June 2010

I was about to board a plane to London for a well-deserved break, when I received a call from a Colorado reporter about yet another raw milk outbreak. This one (I think it is the 10th or 11th raw milk outbreak this year) is a Longmont, Colorado goat dairy that has been ordered to stop distributing raw milk products after 16 people became ill after drinking milk.

Two children who drank goat milk from the Billy Goat Dairy required hospitalization, Boulder County Public Health reported Wednesday. Of the people who reported becoming ill from consuming the milk products, lab tests confirmed the presence of Campylobacter and E. coli O157:H7, the health department said.

The Billy Goat Dairy operates a goat share program in which individuals buy a share of a goat and in return receive raw, unpasteurized milk. Health officials are contacting every household who participates in the goat share operation to determine if they became sick and to collect samples.

Noroviruses are estimated to cause 23 million cases of acute gastroenteritis (commonly called the "stomach flu") in the U.S. each year, and are the leading cause of gastroenteritis. Of viruses, only the common cold is reported more often than viral gastroenteritis (norovirus).  Click below for handy download:

Noroviruses may cause more outbreaks of foodborne illness than all bacteria and parasites. They can cause extended outbreaks because of their high infectivity, persistence in the environment, resistance to common disinfectants, and difficulty in controlling their transmission through routine sanitary measures.

The norovirus is transmitted primarily through the fecal-oral route and fewer than 100 norovirus particles are said to be needed to cause infection. Transmission occurs either person-to-person or through contamination of food or water. Transmission can occur by touching surfaces or objects contaminated with norovirus and then placing that hand in your mouth; having direct contact with another person who is infected and showing symptoms; sharing foods or eating utensils with someone who is ill; exposure to aerosolized vomit; and consuming food contaminated by an infected food handler.

The virus is shed in large numbers in the vomit and stool of infected individuals, most commonly while they are ill. Some individuals may continue to shed norovirus up to two weeks after they have recovered from the illness.

Two day cares in Ellensburg, Washington have been closed after one confirmed E. coli O157:H7 illness and two suspected ones were reported to county officials.

The Yakima Herald-Republic reports that the Kittitas County Public Health Department temporarily shut down Creative Kids Learning Center and Little Tot Town after the cases were reported this past week.  The confirmed case involves a 5-year-old who does not attend either child care facility. The suspected cases are two siblings who attend the two closed facilities.

County investigators also found numerous other children and staff members with symptoms.

Clearly there is an index case – the first child or adult sickened.  The real question that the investigators will now be focusing on is how this first child became infected and how that child likely passed the E. coli to the other children and staff members?

According to news reports, Cook County public health officials are investigating a salmonella outbreak at the Skokie Country Club in Glencoe, Illinois. So far, 29 people have been sickened with confirmed salmonella, including seven hospitalizations.

Officials say they’re also checking on more than 50 additional reports of salmonella-like symptoms in people who ate at the club. The department’s Stephen Martin says club officials have voluntarily closed their kitchen facilities during the investigation. People with salmonella symptoms who ate at the club between June 12 and June 24 should call the county public health department.

I received a few emails from readers who did not get their daily quota of Marler Blog wondering what happened.  Well, I went fishing in the Florida Keys.

And, actually caught something (catch and release) – 125 pound Tarpon – which took me over two and a half hours to bring along side the boat.

Health officials were investigating an outbreak of salmonella poisoning at the Skokie Country Club in Glencoe. As of this morning, there have been seven laboratory-confirmed cases of the bacteria originating from the north suburban country club since June 10, officials said.

Salmonella is a group of bacteria that can cause diarrheal illness in humans. According to the Centers for Disease Control and Prevention, most people infected with salmonella develop diarrhea, fever and abdominal cramps 12 to 72 hours after infection. The illness usually lasts up to a week and most people recover without treatment. In some people, however, the diarrhea may be so severe that the patient needs to be hospitalized. In these people, the CDC says, the infection may spread from the intestines to the blood stream, and then to other parts of the body and cause death, unless the person is immediately treated with antibiotics.

According to the CDC, a total of 37 individuals infected with a matching strain of Salmonella Chester have been reported from 18 states since April 11, 2010. The number of ill people identified in each state with this strain is as follows: AK (1), CA (5), CO (2), GA (7), IL (1), KY (1), MA (2), MN (2), MO (1), NC (1), OK (1), OR (2), SC (2), TN (1), TX (1), UT (2), VA (4), and WA (1). Among those for whom information is available about when symptoms started, illnesses began between April 5, 2010 and June 3, 2010. Case-patients range in age from <1 to 88 years old, and the median age is 36 years. Fifty-five percent of patients are female. Among the 19 patients with available hospitalization information, 7 (37%) were hospitalized.

