April 2008

You might recall a post I made several months back about Nebraska Beef suing the Salem Lutheran Church of Longville, Minnesota claiming, among other things:

  • That, upon information and belief, an environmental assessment of the church kitchen and food preparation procedures by the Minnesota Department of Health indicated that there was a high potential of cross-contamination between the ground beef [filled with pathogenic cow shit] and other foods during food preparation.
  • That, upon information and belief, the damages sustained by the Plaintiff[s], if any, [one died of E. coli-related complications, and one suffered acute kidney failure] are the direct and proximate result of the negligence and/or other fault for tortuous conduct of Third-Party Defendant Salem Lutheran Church.

Now, I just got notice that Nebraska Beef intends to put the pastor under oath – good gawd!

As you also might recall, in late July and early August 2006, the Minnesota Department of Health (MDH) received three E. coli O157:H7 stool isolates from residents of, and visitors to, Longville, Minnesota. Pulsed-field gel electrophoreses (PFGE) patterns for all three were indistinguishable, and the pattern had never been seen before in Minnesota. At the same time, MDH learned of an outbreak of gastrointestinal illnesses among members of the Salem Lutheran Church in Longville.

MDA and MDH learned that ground beef used to make meatballs for the church meal, as well as the ground beef purchased by numerous area restaurants, was purchased at Tabaka’s Supervalu. On July 17, members of the church had purchased 40 pounds of ground beef from the Supervalu. MDA conducted an on-site inspection at the store on August 7, 2006. MDH’s epidemiological investigation revealed seventeen illnesses that met the case definition. Of these, three people developed hemolytic uremic syndrome (HUS), and one patient died.

The MDA traceback of the chuck rolls from Interstate Meat revealed that the “most plausible” source of the chuck rolls delivered to the Supervalu was the Nebraska Beef processing plant. In addition to this, the USDA reported that a sample of beef trimmings collected on June 14, 2006 at a processing plant cultured positive for E. coli O157:H7, and that the isolate was indistinguishable by PFGE analysis to the outbreak strain. The processing plant was determined to be Nebraska Beef, the company that most likely supplied the implicated chuck rolls to Tabaka’s Supervalu.

William Marler, managing partner of Seattle-based Marler Clark, has been selected for a prestigious law award recognizing his work on behalf of a safer food supply. The Washington State Trial Lawyers Association (WSTLA) has selected him for the 2008 Public Justice Award, which is bestowed upon "an individual or organization whose efforts, courage, litigation, or innovative work results in the creation of a more just society." The award will be presented to Mr. Marler at the May 1, 2008 Law Day Dinner.

An accomplished personal injury lawyer and national expert in foodborne illness litigation, William Marler has been a major force in food safety policy in the United States and abroad. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce.

Mr. Marler and his firm, Marler Clark, recently sponsored a two-day conference on food safety titled "Who’s Minding the Store: The Current State of Food Safety and How it Can be Improved." The Seattle conference brought together national and local representatives of government, industry, consumer organizations, scientists, and the media. In addition, the conference featured a panel of international experts from China, New Zealand, the UK, and the European Union in a discussion of food safety in the global marketplace.

Mr. Marler was also recognized this year by the King County Bar Association (KCBA), which has selected him for the 2008 Outstanding Lawyer Award. The KCBA will present Mr. Marler with the award on June 26, 2008 at their annual awards dinner.

CDC is collaborating with public health officials in multiple states across the United States and with the U.S. Food and Drug Administration (FDA) to investigate a multi-state outbreak of Salmonella Agona infections. An investigation that includes interviews of persons with Salmonella Agona infections and comparison of the DNA fingerprints suggests that cereal from Malt-O-Meal unsweetened Puffed Rice Cereals and unsweetened Puffed Wheat Cereals is likely related to these illnesses.

As of April 22, 2008, state and city health departments from 12 states have identified 21 ill persons infected with same genetic fingerprint of Salmonella Agona. Ill persons with the outbreak strain have been identified from Colorado (1), Delaware (1), Maine (3), Massachusetts (2), Minnesota (1), North Dakota (1), New Hampshire (2), New Jersey (4), New York (3), Pennsylvania (1), Rhode Island (1), and Vermont (1). Onset dates, which are known for 13 patients, ranged from January 22 to March 8, 2008. Patients’ ages ranged from 4 months to 95 years with a median age of 66 years. Five hospitalizations and no deaths have been reported.

