Marler Blog - Providing commentary on food poisoning outbreaks & litigation

The CDC estimates that "non-O157 STECs (like O26, O45, 0103, O111, O121, and O145) cause 36,700 illnesses, 1,100 hospitalizations and 30 deaths in America each year."

In speaking about the recent E. coli O145 outbreak linked to romaine lettuce, Patricia M. Griffin, chief of CDC's Enteric Diseases Epidemiology branch, said it is likely that E. coli O145 has caused previous food poisonings but has gone undetected because only about 5 percent of clinical laboratories are able to detect it. "The fact that we found it now doesn't mean it wasn't there before," she said. "The ability to look for the organism in ill people and in outbreaks and food has been increasing. We're gradually finding more of these organisms."

And, here is the memo to prove it (click image to download):

With raw milk in the news nearly everyday, I thought supporting a website that offered unbiased facts on the pros and cons of consuming raw milk products would be useful in the raw milk debate. More than anything, I wanted to be able to have a place where parents could “find out the answers to commonly asked questions about raw (unpasteurized, unprocessed) milk benefits, safety, and how risks from raw milk compare with other foods like pasteurized milk, fresh fruits and vegetables, and meat/poultry/fish.”

I hope you find the site helpful - www.realrawmilkfacts.com.

There seems to be no middle ground in the debate over raw milk. On the one side, you have farmers happy to sell a product for $10 to $18 a gallon, and consumers who believe that they are purchasing a product that is not only more healthful but will also cure everything from allergies to autism. On the other side, you have public health officials defending the time-tested benefits of pasteurization as a way to make milk safe to consume.

But even though the argument appears to have two sides, the reality is as simple as it is undeniable: raw milk is seriously risky, and should be consumed, if at all, with extreme caution.

Health department officials in Minnesota this week have reported three, and possibly four, E. coli O157:H7 infections linked to drinking raw milk from a dairy in Gibbon. All of the sick were infected with a strain of bacteria that has the same “pulsed field gel electrophoresis” (PFGE) pattern, or DNA fingerprint. One infected child has now developed Hemolytic Uremic Syndrome (HUS), a potentially deadly complication.

Counting Minnesota, there have now been at least nine outbreaks of illness tied to raw milk since January 2010. The other states with outbreaks include Nevada, Utah (two outbreaks), New York, and Pennsylvania. There was also a multistate outbreak with illnesses confirmed in Michigan, Indiana, and Illinois. Washington has had two as well. And, even worse, these outbreaks involved at least three different pathogens: E. coli O157:H7; Salmonella, and Campylobacter. More specifically:

• In January, a dairy farm in New York was linked to five Campylobacter infections.
• Another outbreak of Campylobacter was reported in February in Pennsylvania. State health officials there said approximately ten people became ill after drinking raw milk. One of the ill developed Guillain - Barre Syndrome, became paralyzed, and is still hospitalized.
• In March, raw milk caused at least seventeen Campylobacter infections in Michigan, Illinois, Indiana.
• In April, Utah was the site of Salmonella and Campylobacter outbreaks tied to raw milk. The first cluster included nine reported cases of Campylobacter infection. The second cluster included six reported cases of Salmonella.
• Earlier this month, Nevada health officials reported that a child became seriously ill with a Campylobacter infection after eating homemade raw milk cheese that was illegally sold door-to-door.
• Washington has had two E. coli O157:H7 outbreaks both linked to the same dairy.

Over the last several years I have tried to bring some level of rationality to the debate over the consumption of raw milk. I first published on my blog a summary of the findings of a review of peer-reviewed literature on the topic of the "pros" of the consumption of raw milk. Most alleged benefits were anecdotal, with a reduction in allergies as the only scientific observation. I then posted about the "cons." The overwhelming “con” of drinking raw milk, according to the scientific literature, relates to the serious risk of infection, and the injury, disability, and death that result.

In trying to base the debate over the pros and cons of raw milk more firmly on facts, and not anecdote and emotion, I have found that the most instructive thing that I can do is to remind debate-participants of “real world” effects that drinking raw milk can cause. For example:

Chris Martin, then age seven, developed an E. coli O157:H7 infection in September 2006 following consumption of raw milk. He was hospitalized beginning September, suffering from severe gastrointestinal symptoms. Shortly thereafter, he developed hemolytic uremic syndrome (HUS). In an effort to properly treat his rapidly deteriorating condition, Chris was moved to multiple medical facilities, twice by life-flight. His HUS was remarkably severe, marked by prolonged renal failure, pancreatitis, and severe cardiac involvement. He required 18 days of renal replacement therapy. On two occasions his cardiac problems became so severe that he was placed on a ventilator. At several junctures, the possibility that he might not survive was very real. Ultimately he was hospitalized through November, after incurring over $550,000 in medical bills. Renal experts have opined that Chris is likely to develop severe renal complications in the future. These complications include end stage renal disease (ESRD) and kidney transplant.

Mari Tardiff was one of those sickened in the June 2008 outbreak of Campylobacter connected to raw milk. As a result of her campylobacter infection, Mari developed Guillain Barré syndrome, or GBS, a potentially fatal inflammatory disorder. By the time she was hospitalized in mid June, Mari was essentially paralyzed. Mari was intubated and placed on mechanical ventilation. For weeks on end, Mari’s condition remained unchanged. She was heavily sedated, unable to move, and entirely dependent on mechanical ventilation for survival. In August, there were indications of slight improvement, and the very slow process of weaning Mari off mechanical ventilation began. At the outset, it was not clear that the process was successful. Through incredible effort on Mari’s part, she was fully weaned off mechanical ventilation by August, and discharged to a rehabilitation facility. She spent more than two months at the rehabilitation facility diligently attempting to re-acquire the ability to speak, breathe, and move her arms and legs on her own. She was discharged home in November, still in need of essentially 24-hour care. Since that time, she has worked every day toward achieving her goal, as yet unreached, of walking again. Medical expenses to date exceed $1,000,000.

Nicole Riggs developed an E. coli O157:H7 infection in May 2008 from consumption of raw goat’s milk. She was nine years old at the time. Nicole suffered from symptoms typical of E. coli O157:H7 infections – bloody diarrhea, cramping, and nausea – that quickly intensified and led to her hospitalization. Once hospitalized, Nicole developed renal failure, anemia, and thrombocytopenia (low platelet count) indicating that she was developing HUS. She was transferred to a Children’s hospital and started on dialysis in order to save her life. She received dialysis for 18 days. Nicole’s renal function slowly returned to the point that she was deemed healthy enough for discharge on June 1. After discharge, she remained under the care of a nephrologist. In addition, damage suffered during her HUS has required that her gall bladder be removed. Medical costs to this point exceed $180,000. As the result of damage to her kidneys suffered during her bout with HUS, Nicole is at significant risk for severe renal complications in the future.

I certainly understand the desire of a farmer to sell a highly profitable product, just as I can understand the desire of consumers to make up their own minds about drinking raw milk. But farmers and consumers need to be fully informed, and the risks need to be fully understood. Because of the debate and the risks, I helped fund the building of Real Raw Milk Facts as a place where the pro’s and con’s of raw milk production and consumptions can be discussed against the background of scientific facts.

Bottom line, be informed.

David Dinsmore of the Town Talk of Alexandria and Pineville Louisiana continues to report on the tragedy surrounding an outbreak of illnesses that sickened more than 40 people and killed three patients at Central Louisiana State Hospital. Mr. Dinsmore reports that test results found the third most common cause of food poisoning -- clostridium perfringens -- was to blame for the outbreak at Central earlier this month, said Dr. David Holcombe, medical director for Region 6 of the Louisiana Department of Health and Hospitals' Office of Public Health. The C. perfringens bacterium appears to have come from the chicken salad served before patients and staff members began getting sick, Holcombe said. Those who had the chicken salad at that time were 23 times more likely to show symptoms, which is a good indicator that the dish was the culprit.

Clostridium perfringens is an anaerobic, Gram-positive, sporeforming rod (anaerobic means unable to grow in the presence of free oxygen). It is widely distributed in the environment and frequently occurs in the intestines of humans and many domestic and feral animals. Spores of the organism persist in soil, sediments, and areas subject to human or animal fecal pollution. (1)

Perfringens food poisoning is the term used to describe the common foodborne illness caused by C. perfringens. The symptoms are caused by ingestion of large numbers of (greater than 10 to the 8th) vegetative cells. Toxin production in the digestive tract (or in test tubes) is associated with sporulation.

