March 2008

Munching on fresh cantaloupe this morning made me check in on the status of the Salmonella Litchfield outbreak that has sickened 50 across the United States over the last months.  Unfortunately, outbreaks tied to cantaloupe have been a far to frequent occurrence. There have been several articles on what consumers can and can not do to protect themselves. I wondered what growers and shippers might be doing. I found this interesting article and great pictures – from 2005. Guess we need to do a bit more?

Scientists Aim for Cleaner Cantaloupe

Simply washing fresh fruits and vegetables may only be marginally effective at removing microbial contaminants, so scientists are investigating new techniques for better processing produce.

Bacteria quickly attach to the surface of fruits and vegetables and form biofilms, a mass of microbes that attach to a surface and to each other by complex sugars. Scientists believe that biofilm coatings may protect bacterial cells from exposure to antimicrobial compounds used to sanitize produce.

Salmonella bacteria are often responsible for produce-related outbreaks of foodborne illness. They’re especially tricky to remove from cantaloupe because they attach to inaccessible sites and form biolfim on cantaloupe rind surface, allowing the bacteria to avoid contact with sanitizing solutions. Surviving Salmonella cells can be transferred from the surface of the melon to the internal tissues during cutting prior to consumption.

Now, researchers at the USDA’s Agricultural Research Service have gained new insight into Salmonella biofilm formation on various surfaces. They have discovered that to form on plastic or stainless steel, the bacteria must produce hair-like structures–called fimbriae–and cellulose to help the cells to attach and colonize the surface.

In cantaloupe, Salmonella cells attach to the rind and rapidly begin developing biofilm by growing and excreting sugars. This discovery helps explain how Salmonella survives harsh sanitizing environments and could help lead to better sanitization techniques.

According to the City of Alamosa’s press release Friday afternoon, Alamosa’s first case of salmonella occurred on March 7.  As of noon Friday, there had been 293 total cases reported, 78 confirmed cases and 12 hospitalized.  The first bottled water alert was March 19.

A Stage 1 Red Alert remains in effect throughout the city this afternoon as officials anticipate a geographically-phased transition to a Stage 2 notification tomorrow and into Sunday. On Tuesday, high concentrations of chlorine began to be introduced into the water system to help eliminate the bacterial contamination that had been identified previously. Water samples are being taken from a cross-section of sites across the city including the hospital, medical clinics, schools, business areas and neighborhoods. Depending on the site, the samples will be tested for salmonella or other bacteria, plus arsenic, copper, lead and other metals. The samplings will reveal when it is safe to progress to the yellow Stage 2 Alert.

The roughly 8,500 residents of the southern Colorado town won’t be able to drink the water until the chemical is washed out.  That could take three weeks.  Alamosa’s water is drawn from a deep well and had been the largest of about 100 water systems in the Colorado that did not require chlorination.  City plans called for a new water plant, already being built, to include chlorination even before the salmonella outbreak.

Red Feather Lounge Patrons May Have Been Exposed to Hepatitis A

The Boise Health Department is warning Treasure Valley patrons about a confirmed case of Hepatitis A.  The warning comes after an employee at the Red Feather Lounge in downtown Boise was found to have the disease.   If you had something to eat or drink at the Red Feather between March 12th and the 17th, the health department recommends you get the vaccine.  The Central District Health Department has had so many calls about people’s potential exposure to Hepatitis A, that they are expanding their immunization clinic hours Wednesday.