This might sound a bit familiar:

Multistate Outbreak of Salmonella Serotype Agona Infections Linked to Toasted Oats Cereal — United States, April-May, 1998

During April-May 1998, a total of 11 states reported an increase in cases of Salmonella serotype Agona infections; as of June 8, a total of 209 cases have been reported and at least 47 persons have been hospitalized, representing an eightfold increase over the median number of cases reported in those states during 1993-1997. The states reporting increases were Illinois (49 cases), Indiana (30), Ohio (29), New York (24), Missouri (22), Pennsylvania (20), Michigan (15), Iowa (8), Wisconsin (6), Kansas (4), and West Virginia (2). This report summarizes the outbreak investigation by local, state, and federal public health officials, which implicated Millville brand plain Toasted Oats cereal manufactured by Malt-O-Meal, Inc. as the cause of illness. Among 162 patients in this outbreak for whom information was available, 85 (52%) were female. Most cases occurred in children and the elderly (47% in persons aged less than 10 years and 21% in persons aged greater than 70 years).

A day after I listened to Bill Richardson, Governor of New Mexico, give a great speech in Seattle, restaurant workers in New Mexico are diagnosed with hepatitis A.  Two Albuquerque I-HOP restaurants are under the microscope after two of its workers were diagnosed with hepatitis A.
According to the New Mexico Department of Health, the employees work at the I-HOP on Wyoming and Paseo and at the one near Interstate-25 and Montano.

Four more hepatitis A cases have been linked to a Chipotle restaurant in La Mesa, California, bringing the total number of confirmed cases to 18.  Local Health and Human Services officials said no employees at the Chipotle restaurant tested positive for hepatitis A.   Health officials are recommending that anyone who ate at the restaurant between March 1 and April 22 get checked by a doctor.  Hepatitis A is commonly transmitted when an object contaminated with the stool of someone with hepatitis A comes in contact with another person’s mouth.  Exposure also can occur when an individual consumes food or water contaminated with the Hepatitis A virus, according to the health department.  Symptoms of hepatitis A include fever, fatigue, nausea and jaundice.

Illnesses as of a few moments ago are holding at 14. However, San Diego Health officials have advised people who ate at the restaurant, at 8005 Fletcher Parkway, between March 1 and April 22 to see a doctor if they are experiencing symptoms of the viral infection.

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) 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. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most viruses are present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults. We have been involved in representing families who have suffered from this virus.

* Carl’s Jr. Hepatitis A Outbreak – Washington
* Chi-Chi’s Hepatitis A Outbreak – Pennsylvania
* D’Angelo’s Deli Hepatitis A Outbreak – Massachusetts
* Friendly’s Hepatitis A Exposure – Massachusetts
* Houlihan’s Hepatitis A Exposure – Illinois
* Maple Lawn Dairy Hepatitis A Outbreak – New York
* McDonald’s Hepatitis A Outbreak – Washington
* Quizno’s Hepatitis A Exposure – Massachusetts
* Soleil Produce Hepatitis A Outbreak – California
* Subway Hepatitis A Outbreak – Washington
* Taco Bell Hepatitis A Outbreak – Florida

Outbreak supports the rationale for expanding E. coli O157:H7 as an adulterant on all meats, including those formerly considered “intact.”

According to Nebraska State health officials, an E. coli outbreak in Sarpy County has sickened 14 people — including a 7-year-old — and sent four people to the hospital. The E. coli outbreak was caused by roast beef served at a reception hall in Sarpy County for a private gathering on March 26. The people affected ranged in age from 7 to 73.  It appears that the “mystery ingredient,” in addition to E. coli O157:H7 were cloves that broke the surface of the roast beef prior to cooking, probably inserting the E. coli bacterium into the meat where cooking was not sufficient to kill the bacteria.

Two weeks ago I attended an FSIS conference where FSIS officials explained the E. coli adulterant rationale on intact meat.  Currently, intact product distributed for consumption as intact product – designated primal and sub-primal cuts such as roasts and steaks – is not considered adulterated if it is contaminated with E. coli.

The USDA’s proposal to consider E coli O157:H7 an adulterant in primal cuts of beef – those that are intact and thought to have a sterile interior – officials said they were concerned about cross-contamination during meat preparation. Daniel Engeljohn, deputy assistant in the FSIS Office of Policy and Program development, said some primal cuts are being made into ground beef, and some of them may not have received an antimicrobial treatment that is typically applied to boneless trim.