The common form of perfringens poisoning is characterized by intense abdominal cramps and diarrhea which begin 8-22 hours after consumption of foods containing large numbers of C. perfringens bacteria capable of producing the food poisoning toxin. The illness is usually over within 24 hours but less severe symptoms may persist in some individuals for 1 or 2 weeks. In the elderly or infirm, those symptoms may often last 1-2 weeks. Complications and/or death only very rarely occur; a few deaths have been reported as a result of dehydration and other complications.

Perfringens poisoning is diagnosed by its symptoms and the typical delayed onset of illness. Diagnosis is confirmed by detecting the toxin in the feces of patients. Bacteriological confirmation can also be done by finding exceptionally large numbers of the causative bacteria in implicated foods or in the feces of patients. Standard bacteriological culturing procedures are used to detect the organism in implicated foods and in feces of patients. Serological assays are used for detecting enterotoxin in the feces of patients and for testing the ability of strains to produce toxin. The procedures take 1-3 days. (1)

The CDC reports a total of 28 individuals infected with a matching strain of Salmonella Newport have been reported from 10 states since March 1, 2010. The number of ill people identified in each state with this strain is as follows: AZ (2), CA (14), CO (1), ID (3), IL (1), MO (1), NM (1), NV (2), OR (1), and WI (2). Among those for whom information is available about when symptoms started, illnesses began between March 1, 2010 and May 7, 2010. Case-patients range in age from <1 to 75 years old, and the median age is 32 years. Sixty-four percent of patients are female. Among the 20 patients with available hospitalization information, 6 (30%) were hospitalized. No deaths have been reported.

There have now been at least seven outbreaks of illness, involving three different dangerous pathogens, tied to raw milk since January 2010. There have been outbreaks in Minnesota, Nevada, Utah (2), New York and Pennsylvania, as well as a single outbreak that included illnesses in Michigan, Indiana, and Illinois. Raw milk consumers have been sickened with E. coli O157:H7; Salmonella, and Campylobacter.

Last night, health department officials in Minnesota have reported three cases of E. coli O157:H7 illness linked to raw milk from a dairy farm in Gibbon. The Minnesota Department of Health and the Minnesota Department of Agriculture are continuing to investigate the illnesses. All of the sick share a strain of the bacteria that have the same “pulsed field gel electrophoresis” (PFGE) patterns, or DNA fingerprint. One of the ill persons has developed Hemolytic Uremic Syndrome (HUS).

Earlier this month, Nevada health officials reported that a child became seriously ill with a Campylobacter infection after eating homemade cheese that was illegally sold door-to-door. The cheese was not properly pasteurized.

In April, Utah was the site of Salmonella and Campylobacter outbreaks tied to raw milk. According to a Utah Public Health Press Release, there were two separate clusters of illness linked to the consumption of raw milk. The first cluster included nine reported cases of Campylobacter infection among residents in Weber, Davis and Cache Counties. This outbreak was linked to the Ropelato Dairy. The second cluster, linked to the Redmond Dairy, included six reported cases of Salmonella infection in residents in Utah, Salt Lake and Wasatch Counties.

In March, raw milk caused at least 17 culture confirmed Campylobacter infections from Family Farms Cooperative in Michigan, Illinois, Indiana. Three cases were from Indiana, one from Illinois, and 13 from Michigan.

Another outbreak of Campylobacter was reported in February in Pennsylvania. State health officials there said approximately 10 people became ill after drinking raw milk from Pasture Maid Creamery. One of the ill developed Guillain - Barre Syndrome, and became paralyzed.

In January, Willow Marsh Farm in New York was implicated in five Campylobacter illnesses.

Also, see www.realrawmilkfacts.com for more information.

What can one lawyer do to change a food safety system that doesn’t do much to keep people safe? If you’re Bill Marler, spend over a half million dollars of your own money funding an independent study to try and make the USDA take action.

Bill Marler is a name people in the food industry game know and, truth be told, may not love. The food safety attorney and advocate first came face-to-face with the devastation caused by the foodborne pathogen Escherichia coli (E. coli) when he represented several of the children sickened or killed by the Jack in the Box outbreak in the early 1990s.

That historic tragedy, which made hundreds ill and killed four, brought about a sea change in how the USDA treats food tainted with E. coli O157:H7.The problem is that the infamous E. coli O157:H7 isn’t alone in the physical and financial ruin it can cause. There are at least six other toxic strains of E. coli that can make people (particularly children and the elderly) exceedingly ill. Marler wants the government to step up and add protections against these pathogens—before another incident like the one involving Jack in the Box forces them to.

“It is a shame that in 2010, after years and years of outbreaks, there are still lethal strains of E. coli in our food supply that are not regulated by the proper government agency,” said Marler. “E. coli O157:H7 has been considered by the USDA’s Food Safety Inspection Service an adulterant in food since 1994. Sixteen years later, non-O157 strains, which can be just as devastating, are not. The recent outbreak of E. coli O145 in lettuce is proof positive that if it’s in cows, sooner or later it will appear in produce as well.”

This distinction means variants of non-O157 strains of E. coli are not regulated or even regularly tested for in the nation’s meat supply. While there are literally hundreds of strains of E. coli living in the intestines of healthy cattle, there are six—identified by the Centers for Disease Control and Prevention—that, in addition to O157—produce Shiga toxin, which can cause kidney failure.

After being contacted by the family of a 13-year-old girl who died from a non-regulated strain of E. coli and overwhelmed by the mounting evidence, Marler (who was on the short list for the job of Undersecretary of Food Safety for the USDA), decided to fund his own study to test how common non-O157 contamination is in the retail ground beef supply.

What he found was staggering and should scare anyone who eats beef.

While full results will be available later this year, tests from the last year and a half from over 4,600 samples from around the country have found that a full 1% are tainted with non-O157 adulterants. Considering the thousands of tons of ground beef consumed in the U.S. each year, this number is potentially devastating.

With this data in hand, Marler with backing of his firm Marler Clark, filed a Petition with the USDA/FSIS to get them to recognize and regulate non-O157 serotypes of E. coli as adulterants. While they have acknowledged that the petition is under review, no immediate action by FSIS has been taken.

Marler isn’t the only person concerned by the FSIS inaction. In April, New York Senator Kirsten Gillibrand penned a letter to USDA secretary Tom Vilsack urging him to respond formally to Marler’s petition as well as one submitted by consumer advocacy group Safe Tables Our Priority (STOP).

Via a press release Gillibrand said, “ The laws that are meant to keep us safe from hazardous foods are in critical need of updating. We need immediate action to keep our families safe.”

STOP laid out the ultimate goal succinctly in their petition by urging FSIS to declare “disease-causing E. coli’s other than O157:H7 as adulterants in beef and begin testing for them.”

The CDC says that E. coli O157:H7 causes 73,000 illnesses a year. The six non-O157 strains are estimated to sicken an additional 37,000 people a year and kill 30. However, the truth is though no one knows for sure because most of the labs used to test for foodborne pathogens don’t test for anything other than O157:H7.

“It is well past time for the USDA to declare that all Shiga-toxin producing strains of E. coli are adulterants and ban them from our food supply,” said Marler.

William Neuman’s article “In E. Coli Fight, Some Strains Are Largely Ignored,” went live a few moments ago. It will be interesting to see if this prompts a serious reassessment by our government of the real risks of non-O157:H7's.  Although Mr. Neuman’s article will be read by a few more millions of people than our petition to the USDA to deem the “big six” as adulterants, I think the petition is a good read - "Petition with the USDA/FSIS for an interpretive rule declaring all enterohemorrhagic Shiga toxin-producing serotypes of Escherichia coli (E. coli), including non-O157 serotypes, to be adulterants."  However, if you want a bit of a quicker overview for why these bugs should be adulterants, please see, "It is well past time for the USDA to declare that all shiga-toxin producing strains of E. coli are adulterants and ban them from our food supply."

Let the discussion begin.  For goodness sake, I spent $500,000 on the tests.