Hepatitis-A Linked to Restaurant Worker

The Butler County Health Department urges patrons of a West Chester restaurant to watch for symptoms of Hepatitis A.  A worker at the P.F. Chang’s China Bistro on Union Centre Boulevard has been diagnosed with the illness.   The Butler County Board of Health issued the following release:

Butler County Health Department and the Ohio Department of Health have learned that a food service worker with confirmed Hepatitis A (infectious Hepatitis) worked while ill. Because of the possibility of contamination of ice, persons who have not been previously vaccinated for Hepatitis A and who report consuming ice, beverages with ice, ice cream or lemons or dined between March 14 and March 25, 2008 at this restaurant are recommended to contact their healthcare provider, local public health department or the Butler County Health Department for post-exposure prophylaxis.
People who dined at, consumed ice, beverages with ice, ice cream or lemons from the P.R Chang Restaurant between March 14 and March 25, 2008 should be referred to their healthcare provider, local public health department, or Butler County Department of Health for assessment and potential vaccination with monovalent Hepatitis A vaccine or prophylaxis with immune globulin (IG). The restaurant is located at 9435 Civic Centre Boulevard, West Chester, OH 45069 (off of the Civic Centre exit on Interstate 75 just north of Cincinnati, OH in eastern Butler County).

It seems that hardly a month 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 foodservice workers, especially those that serve the very young and the elderly.

The Centers for Disease Control (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 food-borne transmission.   In 1999, over 10,000 people were hospitalized due to hepatitis A infections and 83 people died. In 2003, 650 people became sickened, 4 died and nearly 10,000 people got Ig shots after eating at a Pennsylvania restaurant.  Not only do customers get sick, but businesses lose customers or some simply go out of business.

According to the Courier Journal, Staphylococcus aureus bacteria may have sickened more than 137 people who ate an Easter buffet at Claudia Sanders Dinner House in Shelbyville, state health officials said today. There is a report of one possible death. Preliminary results from the Kentucky State Lab suggested that Staphylococcus aureus might be the culprit of the food poisoning, although it’s not definitive since it was found in some stool samples and not others.

University of Arizona Food Safety Department has a good definition of Staph Food Poisoning:

Staphylococcal bacteria are very common. They are found in a wide variety of mammals and birds as well as on most surfaces. People are considered to be the main source associated with staphylococcal food poisoning. These bacteria are present in the nose, throat, hair, and skin of healthy persons. They are plentiful in cuts, pimples, and abscesses on people and their pets. Staphylococcus can live in high concentrations of salt and sugar where other bacteria would die. Some strains of Staphylococcus aureus are capable of producing a highly heat stable toxin. Staphylococcus grows best and multiplies rapidly between 68° and 99° F. Normal cooking temperatures will not destroy the toxin produced by this bacteria. This is why it is so important to wash your hands and always following good food handling practices when working with food.
Staphylococcal food poisoning results from growth and toxin production in food followed by eating the food containing the toxin. Symptoms of Staphylococcal food-poisoning occur between 1 to 8 hours after eating the contaminated food. This food-borne illness can last for 6 to 24 hours. Complete recovery may take 2 days or longer in severe cases. The most common symptoms include nausea, vomiting, abdominal cramping and exhaustion.

Nine in this state sick from cantaloupes

The PI reported today that the numbers of ill people sickened by Honduran Cantaloupe stands at 50 people in 16 states. Nine were in Washington State. At least 14 people have been hospitalized, but no deaths have been reported. According to the The Food and Drug Administration has traced the outbreak to cantaloupes grown in Honduras. It has stopped the import of cantaloupes from Honduran grower and packer Agropecuaria Montelibano. Several other companies that sold cantaloupes grown and packed by Agropecuaria have issued recalls this week, including Chiquita, Bounty Fresh LLC, Simply Fresh Fruit, Tropifresh and Dole

Once again the Minnesota State Department of Health (BEST INVESTIGATORS IN THE COUNTRY) reported two recent cases of salmonellosis in Minnesota have been linked to raw, frozen, breaded and pre-browned, stuffed chicken entrees.

The implicated product is Milford Valley Farms Chicken Cordon Bleu with a stamped code of C8021. This product is sold at many different grocery store chains.  This the fifth outbreak of salmonellosis in Minnesota linked to these types of products since 1998. The findings prompted the officials to urge consumers to make sure that all raw poultry products are handled carefully and cooked thoroughly, and to avoid cooking raw chicken products in the microwave because of the risk of undercooking.