The Centers for Disease Control and Prevention (CDC) estimated in 1999 that 73,000 cases of E. coli O157:H7 occur each year in the United States. Approximately 2,000 people are hospitalized, and 60 people die as a direct result of E. coli O157:H7 infections and complications. The majority of infections are thought to be foodborne-related, although E. coli O157:H7 accounts for less than 1% of all foodborne illness. We have been involved in representing families who have suffered from this bacterium.

* AFG / Supervalu E. coli Outbreak – Minnesota
* AgVenture Farms Petting Zoo E. coli O157:H7 Outbreak Litigation – Florida
* Bauer Meat E. coli Litigation – Georgia
* BJ’s Wholesale Club E. coli Litigation – New York and New Jersey
* Captain’s Galley Seafood Restaurant E. coli Outbreak – North Carolina
* Cargill E. coli Outbreak – Nationwide
* Carneco / Sam’s Club E. coli Outbreak – Wisconsin & Michigan
* CCC Alternative Learning Daycare E. coli Outbreak – Texas
* China Buffet E. coli Outbreak – Minnesota
* ConAgra Ground Beef E. coli Outbreak – Nationwide
* Crossroads Farm Petting Zoo E. coli Outbreak – North Carolina
* Dee Creek Farm E. coli Outbreak – Washington & Oregon
* Dole Lettuce E. coli Outbreak – Minnesota, Wisconsin, and Oregon
* Dole Spinach E. coli Outbreak – Nationwide
* Emmpak E. coli Outbreak – Wisconsin
* Excel E. coli Outbreak – Georgia
* Finley Elementary School E. coli Outbreak – Washington
* Fresno Meat Market E. coli Outbreak – California
* Gold Coast Produce E. coli Outbreak – California
* Golden Corral E. coli Outbreak – Nebraska
* Habaneros E. coli Outbreak – Missouri
* Jack in the Box E. coli Outbreak – Western States
* Karl Ehmer Meats E. coli Outbreak – New Jersey
* KFC E. coli Outbreak – Ohio
* Kid’s Korner Daycare E. coli Outbreak – Missouri
* Kindercare E. coli Outbreak – California
* King Garden Restaurant E. coli Outbreak – Ohio
* Lane County Fair E. coli Outbreak – Oregon
* Nebraska Beef E. coli Litigation – Minnesota
* Olive Garden E. coli Outbreak – Oregon
* Organic Pastures E. coli Outbreak – California
* Parsley E. coli Outbreak – Washington & Oregon
* Peninsula Village E. coli Outbreak – Tennessee
* PM Beef Holdings, Lunds & Byerly’s E. coli Outbreak
* Robeson Schools E. coli Outbreak – North Carolina
* Rochester Meat Company E. coli Outbreak – Wisconsin, California
* Sizzler E. coli Outbreak – Wisconsin
* Sodexho Spinach E. coli Outbreak – California
* Spokane Produce E. coli Outbreak – Washington, Oregon, Idaho
* Stop & Shop E. coli Case – New Hampshire
* Taco Bell E. coli Outbreak – Northeast
* Taco John’s E. coli Outbreak – Iowa and Minnesota
* Topps and Price Chopper E. coli Case – New York
* Topps Meats E. coli Outbreak – Nationwide
* Totino’s and Jeno’s Pizza E. coli Outbreak – Nationwide
* United Food Group E. coli Outbreak – Western States
* Washington County Fair E. coli Outbreak – New York
* Wendy’s E. coli Outbreak – Oregon
* Wendy’s E. coli Outbreak – Utah
* White Water Water Park E. coli Outbreak – Georgia

Those sickened include six women and eight men, ranging in age from 23 to 55.  The concern is over anyone who dined at the restaurant located at 8005 Fletcher Parkway between March 1 and April 22.

Anyone who is symptomatic for Hepatitis A should immediately see his or her doctor to be screened for the illness.  Symptoms include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice.