The Miami-Dade Health Department said today that a cook at the Bayside Chili’s restaurant has a confirmed case of a serious, contagious illness and likely prepared food with it for some time before it was finally diagnosed. The cook had gone to work with Typhoid fever for at least 10 days before going to the doctor.

According to news reports, every employee at the Chili's is being examined to see if the disease was spread to them, but there may not be any way to get to the hundreds of people who may have consumed food prepared by the contaminated cook.

Typhoid fever is caused by Salmonella Typhi, a bacteria that can be “passed” on through fecal/oral contact by eating or drinking something prepared by someone with the illness.

Minnesota State health officials have linked three cases of E. coli O157:H7 illness with raw milk from a dairy farm in Gibbon, Minn. The Minnesota Department of Health urges anyone who may have recently purchased milk from the Hartmann Dairy Farm, also known as M.O.M.’s, to discard the product and not consume it. The milk may be labeled organic and consumers may be unaware that the milk has not been pasteurized. In addition, consumers should not eat cheese, ice cream or other dairy products from the farm, which also may have been made from raw, unpasteurized milk.

Symptoms of E. coli O157:H7 illness typically include stomach cramps and diarrhea, including bloody diarrhea.People typically become ill two to five days after eating contaminated food. E. coli O157:H7 disease sometimes leads to a serious complication called hemolytic uremic syndrome (HUS), which can cause kidney failure and can occur a week or more after the onset of diarrhea. People who have developed symptoms after consuming unpasteurized milk should seek immediate medical attention. Those most at risk of developing complications from E. coli infection include the very young, the elderly, and people with weakened immune systems.

The Minnesota Department of Health and the Minnesota Department of Agriculture are continuing to investigate a cluster of four E. coli O157:H7 illnesses that all have the same “pulsed field gel electrophoresis” (PFGE) patterns, or DNA fingerprint. Three of the four cases report a link to milk from Hartmann Farm; the fourth case is under investigation. Three of the four people were hospitalized as a result of their illness; one case has developed HUS.  Minnesota law prohibits most raw milk sales, except for occasional purchases directly at the farm where the milk is produced.

For more information on raw milk see, www.realrawmilkfacts.com.

Here is something positive - E. coli O157:H7 victim, Linda Rivera, walked 50 feet today.

I have been struggling with that question as I am preparing for my upcoming speech at NEHA in a few weeks.

As most know, Upton Sinclair’ 1906 novel, “The Jungle,” was intended to expose the exploitation of the workers in the Chicago packing houses, but became a best seller because it exposed the underbelly of the turn-of-the-century beef industry. Sinclair famously noted the impact of his book by stating, "I aimed at the public's heart, and by accident I hit it in the stomach." In fact, he felt his book was popular, "not because the public cared anything about the workers, but simply because the public did not want to eat tubercular beef.”  Interesting little video on the history:

In another interesting bit(e) of history, I found that the major meat packers were eventually the main lobbyists with Congress to pass legislation paying for inspection and certification of meat packaged in the United States (with our tax dollars) as opposed to simply legislating enforceable standards. The packer pressure, coupled with the public outcry, led to the passage of the Federal Meat Inspection Act. Where for the most part, we still are today.  Well, back to speech writing.

The below dropped into my inbox. It looks like after a 19-month vacancy Food Safety Inspection Services (USDA) is possibly going to finally get a person to run the place.

To: All Committee Members

Title: Hearing to Consider the Nomination of Elizabeth Hagen for Positions with the USDA

Date: Wednesday, May 26, 2010 - Likely Not

Time: 9:30 a.m.

Place: 328A Russell Senate Office Building

WITNESS LIST - Elizabeth Hagen, of Virginia, to be Under Secretary of Agriculture for Food Safety

If any of the Committee Members, Blanche Lincoln (D-AR) ‚Ä®- Max Baucus (D-MT) ‚Ä®- Michael Bennet (D-CO) ‚Ä®- Sherrod Brown (D-OH) ‚Ä®- Bob Casey (D-PA)‚Ä® - Kent Conrad (D-ND)‚Ä® - Kirsten Gillibrand (D-NY) ‚Ä®- Tom Harkin (D-IA) ‚Ä®- Amy Klobuchar (D-MN) ‚Ä®- Pat Leahy (D-VT)‚Ä® - Ben Nelson (D-NE) ‚Ä®- Debbie Stabenow (D-MI)‚Ä® - Saxby Chambliss (R-GA) ‚Ä®- Thad Cochran (R-MS)‚Ä® - John Cornyn (R-TX) ‚Ä®- Chuck Grassley (R-IA) ‚Ä®- Mike Johanns (R-NE) ‚Ä®- Dick Lugar (R-IN)‚Ä® - Mitch McConnell (R-KY) ‚Ä®- Pat Roberts (R-KS)‚Ä® - John R. Thune (R-SD), need a list of questions, feel free to call or read this - "IF there was an USDA Undersecretary for Food Safety this is what they should be doing."

There are few cases that have impacted me more than Abby's.  We were honored to donate to set-up a scholarship in Abby's name:

Helping on a scholarship in Abby's memory is one thing, getting our government to do something would be even better.  Perhaps this is a post they should pay attention to:  Mr. President, Senators, Congress Members watch this video now!

Many restaurants or manufacturers of food seldom, if ever, issue an apology when their food poisons a customer.  So, when the owner of Los Dos Amigos Family Mexican Restaurant issues a written apology to its patrons for the recent salmonella outbreak at the Jackson Street, Roseburg, business, you need to take notice.

Thirty people reportedly got sick from the outbreak.  Owner Gustavo Anaya and his son Manny Anaya delivered letters to media outlets in Douglas County on Friday.

“We send our sincerest apologies to the people and family members who were affected by the salmonella outbreak,” the letter stated.

Good for them.  My guess is that a business that apologizes is also a business that is interested in making sure something similar never happens again.

In early April 2009, health officials from several states began investigating reports of E. coli O157:H7 illnesses associated with the consumption of ground beef products manufactured by the JBS Swift company. On June 24, 2009, JBS Swift announced a voluntary recall of approximately 41,280 pounds of beef products due to potential contamination with E. coli O157:H7. Most of the products associated with the June 24 recall bore the establishment number "Est. 969" and had identifying package dates of "042109" or "042209."

By June 28, the recall was expanded to include 380,000 pounds of beef primal products. The products implicated in the expanded recall were produced on April 21, 2009, and were distributed nationally and internationally. These items bore the establishment number "EST. 969," an identifying package date of "042109," and a time stamp ranging from "0618" to "1130." According to the Centers for Disease Control and Prevention (CDC), some of the products were likely cut again or made into ground beef at retail and then re-packaged. Thus, ground beef packages purchased by consumers may not have exhibited identifying information.

After the recall announcements, the multi-state investigation into the reported E. coli O157:H7 illnesses continued. Samples from unopened packages of ground beef recovered from the house of one of the patients were tested by the Michigan Public Health Laboratory. The tests yielded an E. coli O157:H7 isolate that was an identical PFGE match to the outbreak strain.

By early July 2009, the Centers for Disease Control and Prevention (CDC) had been notified of twenty three persons from nine states that were infected with the same PFGE-confirmed strain of E. coli O157:H7 implicated in the JBS Swift recall. The number of ill persons identified in each state was as follows: California (4), Maine (1), Michigan (6), Minnesota (1), New Hampshire (1), New Jersey (2), New Mexico (1), New York (1) and Wisconsin (6).

Among the seventeen ill persons for whom hospitalization status is known, twelve (70%) were hospitalized. Two of the hospitalized patients developed Hemolytic Uremic Syndrome - HUS. Fourteen of the patients (64%) were male and 59% were less than nineteen years old, with ages ranging from 2 to 74 years.  We represented the HUS victims.

A total of 26 confirmed and 7 probable cases related to this outbreak have been reported by the CDC from 5 states since March 1, 2010. The number of ill persons identified in each state with this strain is: MI (11 confirmed and 2 probable), NY (5 confirmed and 2 probable), OH (8 confirmed and 3 probable), PA (1 confirmed), and TN (1 confirmed). The reported cases in Tennessee and Pennsylvania do not reflect expansion of the outbreak but retrospective identification of cases using the PulseNet system – these cases are part of the original cluster due to the original implicated lot of lettuce from March.