Investigators from the Minnesota Department of Health (MDH) and the Minnesota Department of Agriculture (MDA) determined that two cases of Salmonella infection from February and March 2008 were due to the same strain of Salmonella Enteritidis. The illnesses occurred in a teenager and a young adult, both from greater Minnesota; both were hospitalized but have since recovered.

According to a press release, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) today announced a public meeting to discuss challenges and proposed solutions in moving forward to address recalls and illnesses related to E. coli O157:H7.

The public meeting will be held on Wednesday, April 9, from 8 a.m. to 5 p.m., and Thursday, April 10, from 8:30 a.m. to 1 p.m. at the Holiday Inn Georgetown, 2101 Wisconsin Ave., NW, Washington, DC. The meeting will feature various presentations and panel discussions by FSIS officials, the Centers for Disease Control and Prevention, a senior foodborne illness litigation firm partner (that would be me), representatives from industry and consumer groups, as well as a small plant owner and operator from South Carolina.

On April 9, participants will explore the broad perspectives on the challenges of addressing E. coli O157:H7, including illness and recall trends, and progress on non-O157:H7 Shiga Toxin-Producing E. coli (STEC) since the FSIS Oct. 2007 public meeting on the subject. Specifically, the Agency and participants will explore proposed next steps as a means to make progress in the challenge of addressing E. coli O157:H7 and non-O157:H7 STECs. FSIS plans to begin a short term study to determine the extent to which non-O157 STECs may be present in FSIS-regulated products, in support of regulatory infrastructure which may be needed for these organisms.  Agenda:

A Broad Perspective on the Challenges of E. coli O157:H7

9:00 a.m.Illness Trends Related to E. coli O157:H7

Dr. Robert Tauxe, Deputy Director, Division of Foodborne, Bacteria, and Mycotic
Diseases, National Center for Zoonotic, Vector-Borne, and Enteric Diseases
U.S. Centers for Disease Control and Prevention

9:30 a.m.Perspective from FSIS

Dr. David Goldman, Assistant Administrator
Office of Public Health Science, Food Safety and Inspection Service

9:45 a.m.Progress on non-O157:H7 Shiga Toxin-Producing E. coli

Dr. Elisabeth Hagen, Executive Associate for Public Health
Office of Public Health Science, Food Safety and Inspection Service

Dr. Daniel Engeljohn, Deputy Assistant Administrator
Office of Policy and Program Development, Food Safety and Inspection Service

10:00 a.m.Observation in Industry

Dr. Mansour Samadpour, Microbiologist
Institute for Environmental Health

10:15 a.m.Legal Perspective

Mr. William Marler, Managing Partner
Marler Clark L.L.P.

Trevor Suslow is a cooperative extension specialist in the Department of Vegetable Crops at UC Davis. His research and extension program centers on studying the effects of microflora on the postharvest quality of perishable produce. He was perfect to write on what consumers should do with Salmonella and Cantaloupe. Download his ideas here.

According to the CDC, between January 18 and March 5, 2008, state health departments identified 50 ill persons in 16 states infected with Salmonella Litchfield with the same genetic fingerprint. Ill persons with the outbreak strain have been reported from Arizona (1 person), California (10), Colorado (1), Georgia (2), Illinois (1), Missouri (1), New Jersey (2), New Mexico (1), New York (5), Ohio (1), Oklahoma (2), Oregon (5), Tennessee (1), Utah (5), Washington (9), and Wisconsin (3). In addition, 9 ill persons with the outbreak strain have been reported in Canada.

We have been contacted by several people who believe  they contracted Salmonella by eating this fruit.  We shall see. 

Ann Imse, Rocky Mountain News reports that the “Big flush begins today in Alamosa.”  Although the flushing seems dramatic, there still seems to be no understanding of the source of the Salmonella in the first place.

