is time for health departments across the country to require vaccinations of food-service workers, especially those who serve the very young and the elderly.
Hepatitis A is a communicable disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Hepatitis A is the only foodborne illness that is vaccine preventable. According to the U.S. Centers for Disease Control and Prevention (CDC), since the inception of the vaccine, rates of infection have declined 92 percent.
CDC estimates that 83,000 cases of hepatitis A occur in the United States every year and that many of these cases are related to foodborne transmission. In 1999, more than 10,000 people were hospitalized due to hepatitis A infections, and 83 people died. In 2003, 650 people became sickened, four died, and nearly 10,000 people got IG (immunoglobulin) shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but also businesses lose customers, or some simply go out of business.
Although CDC has not yet called for mandatory vaccination of food-service workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of foodborne illness in the U.S.
Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S., despite FDA approval of hepatitis A vaccine in 1995. Widespread vaccination of appropriate susceptible populations would substantially lower disease incidence and potentially eliminate indigenous transmission of hepatitis A infections. Vaccinations cost about $50. The major economic reason that these preventive shots have not been used is because of the high turnover rate of food-service employees. Eating out becomes a whole lot less of a gamble if all food-service workers faced the same requirement.
According to the CDC, the costs associated with hepatitis A are substantial. Between 11 percent and 22 percent of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs in providing post-exposure prophylaxis to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $433 to $1,492 per case for children younger than 18. In 1989, the estimated annual direct and indirect costs of hepatitis A in the U.S. were more than $200 million, equivalent to more than $300 million in 1997 dollars. A new CDC report shows that, in 2010, slightly more than 10 percent of people between the ages of 19 and 49 got a hepatitis A shot.
Vaccinating an employee make sense. It is moral to protect customers from an illness that can cause serious illness and death. Vaccines also protect the business from the multi-million-dollar fallout that can come if people become ill or if thousands are forced to stand in line to be vaccinated to prevent a more serious problem.
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A week ago one of my food safety followers on Twitter sent me this photo that was apparently circulating offering for sale on eBay a product that was recalled over a decade ago. They asked if it was legal for someone to sell a recalled food product.
First, after a quick search on eBay I did not see the product still for sale, but it did pique my interest in the question.
Setting aside that it is stupid to try and sell (at an outrageous mark-up) a recalled product that was known to be contaminated with Salmonella, the answer is that it is illegal as viewed from the FDA and is against eBay’s own policies.
For a bit of history, this Salmonella outbreak sickened a total of 715 cases that were identified in 48 states. Patients had a median age of 53 years (range, 2 months to 95 years); 519 of 708 (73%) were female. Among 707 Salmonella isolates where specimen site was available, 421 (60%) were from stool specimens, 264 (37%) were from urine specimens, and 22 (3%) were from other or multiple specimen sources. The median age of patients with urine isolates was 62 years (range, 2 to 94 years), compared with 48 years (range, 2 months to 95 years) for patients with stool isolates. Ninety-four percent (247/263) of patients with urine isolates were female, compared with 62% (257/416) of patients with stool isolates .
Although the outbreak slowed after the product was recalled in February, cases continued to be confirmed after this time period. The cases were ultimately linked to the consumption of Peter Pan and Great Value brand peanut butter manufactured in ConAgra’s Georgia peanut butter plant. Any Peter Pan or Great Value brand peanut butter beginning with product code 2111 was recalled in response to the outbreak investigation.
So, here is the illegal part.
The Federal Food Drug and Cosmetic Act under 21 US §331 – Prohibited acts:
21 US §321 defines “person” to include “individual, partnership, corporation, and association.”
21 US §331 prohibits (a) the introduction or delivery for introduction into interstate commerce of any food….that is adulterated.
21 US §333 then states: (1) any person who violates a provision of section 331 of this title shall be imprisoned for not more than one year or fined not more than $1,000 or both.
Clearly, any person selling a recalled product – for whatever purpose – is doing an illegal act under the Federal Food Drug and Cosmetic Act .
Also, eBay’s Product Safety Policy make clear that it is against its own policy to sell the product. The rule is that selling products that pose a health or safety hazard aren’t allowed. To ensure the safety and well-being of our members, eBay does not allow listings for items that are banned, recalled, or dangerous to a buyer. The following types of items are not allowed:
Products recalled by a manufacturer or government agency
Products where the sale of the product is prohibited by law or regulation
Products that pose a health or safety hazard as specified by any government agency
Well, that all seems pretty clear.
Someone also reminded me that we had a similar problem in 2017, both with online and retail sales of a recalled product.
The CDC reported that thirty-two people infected with the outbreak strains of STEC O157:H7 were reported from 12 states.
Illnesses started on dates ranging from January 4, 2017 to April 18, 2017. Ill people ranged in age from 1 to 70 years, with a median age of 9. Twenty-six (81%) of the 32 ill people were younger than 18 years. Among ill people, 59% were male. Twelve ill people were hospitalized, and 9 people developed hemolytic uremic syndrome, a type of kidney failure.
The Hawaii Department of Health (HDOH) is investigating a cluster of 74 hepatitis A infections on Oahu. Onset of illness has ranged between June 12 and July 14. Sick individuals were likely exposed to the fecal human virus through food, drink or personal exposure two to six weeks prior to the onset of symptoms – so the likely exposure period is May 1 through July 1.
We are still seeing a significant downturn in E. coli cases linked to red meat, but are seeing cases in products like flour and soy nut butter, that leave all a bit perplexed. We are also seeing less cases linked to leafy greens generally. Our growth areas seem to be imported food products and restaurant-related outbreaks.
In April 2015 U.S. District Judge Mark Bennett sentenced the DeCosters to prison, saying they knew or should have known about the risks posed by the presence of Salmonella in and around millions of egg-laying hens. However, he allowed the DeCosters to stay free while they appealed the sentences, which they argued were unconstitutional and unreasonably harsh. The 8th U.S. Circuit Court of Appeals upheld the sentences in July 2016 and stayed any action until the U.S. Supreme Court appeal was resolved.
Although the brand was recalled, the Best Buy Date was not part of the recall. My apologies to my friends at Safeway.
During the course of these investigations, the FDA determined that:
Although the brand was recalled, the Best Buy Date was not part of the recall. My apologies to my friends at Safeway.
For a bit of history, this 