The bacteria responsible for this outbreak are referred to as Shiga toxin-producing E. coli, or STEC. STECs have been associated with human illness, including bloody diarrhea and HUS. STEC bacteria are grouped by serogroups (e.g., O157 or O145). The STEC serogroup found most commonly in U.S. patients is E. coli O157. Other E. coli serogroups in the STEC group, including O145, are sometimes called “non-O157 STECs.” Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including E. coli O145; therefore, E. coli O145 may go unreported. Because it is more difficult to identify than E. coli O157, many clinical laboratories do not test for non-O157 STEC infection.

Among the confirmed and probable cases with reported dates available, illnesses began between April 10, 2010 and April 26, 2010. Infected individuals range in age from 13 years old to 31 years old and the median age is 19 years. Sixty-four percent of patients are male.  Among the 30 patients with available information, 13 (39%) were hospitalized. Three patients have developed a type of kidney failure known as hemolytic-uremic syndrome, or HUS. No deaths have been reported.

Oregon Public Health officials today are warning consumers about a nationwide recall of alfalfa sprouts produced by Caldwell Fresh Foods of Maywood, Calif., and sold under several label names in Oregon. The sprouts are being sold in at least 17 other states in the West, Midwest and the South. The sprouts have been identified as the source of an outbreak of salmonellosis. All Caldwell-produced alfalfa sprout products are covered in the recall.

To date, 23 people from 10 states, including one Multnomah County infant, have been identified with matching Salmonella Newport. At least four of these people, including the Oregon child, were hospitalized. No deaths have been reported.

“Once again, alfalfa sprouts have been identified as the cause of an outbreak of salmonellosis,” said William E. Keene, PhD, MPH, a senior epidemiologist at Oregon Public Health. “Consumers who have sprouts at home should check to see if they have the recalled brands, and if so should discard them immediately. Retailers should immediately check their stocks and pull any Caldwell products.”

The recalled sprouts were packaged in four-ounce plastic cups and one-pound plastic bags under the Caldwell Fresh Foods brand; four-ounce plastic cups under the Nature’s Choice brand; five-ounce plastic clamshell containers under the California Fresh Exotics brand; and two-pound and five-pound plastic bags in cardboard boxes with a Caldwell Fresh Foods sticker. In Oregon, the recalled sprouts were sold at Trader Joe’s, Wal-Mart and possibly other locations, including restaurants and delicatessens.

“Caldwell has agreed to voluntarily recall their alfalfa sprouts and is cooperating fully with our ongoing investigation,” Keene said.

State and federal agencies are working with Caldwell to remove potentially contaminated sprouts from distribution and to identify the source of the problem — usually contaminated seed. Retailers and wholesalers that have any of the recalled sprouts should segregate them from other produce and contact their distributor or Caldwell at 323-589-4008 for additional information. Restaurant and deli operators should check their stock immediately to identify and pull any of the recalled products, Keene said.

Salmonellosis is an acute bacterial infection that can cause diarrhea, fever and vomiting. Symptoms usually develop within one to five days after eating contaminated food. Most cases resolve without the need for medical attention, and antibiotics are not advised for people with uncomplicated illness.

People who have eaten sprouts and developed severe symptoms should discuss this exposure with a health care provider. Some people with salmonellosis develop serious illness that can lead to hospitalization and even death, according to Keene.

Raw sprouts have been repeatedly identified as the cause of outbreaks of salmonellosis, E. coli O157:H7 infections, and other diseases. This is the 12th sprout-caused outbreak that has sickened Oregonians since 1995, Keene said. “Anyone concerned about a food-borne disease should consider this before eating sprouts. The risk of severe illness is particularly high among the elderly, the immunocompromised and the very young.”

The Columbus Dispatch reports that the U.S. Centers for Disease Control and Prevention have determined that the strain of bacteria was Escherichia coli 0143:H34.  The E. coli in the bag of lettuce tested in Ohio hasn't been linked to any known food-borne illness here or elsewhere, but it could sicken people. For some food-safety advocates, the finding highlights the ubiquitous nature of contamination and builds the case to expedite reforms to improve the cleanliness of the nation's food supply.  The second type of E. coli was found in shredded lettuce from food-processor Freshway Foods in Sidney, Ohio. Another sample from the same company proved key to linking a multistate outbreak of E. coli 0145 infection to romaine lettuce and eventually back to a farm in Arizona where the lettuce was grown.

U.S. Food and Drug Administration officials have said they think the contamination started at the farm, but they have refused to name the farm as they continue to look for the root cause of the outbreak.

As I said the other day, I continue to get information on who "The Yuma Farm" is.  Some of the information may well be incorrect.  Interestingly, during those discussions, I learned that there is also a lettuce Salmonella outbreak in the "upper-Midwest," that appears linked to industry leader, Fresh Express.  It is interesting that the Health Department and FDA remain silent on this one too.

AP’s Scott Bauer and I caught up with each other this morning shortly after Governor Jim Doyle vetoed a bill that would have allowed limited sales of raw milk in Wisconsin, saying he was protecting citizens' health and safety. He also expressed concerns about how a possible outbreak of disease from drinking the unpasteurized milk could affect the state's $26 billion dairy industry.

"I recognize that there are strong feelings on both sides of this matter, but on balance, I must side with the interests of public health and the safety of the dairy industry," he said in his veto letter to lawmakers.

Since I provided information and video’s to the Governor on raw milk, Mr. Bauer asked my thoughts on the veto:

Seattle attorney Bill Marler, who has represented children and families all over the country sickened by E. coli and other food contaminants, said Doyle did the right thing.  "Because Wisconsin's well-known as the 'Dairy State,' it sends the message that other states need to take a deep breath and understand that raw milk does not come without risks," Marler said.

As I have said before, a complete ban is not workable. However, I would suggest any raw milk program consider the following:

1. Raw milk should be sold only on farms that are certified by the state and inspected and tested regularly. Make ambiguous black market milk/cheese sales and "pet food sales" meant for human consumption clearly illegal

2. Raw milk should not be sold in grocery stores or across state lines--the risks of mass production and transportation are too great; the risk of a casual purchase by someone misunderstanding the risks is too great, as well

3. Farms should be required to have insurance coverage sufficient to cover reasonable damages to their customers

4. Practices such as outsourcing (buying raw milk from farms not licensed for raw milk production) should be illegal

5. Colostrum should be regulated as a dairy product, not a nutritional supplement

6. Warning signs on the bottles and at point-of-purchase should be mandatory. An example:

"WARNING: This product has not been pasteurized and may contain harmful bacteria (not limited to E. coli O157:H7, Campylobacter, Listeria and Salmonella). Pregnant women, infants, children, the elderly and persons with lowered resistance to disease (immune compromised) have the highest risk of harm, which includes Diarrhea, Vomiting, Fever, Dehydration, Hemolytic Uremic Syndrome, Guillain-Barre Syndrome, Reactive Arthritis, Irritable Bowel Syndrome, Miscarriage, or Death, from use of this product."

For more information on raw milk, please visit www.realrawmilkfacts.com.

According to a Utah Public Health Press Release, officials are investigating two separate clusters of illness linked to the consumption of raw milk. To date, the first cluster includes nine reported cases of Campylobacter infection among residents in Weber, Davis and Cache Counties. The second cluster includes six reported cases of Salmonella infection in residents in Utah, Salt Lake and Wasatch Counties. All of the patients involved have reported drinking raw milk (unpasteurized milk) purchased at local vendors licensed in the State of Utah to sell raw milk.

Health officials are working closely with the Utah Department of Agriculture and Food (UDAF) and the dairies where the raw milk was produced. Raw milk from the two dairies has been tested for several bacteria.

The dairy in central Utah that produced the raw milk linked to the Salmonella illness cluster provided samples of raw milk produced from April 5 to April 22. These samples came back positive for Salmonella. However, raw milk samples taken from milk produced by the dairy collected April 22 to April 30 have come back negative for Salmonella.

Coliform testing done on milk at the dairy in northern Utah linked to the Campylobacter illness cluster came back high for coliform counts. High coliform counts may be linked to the presence of disease-causing pathogens in the milk.