Although it appears at this point, food service workers may not be the cause of this outbreak, Phyllis Entis at efoodalert correctly notes that “only St. Louis County in Missouri and Clark County, Nevada mandate this [Hepatitis A vaccines for food service workers].” Phyllis goes on the point out:
The CDC Advisory Committee on Immunization Practices (ACIP) has this to say about hepatitis A and food handlers:

"Foodborne hepatitis A outbreaks are recognized relatively infrequently in the United States. Outbreaks typically are associated with contamination of food during preparation by an HAV-infected food handler; a single infected food handler can transmit HAV to dozens or even hundreds of persons (34,36,37,78–81). However, the majority of food handlers with hepatitis A do not transmit HAV. Food handlers are not at increased risk for hepatitis A because of their occupation. However, among the approximately 40,000 adults with hepatitis A reported during 1992–2000 for whom an occupation was known, 8% were identified as food handlers, reflecting the large number of persons employed in the food service industry (34). Evaluating HAV-infected food handlers is a common and labor-intensive task for public health departments. In a 1992 common-source outbreak involving 43 persons, the estimated total medical and disease control cost was approximately $800,000 (82)."


Nevertheless, ACIP does not recommend routine vaccination of food handlers, on the grounds that this is not an occupation that presents increased risk of becoming infected with the virus. They don’t appear to consider the potential benefits or cost-savings to the general public that food handler vaccination would bring.

Current CDC recommendations for hepatitis A vaccination include:

* all children under one year of age;
* adults who live in a community with a high rate of hepatitis A infection;
* males who have sex with other men;
* users of street drugs;
* those who work in or travel to countries with a high rate of hepatitis A infection;
* people with long-term liver disease;
* people who receive agents to help their blood clot; and
* people who work with hepatitis A virus-infected animals or who work with the virus in a research setting.

Roughly one-third (31% in 2006) of US residents already have long-term immunity to hepatitis A, either through prior infection or as a result of having been vaccinated. This proportion should continue to rise, if parents follow CDC recommendations and have their children immunized.

Meanwhile, the two-thirds of the public without immunity to hepatitis A are at risk of infection from the occasional asymptomatic – and symptomatic – carrier working as a food handler. Perhaps it’s time for one of the major restaurant food chains to take the lead and require that its employees be tested for hepatitis A immunity and, if necessary, be vaccinated. Are you listening, Chipotle?

E. coli illnesses seem to be a part of nearly every news cycle. This week stories of illnesses have come from Colorado and Nebraska.

The Omaha World-Herald reports – “Sarpy County E. coli outbreak investigated”

State health officials are continuing to investigate an E. coli outbreak in Sarpy County that sickened 14 people — including a 7-year-old — and sent four people to the hospital. Dr. Tom Safranek, state epidemiologist, said the outbreak was caused by roast beef served at a reception hall in Sarpy County for a private gathering on March 26. The meat was prepared at a person’s home and brought to the event, he said. The people affected ranged in age from 7 to 73. The four people who were hospitalized were released several weeks ago, he said.

The Rocky Mountain News reports – “Illness hits tornado-stricken family-Daughter hospitalized in latest crisis to hit Holly household”

A little more than a year after a tornado took his wife and turned his life upside down, Gus Puga finds himself in the throes of another family crisis — this time at the bedside of his seriously ill daughter. Little Noelia Puga, a 4-year-old bundle of energy, is in the pediatric intensive care unit at Children’s Hospital, battling an E. coli infection. She was on dialysis and oxygen Thursday, but physicians expect her to make a full recovery, her father said.

San Diego County health officials say they have identified six more cases of hepatitis A that may be linked to a restaurant in La Mesa, bringing to 12 the total number of people sickened. Those who became ill ate at the Chipotle Mexican Grill between March 1 and April 22.

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) 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. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most viruses are present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults. We have been involved in representing families who have suffered from this virus:

* Carl’s Jr. Hepatitis A Outbreak – Washington
* Chi-Chi’s Hepatitis A Outbreak – Pennsylvania
* D’Angelo’s Deli Hepatitis A Outbreak – Massachusetts
* Friendly’s Hepatitis A Exposure – Massachusetts
* Houlihan’s Hepatitis A Exposure – Illinois
* Maple Lawn Dairy Hepatitis A Outbreak – New York
* McDonald’s Hepatitis A Outbreak – Washington
* Quizno’s Hepatitis A Exposure – Massachusetts
* Soleil Produce Hepatitis A Outbreak – California
* Subway Hepatitis A Outbreak – Washington
* Taco Bell Hepatitis A Outbreak – Florida