Although she reports that “chlorinated water will rush through 50 miles of pipes beginning today to try to cleanse salmonella from the municipal water system,” there still seems to be questions as to whether this will actually solve the problem. As she reported: “Officials don’t know how or where salmonella entered the water system, which is an unusual deep-well system. It has not required disinfection until now.”  There were reports that there was no concern about employees or terrorism as the cause.

Ms. Imse also reported on the filing of the first of what will likely be many claims against the city:

Meanwhile, a Seattle attorney has filed a claim against the city of Alamosa on behalf of a child . . . who he says suffered severe gastrointestinal illness and was hospitalized for five days because of the salmonella outbreak. Seattle attorney Bill Marler, who specializes in food poisoning cases, said today that when a Colorado city is sued, damages are capped at $150,000 for any injured person or a maximum of $600,000 for all injured parties.

Ann Imse’s story in the Rocky Mountain News, "Water contamination hits home," says it all about how important safe water is for people – especially children:

For Jenn and Ray Cook, this city’s salmonella crisis began March 9 with a terrifying sound. Their 7-month-old son woke up screaming at 3 a.m. with bloody diarrhea and a fever of 103 – just weeks after his second heart surgery. San Luis Valley Regional Medical Center quickly decided the fluffy-haired baby needed special care. "They Flight-for-Lifed him to Children’s Hospital in Denver," said his mother, Jenn, 28. Jordan, who is missing the left ventricle of his heart and faces one more operation, was given intravenous fluids and oxygen. Children’s doctors then spent five days trying to figure out what was wrong with him. Finally, tests hit on the answer: Salmonella poisoning. He was one of the first cases. Baby Jordan is recovered now, to his parents’ relief. On Wednesday, he was smiling broadly and sporting pale blue socks to match his shirt.

About Salmonella Typhimurium – In 2005 a total of 36,184 Salmonella isolates were reported to the Centers for Disease Control and Prevention. The national rate of reported Salmonella isolates in 2005 was 12.2 per 100,000 based on 2005 census population estimates. Salmonella serotype Typhimurium (S. Typhimurium) has been the most commonly isolated serotype since 1997. In 2005 there were 6,982 human cases of S. Typhimurium reported to the CDC. S. Typhimurium is also the most common serotype detected in clinical samples obtained from bovine sources, and from non-clinical samples from chicken sources. A large proportion of S. Typhimurium isolates are resistant to antimicrobial drugs. In a 2003 national survey, 45% were resistant to one or more drugs and 26% had a five-drug resistance pattern characteristic of a single phage type, DT104.  (REF: DHHS, CDC, 2005 Salmonella Annual Summary).

Surveillance for waterborne-disease outbreaks–United States, 1993-1994.

The outbreak in Missouri that was caused by Salmonella serotype Typhimurium resulted in illness in an estimated total of 625 persons, including 15 persons who were hospitalized and seven who died. The most likely source for the outbreak was the larger of two storage towers, which was inadequately protected from wild-bird droppings. S. Typhimurium was isolated from the sediment of one of the towers, and tap water was positive for fecal coliforms.

Associated Press reported today that “Source of Alamosa salmonella a mystery.”  217 people have now been confirmed as part of the Salmonella outbreak.  Alamosa city water has tested positive as well.  Well, I guess the question is if we don’t know what the cause is, why are they “flushing” the water system with chlorine?

Apparently, “officials have ruled out disgruntled employees and terrorism” as the cause of the contamination.  However, what about a cracked wellhead or piping that allows infiltration of the Salmonella bacteria?

Quotes of the day:

"There are many unkowns.”

"Many questions will be answered as they move through this process."

My vote, pass me a scotch.  So, where does Salmonella come from – little help here:

Birds

Rats

Pork Salami (So presumably live pigs too)

Dairy Cows

Ground Beef (So presumably live cows too)

Dogs and Cats