There are inherent risks associated with the consumption of raw milk because of disease-causing bacteria that are commonly found in milk, such as Campylobacter, Salmonella, Listeria, and E. coli. Even with strict state regulations in place regarding the sale of raw milk, there is no guarantee that raw milk is free of disease-causing bacteria.

Raw milk contaminated with disease-causing bacteria does not smell or look any different from non-contaminated raw milk, and there is no obvious way for the consumer to know if the raw milk is contaminated.

Common symptoms of infection with Campylobacter and Salmonella include: diarrhea, abdominal pain, fever, headache, nausea and vomiting. Illness can last for up to a week or more and can be serious, especially for young children, pregnant women, the elderly and those who have weakened or compromised immune systems. In some severe cases, illness can lead to more serious complications, including Guillain-Barré Syndrome.  For more resources, see www.realrawmilkfacts.com.

What we know to date:

• There are 23 confirmed and 7 probable E. coli O145 cases related to eating romaine lettuce in Michigan, New York, Ohio, and Tennessee manufactured by Freshway Foods and grown by “the Yuma farm.”
• Investigators in New York obtained an E. coli O145 isolate from an unopened bag of romaine lettuce manufactured by Freshway Foods and grown by “the Yuma farm” that matches the outbreak strain.
• The Ohio Department of Agriculture has also tested bagged lettuce implicated in the outbreak and found a second, unrelated strain of E coli in a bag of shredded romaine lettuce from Freshway Foods and grown by “the Yuma farm.”
• A case-control study in Michigan found a significant association between illness and consumption of romaine lettuce from Freshway Foods and grown by “the Yuma farm.”
• Among the 30 patients with available information, 12 (40%) were hospitalized.
• Three patients have developed kidney failure known as hemolytic-uremic syndrome, or HUS.
• Freshway Foods voluntarily recalled certain romaine lettuce products because of the connection to the E. coli O145 foodborne illness outbreak. The recalled shredded romaine lettuce had “best if used by” dates of May 12 or earlier was grown by “the Yuma farm.”
• Andrew Smith, Co., a grower-shipper who distributed the lettuce from “the Yuma farm” in Yuma, has contacted its customers to recall any lettuce originating from “the Yuma farm.” Vaughan Foods a supplier of processed and packaged lettuce for restaurants and other foodservice facilities received romaine lettuce grown on “the Yuma farm” from Andrew Smith, Co. and is recalling romaine lettuce with “use-by” dates of May 9 and May 10.

What we do not know to date:

• How many people are really sick because the CDC said there is limited surveillance data on illnesses involving non-O157 serotypes of Shiga toxin-producing E coli (STEC), including O145. "Therefore E coli O145 may go unreported. Because it is more difficult to identify than E. coli O157, many clinical laboratories do not test for non-O157 STEC infection."
• Who the hell is “the Yuma farm,” and why does the FDA think we “can’t handle the truth?”

It is a good thing that we have a lawsuit to sort this all out.  See, we get to put Freshway under oath - Q:  "Who did you buy romaine lettuce from?"  A:  "Andrew Smith."  Then we get to put Andrew Smith under oath - Q:  "Who did you buy romaine lettuce from?"  A:  "?"  But, believe me, it will NOT be "the Yuma Farm."

According to the Deseret News, six people, ages 2 to 56, were diagnosed with Salmonella Newport in April, according to Utah County Health Department spokesman Lance Madigan. Four of the cases were in Utah County, with one each in Salt Lake and Wasatch counties. When investigators went through their where-have-you-been, what-have-you-eaten studies, they found all six had consumed raw milk bought from Real Foods stores in Orem and Heber City. That led them to Redmond Farms in Sevier County, where the raw milk was produced, he said.

Several state and county agencies say samples of unpasteurized milk show it contained Salmonella. The Utah Department of Agriculture and Food, Utah Department of Health and Utah County Health Department announced their findings Friday.

Scott Bauer of the AP, reports that Wisconsin Governor Jim Doyle may be having second thoughts on the raw milk bill that cleared both houses of the legislature. It seems that cheesemakers, doctors, veterinarians and other opponents of legalizing raw milk sales in Wisconsin are urging Gov. Jim Doyle on Friday to veto the bill, citing safety risks. Doyle last month indicated he was likely to sign it into law, but this week began to back off those statements after being barraged with opposition to the plan. Doyle now says he needs more time to study the issue and he hasn't decided what to do. He has until Thursday to act on it or allow it to become law without his signature.

"The public health and dairy communities are almost unanimous, if not completely unanimous, in their opposition to the bill," Doyle spokesman Adam Collins said. "The governor is weighing what he is hearing very carefully and will make a decision soon."

I wonder if the Gov reads the paper from Utah?

It was a fascinating few hours at a meeting with a delegation from China as they listened to former FSIS head, Tom Billy, CSPI Food Safety Director, Caroline Smith DeWaal and yours truly, talk candidly about the state of affairs of food safety in the United States. I spoke primarily about how the civil justice system (if used properly) can be a tool, not only to compensate victims, but also as a way for companies to be held accountable for poisoning their customers. I also discussed the need to conduct open discovery so the public can learn how an outbreak occurred and other companies can learn from past errors. I got in a bit of an international dispute when one of the Chinese delegates touted their criminal sanctions (e.g. executions) of food miscreants as opposed to letting the people have access to the courts. I suggested that we import some of China’s criminal laws (not the executions) and we export a few trial lawyers to China. The later drew robust praise from several U.S. Businessmen in attendance, the former not so much.

Last night I also had the opportunity to reconnect with Dr. Gupta who was filming “Lettuce recall: Dr. Sanjay Gupta digs deeper.” Here is the transcript:

The Centers for Disease Control and Prevention has confirmed that at least 23 people in four states have been sickened after eating Romaine lettuce contaminated with E. coli bacteria. The company that distributed the lettuce, Freshway Foods, has voluntarily recalled its products and told CNN it has been cooperating fully with public health officials to track the source of the outbreak. The lettuce was sold to wholesalers, food service outlets, delis and salad bars; no E. coli has been found in the bagged lettuce you can buy in the grocery store.

Dr. Sanjay Gupta sat down with attorney Bill Marler to talk about food safety. Marler, a Seattle, Washington, attorney who specializes in representing victims of foodborne illness, is representing a client in the new lawsuit against Freshway Foods.

Dr. Sanjay Gupta: You and I have talked about these issues over the years. What concerns you the most about this?

Bill Marler: Well, I think one of the big concerns is that we are seeing a new form of pathogenic E. coli hitting the market. This particular outbreak is E. coli 0145 just as deadly as the E. coli we hear about a lot, the O157:H7. But I think one of the big concerns is that we are seeing a new bug coming after us in the marketplace.

Gupta: A few years ago we went to one of the hardest hit outbreaks in recent years. The thing that you really impressed upon me at that time Mr. Marler, is this idea you have animals sometimes contaminating crops, you have a lot of natural occurrences that naturally can lead to food being contaminated. First of all, have things been improved since then? And can you really prevent that sort of thing from happening?

Marler: Well, I think the industry - many parts of the industry - have done a remarkable job. We certainly are not seeing the large-scale 200-250 sickened in outbreaks. We still see three or four sometimes five spinach or lettuce outbreaks yearly, and they are much smaller. This particular outbreak appears to be emanating from Arizona and this is the first time that there has been a leafy green outbreak in Arizona. So there are a lot of moving parts that I think we will learn a lot of over the next several months.

Gupta: Is it the FDA, the food maker, when you say somebody has to compensate? Who's going to compensate?

Marler: Ultimately it will be the grower, the shipper and the manufacturer of this particular lettuce. They have a responsibility to a consumer to do the absolute best they can to get animal feces out of their food products. And that obviously didn't happen here. Twenty-three states are recalling products. There are at least 23 people sick, probably a lot more because not very many lab tests for E. coli 0145.

See the full interview with Bill Marler on “Sanjay Gupta M.D.,” Saturday and Sunday at 7:30 a.m. ET.

I had a chance tonight after landing in Washington D. C., to chat with Dr. Sanjay Gupta about the status of the “leafy green’s industry.” So far in the recent E. coli O145 outbreak there are 23 confirmed illnesses in four states. However, the Romaine Lettuce has been recalled in 23 states. Here is the interview:

Food safety lawyer Bill Marler said consumers should not give up eating a good thing out of fear. He also suggested that whole lettuce was a safer option than the bagged variety.

"Mass-produced lettuce is big business. The public wants it. But think hard whether the convenience is worth the risk," said Marler, who has filed a lawsuit on behalf of an Ohio State University student who was sickened by E. coli 0145.

The Seattle, Washington-based lawyer credited the industry with having done "a remarkable job" in ensuring that large-scale outbreaks are not as common as they once were, but he said growers, shippers and manufacturers need to do more.

"They have a responsibility to the consumer to do the absolute best they can to get animal feces out of their food products," he said, referring to the source of the bacteria.

He speculated that the true number of people sickened by the outbreak is more than 23. "Probably a lot more, because not very many labs test for E. coli 0145," he told CNN Senior Medical Correspondent Dr. Sanjay Gupta.

In what seems like a near daily article on raw milk, I gave Georgina Gustin of the St. Louis Post-Dispatch (my dad was a paper boy for them during the depression) a few choice words:

Bill Marler, an attorney who specializes in food-borne illness cases, recently represented two Missouri residents who were sickened by raw milk. One was a 1-year-old boy; the other, a 9-year-old girl. Both suffered acute kidney failure related to E. coli, and both drank raw goat's milk that was traced back to the same farm and bought from a store in Barry County that was selling the milk illegally. The cases were settled out of court.

Marler is currently representing two people from Connecticut, where retail raw milk sales are legal, who claim they were sickened by raw milk purchased at [a grocery store chain]. [The grocery store] has since decided to pull raw milk from its stores in states where it could sell it legally.

"I have not seen any scientific literature that supports a lot of the claims raw milk supporters cite," Marler said. "It's very anecdotal."

… But for others, the regulators are just performing their public health duties, trying to prevent illness. To some, new legislative efforts to relax raw milk laws could encourage more producers in the struggling dairy industry to get into the raw milk game and could result in health risks.

"There are raw milk producers who do a good job and don't poison themselves or their customers," Marler said. "But I guarantee you that as legislation expands … you'll have more low-end operators and more sick people."

This issue is not going away anytime soon.

Suzanne Jacobs of the Michigan Daily wrote in her front page story this a.m., “E. coli outbreak at ‘U’ caused by non-USDA regulated strain,” about the failure of most labs, business and health departments to test for pathogenic E. coli other than E. coli O157:H7. I had a long talk with AP on why I thought my petition to USDA/FSIS to deem these other nasty bugs as adulterants (even though this outbreak – involving lettuce – is not a USDA/FSIS regulated product), would in the long run make our food supply safer. Here is most of that interview:

Bill Marler, a Seattle-based personal injury lawyer with experience in food-borne illness litigation, said this outbreak could help push the USDA to consider implementing testing regulations for non-O157 strains of E. coli.

“Not that I wish illness on people, but the timing of the 0145 outbreak…is certainly going to get the USDA to have to respond,” Marler said. “Over the last 15 years, there (have been) a lot of cases of ill and sick and dead people who haven’t been linked to E. coli O157 but certainly had symptoms consistent with an E. coli illness."

According to Marler, testing for other harmful strains would be neither difficult nor unreasonably expensive. The recent outbreak, he said, should serve as a wake-up call.

“If no one forces you to do something, you tend not to do it,” Marler said. “I think government and industry have gotten comfortable doing O157 testing, and those other bugs are the devil you don’t know. If you’re not testing for it, you don’t find it, and if you don’t find it, you’re not doing anything for it.”

Marler said he was “frustrated and a bit incredulous” that the government still wasn’t testing for non-O157 strains, so he started his own research into the prevalence of these unregulated bugs in 2008.

After hiring a lab to run tests for non-O157 strains in hamburger meat, Marler said the results showed that 1.9 percent of the first 1,000 samples contained the harmful bacteria. The lab, he said, sent the results to the USDA at the time but did not receive a response.

The testing, which extended to 5,000 samples, will conclude in June, and the study’s results will be published in July, Marler said. The results consistently showed that about 2 percent of the meat contained non-O157 strains of E. coli.

“(Two percent) may not sound like a lot,” he said. “But if you think about it and extrapolate it…it’s a pretty big number.”

Marler said he filed a petition with the USDA in October last year to label the top five non-O157 strains, including O145, as adulterants, but the USDA has been slow to respond to the request.

Marler added that it is crucial to get these regulations in place now because of the way bacteria evolve. In 50 years, he said, O157 could be one of the less prominent strains and one of the currently unregulated ones could move to the forefront.

“Like they adapt, we have to adapt,” Marler said. “That’s the relationship we have with pathogenic bacteria, and if we don’t adapt, they kill us — that’s their job.”

Rumor has it that USDA/FSIS may finally be taking this issue seriously. We shall see.

It must be the heat - will be over 100 today.

In my work there are cases that haunt you. Some are the cases you work on for years, but cannot figure out the legal source of the poison that killed someone’s child. Then there are other cases, like the senseless death of Abby nearly a year ago, and her grandfather’s death just last Saturday, that hang with you, and will forever.

Putting litigation behind a grieving family changes very little. Having answers for what happen and giving closure helps, but it no substitute for life, and that smile.

I wish President Obama, Secretary Vilsack, FSIS Undersecretary (if we had one) had attend these funerals.  Perhaps if they had our food supply would be a bit safer.

I was reading the Saratogian and the Poughkeepsie Journal this morning and was struck by the fact that once again consumers of food – this time kids – inform us by getting sick of yet another foodborne illness outbreak – this time E. coli O145 tainted romaine lettuce – Again, AFTER they get sick. Great thought, our kids are the canaries in the E. coli O145 coal mine.

According to the Poughkeepsie Journal, Freshway Foods shredded romaine lettuce sent from the Wappingers Central School District to the New York state Health Department tested positive for E. coli O145 bacteria and led to a national recall AFTER several students were sickened. Two students from the district were hospitalized at Westchester Medical Center last month with hemolytic uremic syndrome (HUS). Two others were hospitalized.

In a letter (full letter below) to parents Thursday, Wappingers Superintendent James Parla said there have not been any new reports of related illnesses in students since April 25. Parla said as of Thursday, there had been two confirmed cases of E. coli, three probable cases and one suspected case. The students go to Roy C. Ketcham High School, John Jay High School Wappingers Junior High School and Van Wyck Middle School, he said.

And, according to the Saratogian, the Saratoga Springs City School District is warning parents that children at four of its schools may have been served Freshway Foods romaine lettuce contaminated with the E. coli bacteria. The lettuce that was served at Caroline Street, Division Street and Geyser Road elementary schools, and the high school, has been removed, school officials said in a voice mail blast to parents Friday.‚Ä®

Government and industry, we can do better than this.

Although Yuma has not been linked to an "leafy green" E. coli outbreak in the past - O157:H7 or otherwise - like O145, it is not like Yuma is risk free - it has more than a few cattle feedlots and is a major flyway for migrating birds.  It also has the "All American Canal."  I wonder what the bacteria count is in that water?

Although more than a few sources have implicated Andrew Smith Company as the source of the Romaine Lettuce that was processed at Freshway Foods and shipped to 23 states and the District of Columbia, there are more things to think about other than the Andrew Smith Company.  For example:

1.  Was any other Romaine Lettuce, from any other source, utilized at Freshway Foods?

2.  What about cross-contamination at the Freshway Foods plant from ill employees or other contaminated product or environment?

3.  What about transportation?  Yuma is a long way from Ohio.  Did the truckers keep the Romaine Lettuce cold?

4.  Also, did Andrew Smith Company supply Romaine Lettuce to any other facility?  Any linked to illnesses?

On top of the above questions, is the E. coli O145 outbreak itself.  Why is this the first O145 outbreak in food that I am aware of in the U.S. (see, www.outbreakdatabase.com)?  Answer, because labs, the government and industry never test for O145.  If you do not test, you do not find.  Therefore, you do not have a problem.  Well, actually, yes you do.

Here is a copy of the letter sent to parents:

May 6, 2010

Dear Parents/Guardians:

I am writing to inform you that over the past few weeks a small number of students reported symptoms of diarrheal illness. The students received immediate treatment at local health care providers. There have not been any further reports of new diarrheal illness in our student populations since April 25, 2010.

It was suspected that the cause of illness was related to infection with E-Coli bacteria. Specifically, at this juncture, there have been two confirmed cases, three probable cases and one suspected case. The students attend Roy C. Ketcham HS, John Jay HS, Wappingers JHS, and Van Wyck Middle School. We have been working cooperatively with the Dutchess County Department of Health and the New York State Department of Health to determine what caused this cluster of illness. There is the likelihood of a link between incidents of illness in our school district with the occurrence of illness in Ohio, Michigan and another part of New York State. We recently sent lettuce from our food service department to the New York State Department of Health to be tested. The lettuce tested positive for E-Coli. This lettuce was part of a specific batch received from a supplier used by the school district. Be assured that we have removed all lettuce from this supplier from all of our schools and we are no longer using this supplier. Also, the Dutchess County Department of Health has inspected our food service premises and determined that we are in full compliance with all regulations and that the E-coli is not a result of any food handling procedures.

We will continue to cooperate with both the Dutchess County Department of Health and the New York State Department of Health regarding this matter. Parents and staff are advised to immediately report any symptoms such as diarrhea (especially if bloody), nausea or vomiting to the nurse’s office in your respective schools.

The health and well-being of our students and staff is of foremost importance to us. Please feel free to contact my office with any questions or concerns about this matter.

Sincerely,
 

James Parla Superintendent of Schools

According to the CDC as a few moments ago, local and state public health officials in Michigan, New York, and Ohio are investigating human illnesses caused by E. coli O145. CDC is supporting these investigations and facilitating regular communication and information sharing between the states and with the U.S. Food and Drug Administration (FDA).

As of May 5, 2010, a total of 19 confirmed and 10 probable cases related to this outbreak have been reported from 3 states since March 1, 2010. The number of ill persons identified in each state with this strain is strain is: MI (10 confirmed and 3 probable), NY (2 confirmed and 5 probable), and OH (7 confirmed and 2 probable).

Among the confirmed and probable cases with reported dates available, illnesses began between April 10, 2010 and April 26, 2010. Infected individuals range in age from 13 years old to 29 years old and the median age is 19 years. Sixty-nine percent of patients are male. Among the 29 patients with available information, 12 (41%) were hospitalized. Three patients have developed a type of kidney failure known as hemolytic-uremic syndrome, or HUS. No deaths have been reported.

The outbreak can be visually described with a chart showing the number of persons who became ill each day. This chart is called an epidemic curve or epi curve. Of note, it takes an average of 2 to 3 weeks from the time a person becomes ill to the time when the illness is confirmed by laboratory testing and reported. Please see the E. coli Outbreak Investigations: Timeline for Reporting Cases for more details.

The bacteria responsible for this outbreak are referred to as Shiga toxin-producing E. coli, or STEC. STECs have been associated with human illness, including bloody diarrhea and a potentially fatal kidney condition called hemolytic-uremic syndrome (HUS). STEC bacteria are grouped by serotypes (e.g., O157 or O145). The STEC serotype found most commonly in U.S. patients is E. coli O157. Other E. coli serotypes in the STEC group, including O145, are sometimes called “non-O157 STECs.” Currently, there are limited public health surveillance data on the occurrence of non-O157 STECs, including E. coli O145, therefore E.coli O145 may go unreported. Because it is more difficult to identify than E. coli O157, many clinical laboratories do not test for non-O157 STEC infection.

Investigators are using pulsed-field gel electrophoresis (PFGE), a type of DNA fingerprint analysis of E. coli bacteria obtained through diagnostic testing to identify cases of illness that might be part of this outbreak. This testing is done in public health laboratories as part of the PulseNet network. Investigators have established a common definition of confirmed and probable cases related to this outbreak. Investigators have established a common definition of confirmed and probable cases related to this outbreak:

Confirmed cases are persons with:

(1) E. coli O145 infection, or E. coli infection with O Group pending, AND
(2) an illness onset on or after March 1, 2010, AND
(3) a DNA fingerprint matching the outbreak strain; AND
(4) an epidemiologic link to the outbreak.

Probable cases are persons with an epidemiologic link to the outbreak and:

(1) E. coli O145 infection with an illness onset on or after March 1, 2010 regardless of DNA fingerprint pattern, AND/OR
(2) hemolytic-uremic syndrome; AND/OR
(3) a laboratory isolate positive for Shiga toxin 2 [stx2] or isolate positive for Shiga toxin, but toxin type is unknown or pending.

The Outbreak

Freshway Foods and the Food and Drug Administration announced mid-morning a recall of Romaine Lettuce after illnesses were reported in Michigan, Ohio and New York - primarily impacting students at University of Michigan, The Ohio State university and Daemen University. The Food and Drug Administration reported the E. coli O145 illnesses included 12 people who have been hospitalized and three with potentially life-threatening symptoms - Hemolytic Uremic Syndrome (HUS). 50 other people may also be ill.

The Smoking Gun

The New York State Public Health Laboratory in Albany discovered E. coli O145 contamination in a bag of Freshway Foods shredded romaine lettuce.

The Recall

In a press release, Freshway Foods said the E. coli O145 - tainted Romaine Lettuce was sold to wholesalers, food service outlets, in-store salad bars and delis in Alabama, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia and Wisconsin. The affected lettuce has a "best if used by" date of May 12 or earlier. The recall also affects "grab and go" salads sold at Kroger, Giant Eagle, Ingles Markets and Marsh grocery stores.

Further Investigation

Given the time of the year, the most likely area for growing Romaine Lettuce is Arizona – likely Yuma. The investigation is likely hampered by the failure of health departments throughout the United States from actually testing ill persons stools for E. coli O145.  For a bit(e) of history on lettuce and e. coli, visit www.outbreakdatabase.com.

E. coli outbreaks, primarily of the O157 variety, have been associated with lettuce or spinach, specifically “pre-washed” and “ready-to-eat” varieties, and are by no means a new phenomenon. By way of illustration:

August 1993 - E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State

July 1995 - Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana

September 1995 - Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho

September 1995 - Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine

October 1995 - Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio

May-June 1996 - Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York

May 1998 - Salad E. coli O157:H7; two reported cases in California

February.-March 1999 - Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska

July-August 2002 - Lettuce (romaine) E. coli O157:H7; 29 reported cases in Washington and Idaho

October 2003-May 2004 - Lettuce (mixed salad) E. coli O157:H7; 57 reported cases in California

April 2004 - Spinach E. coli O157:H7; 16 reported cases in California

September 2005 - Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon

September 2006 - Spinach E. coli O157:H7; 205 case (five deaths) nationwide

November 2006 - Lettuce E. coli O157:H7; New York, New Jersey, Pennsylvania; 71 sickened

December 2006 - Lettuce E. coli O157:H7; Iowa, Minnesota, Wisconsin; 81 ill

May 2008 - Lettuce E. coli O157:H7; Washington; 9 ill

But we all know that the list is not fully complete, nor does not end there.  There have been may others sickened in produce-related outbreaks of E. coli O157:H7, Salmonella, and other dangerous bugs.  For a good look at "leafy green" outbreaks, check out www.outbreakdatabase.com.

A. News of the Outbreak

On November 27, 2007, a health department officer in central Massachusetts contacted the Massachusetts Department of Public Health (MDPH) to report a Listeria infection in an 87-year-old man, later identified as John Powers. Pulsed-field gel electrophoresis (PFGE) performed on Mr. Powers's Listeria monocytogenes stool isolate produced a pattern indistinguishable from that of isolates from three other cases identified in residents of central Massachusetts in June, October, and early November 2007. MDPH, in collaboration with local public health officials, conducted an investigation, which implicated pasteurized, flavored and non-flavored, fluid milk produced by a local dairy as the source of the outbreak. The milk was later revealed to have been produced by Whittier Farms, Inc., a family owned dairy located in Sutton, Massachusetts. In fact, it was coffee-flavored milk, produced by Whittier Farms and purchased at Shady Oaks Farm, that tested positive for Listeria and that was a PFGE-match to the strain of Listeria associated with Mr. Powers, the other victims, and the environmental samples collected from the dairy facility.

Whittier Farms operated a milk product pasteurizing, bottling, and processing facility; the dairy had operated for nearly 50 years. Raw milk was transported by tanker truck to the Whittier Farms processing facility from the company’s own farm (with nearly 300 cows) and from another, independent farm located 25 miles away. Whittier Farms produced various milk and non-milk beverage products in glass and plastic bottles, including several varieties of flavored milk. Retail outlets were located at the dairy and the farm; however, the bulk of the dairy's milk products were sold through home delivery, and at various retail establishments in Massachusetts, including Shady Oaks Farm in Medway. The milk products were sold under the Whittier Farms name and other brand names. Bulk cream was distributed to a bakery in Rhode Island, where it was used in cooked products.

B. The Outbreak Investigation

The MDPH defined a case of outbreak-associated listeriosis as illness in a Massachusetts resident with illness onset in 2007 who: (1) was culture-positive for Listeria monocytogenes with PFGE patterns that matched the outbreak patterns as established by the first case; or (2) had culture-confirmed Listeria monocytogenes and a history of consuming milk products produced by Whittier Farms during the six weeks preceding illness and for whom a bacterial isolate was not available for PFGE analysis.

Five patients had illness consistent with the case definition. All but one of the patients met the first case definition criterion. The median age of the patients was 75 years old (range: 31 to 87 years); three were male. All five patients were hospitalized. All three of the males (75 to 87 years old), including Mr. Powers, died from sepsis attributed to Listeria, and died close to the time of their acute illness onset. The first case in a female was in a 31 year old woman who had chorioamnionitis at 36 weeks gestation. She delivered a healthy but premature infant. A subsequent placental culture tested positive for Listeria. The second case in a female was in a 34 year old woman who had a fever and abdominal pain. She experienced a stillbirth at 37 weeks gestation, and cultures of her blood, fetal blood, and placental tissue all were positive for Listeria monocytogenes.

Interviews were subsequently conducted with the patients or their families. One patient, however, could not be interviewed. Of the remaining four patients, all but one had consumed products from Whittier Farms during the six weeks preceding their illness.

On December 17, evidence of Listeria growth was reported from a coffee-flavored milk sample, retrieved from the home of Mr. Powers. In response to the December 17 findings, the Massachusetts Food Protection Program (MFPP) inspected Whittier Farms and collected eleven samples of unopened, flavored and unflavored milk products for testing on December 18. On December 21, the organism from the December 17 sample was confirmed to be Listeria monocytogenes and was a match to the four clinical isolates from the other patients. Thus, the source of this particular genetic strain of Listeria was identified. The same unique PFGE pattern was identified within Whittier Farms milk products and the four PFGE confirmed cases associated with the outbreak, including Mr. Powers. From this point forward, there was no doubt that the Whittier Farms product resulted in the patients’ Listeria infections.

C. Product Recall and Dairy Closure

MFPP returned to Whittier Farms on December 26 and collected environmental swab samples from inside the processing facility. On December 27, the State Laboratory Institute (SLI) of MDPH reported a presumptive positive Listeria specimen in a sample of unopened, coffee-flavored milk that had been collected from Whittier Farms on December 19. In response to this finding, MFPP asked the dairy to voluntarily cease all operations and recall its dairy products; Whittier Farms complied with this request on December 27. On December 30, SLI confirmed that Listeria monocytogenes with PFGE patterns identical to the outbreak strain was isolated from a sample of unopened, coffee-flavored milk ingested by Mr. Powers.

From December 28, 2007, to January 3, 2008, MFPP conducted a full environmental investigation in conjunction with the Food and Drug Administration and the local board of health. The facility did not have an environmental monitoring program for Listeria monocytogenes. Although this is not required by law, is typically implemented as a best practice by other food processors of ready-to-eat foods. Contamination, as demonstrated by the positive environmental samples, was documented in close proximity to areas where hoses were used to clean equipment. On February 1, 2008, Whittier Farms decided to permanently close the milk processing facility, citing an inability to invest the money necessary to make the facility safe.

On January 2, 2008, after the closure of Whittier Farms and the recall of its dairy products, approximately 100 additional environmental and product samples were collected by MFPP from the dairy's processing facility and adjacent retail store. One environmental swab from a floor drain in the finished product area, one skim milk sample, and seven flavored milk samples tested positive for Listeria monocytogenes and matched the outbreak strain by PFGE analysis. Two additional environmental swabs and four additional samples of milk, both flavored and non-flavored, tested positive for seven distinct strains of Listeria, including three different Listeria species and three strains of Listeria monocytogenes with PFGE patterns that differed from those of the outbreak strain.

I doubt they did when Lynne Terry wrote - “Failure to test for six strains of E. coli leaves gaps in nation's food safety network” - this morning. Here is the full story:

Two years ago, Bill Marler was contacted by the family of a 13-year-old girl killed by E. coli.

They wanted to sue, and the Seattle lawyer, an expert on food poisoning cases, wanted to help. But the strain that sickened the Ohio teen falls outside federal regulations, with neither government officials nor food manufacturers testing for it.

Frustrated by the dearth of data, Marler hired a private lab to conduct a large-scale, nationwide study of ground beef, a key culprit in E. coli cases. During the past year and a half, that lab has tested 4,600 samples from a variety of manufacturers.

IEH Laboratories, north of Seattle, found that about 1 percent were tainted by six harmful E. coli strains -- including the one that killed the teen -- that are not regulated by the U.S. Department of Agriculture.

Only 5 percent of labs in the U.S. routinely test for them, said Dr. Patricia Griffin, head of food-related epidemiology at the Centers for Disease Control and Prevention, leaving a gap in the food safety network.

But a push is afoot to change that. The CDC has called for stepped-up testing, and on Thursday, Wal-Mart announced a beef safety program aimed at curbing these strains and other pathogens.

That decision comes amid two nationwide outbreaks.

Public health officials in Ohio, Michigan and New York are looking into an outbreak of E. coli O145 that has sickened perhaps dozens of people. In Colorado, 10 inmates were sickened by E. coli O111, the same strain that killed the 13-year-old girl.

Health officials in Ohio and Michigan are testing food samples, but so far no one knows what the culprit was.

"It is a shame that in 2010, after years and years of outbreaks, there are still lethal strains of E. coli that some parts of our government do not regulate in the food supply," Marler said.

In November, Marler filed a petition asking the USDA to declare the six strains harmful adulterants.

Last week, U.S. Sen. Kirsten Gillibrand, D-N.Y., chimed in, asking Agriculture Secretary Tom Vilsack to do the same thing.

"The laws that are meant to keep us safe from hazardous foods are in critical need of updating," she said in a news release. "We need immediate action to keep our families safe."

The agency has named only E. coli O157:H7 a hazardous adulterant, requiring testing and recalls.

"It's by far the most common cause of illness and outbreaks," Griffin said.

E. coli O157:H7 causes 73,000 illnesses and 50 deaths every year in the United States. The six other strains -- O26, O45, O111, O121, O145, O103 -- are considered less pervasive, sickening an estimated 37,000 people a year and killing nearly 30. But they could be causing more illnesses that labs don't detect because they're not testing for them.

The USDA is looking at regulating the additional strains. "It was granted an expedited review," said Brian Mabry, spokesman for USDA's Food Safety and Inspection Service.

As part of President Barack Obama's emphasis on food safety, Vilsack has ordered a complete review of the USDA's food safety regulations, said Caleb Weaver, the agency's chief spokesman.

"We will not rest until we have eliminated food-borne hospitalizations and deaths," Weaver said.

There are hundreds of strains of E. coli that live in the intestines of healthy cattle and other animals. Most do not hurt humans. What makes O157 -- and the six strains singled out by the CDC -- a problem is that they produce Shiga toxin, which can cause kidney failure.

"We now know a lot about E. coli O157," said William Keene, senior epidemiologist at the state Public Health Division.

Its first big national appearance was in Oregon and then Michigan in 1982 when at least 47 people were sickened by tainted McDonalds' hamburgers.

Then in 1993, 732 people in California, Washington, Idaho and Nevada got sick and four children died after eating undercooked Jack-in-the-Box hamburgers contaminated with O157:H7.

That prompted the USDA to declare the strain a hazardous adulterant.

In his campaign to push for more testing, Marler said Wal-Mart's beef safety plan, which goes into effect starting June 2011, is a step in the right direction.

"I commend them for doing that," Marler said. "I hope that other retailers will follow suit."