As Teresa Paulsen, a spokeswoman for ConAgra, said a few days ago:

Some of the ingredients, in particular the protein such as the chicken, are precooked before packaging. She said the package has explicit instructions on how to cook the entree in a microwave or oven.  "If it’s cooked according to package instructions, any pathogen would be killed," she said.

Perhaps a warning on the box like this is in order?

Think about it.  Marie makes hundreds of thousands of these products and only a few people get ill.  So, either these 37 people just happen to not cook the product properly on this one occasion, or, what is far more likely, they were cooking it the same way they do every time, but this time the product had Salmonella in it.  Right, if ConAgra, a multi-billion dollar corporation, cannot get Salmonella out of its products, it thinks it is the consumer’s job?  Give me a break.

A second lawsuit was filed in Oregon District Court today against food giant ConAgra. The lawsuit arises from the nationwide Salmonella outbreak linked to the Marie Callender’s brand frozen Cheesy Chicken and Rice dinners. Food safety law firm Marler Clark filed the lawsuit on behalf of Oregon resident Kevin Taylor, Jr.

Two days after Mr. Taylor, 24, consumed the Marie Callender’s dinner, he woke up with a fever, abdominal cramps, and diarrhea. His symptoms worsened quickly, but because he was uninsured, he stayed home and tried to wait for the illness to pass. When his diarrhea become bloody, however, he and his family became concerned, and his mother rushed him to an urgent care clinic, where he was treated and released. Mr. Taylor was given prescriptions for his illness, but his lack of insurance prohibited him from filling them.

Ultimately, Mr. Taylor remained ill at home and unable to work for another week. He lost ten pounds during the illness, and though he continues to recover, he suffers from a greatly diminished appetite. Stool tests done at the urgent care clinic later showed that he had been infected with the strain of Salmonella Chester associated with the ConAgra-Marie Callendar’s outbreak.

ConAgra recalled the Marie Callender’s brand meal after state and local health authorities identified it as the source of a Salmonella outbreak that has sickened 30 people in 15 states to date. The CDC reports the illnesses in each state as: California with 4 ill, Colorado (2 ill), Georgia (6), Illinois (1), Kentucky (1), Massachusetts (2), Minnesota (2), Missouri (1), North Carolina (1), Oklahoma (1), Oregon (2), South Carolina (2), Tennessee (1), Utah (1), and Virginia (3). ConAgra estimates that 800,000 packages were in stores nationwide and in consumers’ freezers when the recall was issued.

From the Illinois Department of Health:

Confirmed cases of Salmonella serotype Hvittingfoss – 97 (case total unchanged from June 21)

Age range of confirmed cases: 2 to 79

Cases have reported eating at Subway restaurants located in 28 counties — Bureau, Cass, Champaign, Christian, Coles, Dekalb, DeWitt, Ford, Fulton, Henry, Knox, LaSalle, Livingston, Macon, Marshall, McLean, Moultrie, Ogle, Peoria, Rock Island, Sangamon, Schuyler, Shelby, Tazewell, Vermilion, Warren, Will and Winnebago.

Investigation is ongoing. Numbers will be updated June 25, if additional cases are identified.

I am heading to what appears to be the last case (this one a hemolytic uremic syndrome case) mediation stemming from the 2007 Topp’s Brand Hamburger E. coli O157:H7 outbreak (assuming that my flight to Los Angeles and then to Miami actually leaves).

According to the CDC, in the Fall of 2007 health officials in several states who were investigating reports of E. coli O157:H7 illnesses found that many ill persons had consumed the same brand of frozen ground beef patties. Ground beef patties recovered from patients’ homes were tested by state public health department and federal laboratories. Tests conducted by the New York State Wadsworth Center Laboratory and by a USDA-FSIS laboratory on opened and unopened packages of Topp’s brand frozen ground beef patties yielded E. coli O157:H7 isolates with several different “DNA fingerprint” patterns.

Investigators compared the “DNA fingerprints” patterns of E. coli O157:H7 strains found in ground beef with “DNA fingerprints” patterns of E. coli O157:H7 strains isolated from ill persons. As of October 26, 2007, 40 cases of E. coli O157:H7 infection have been identified with PFGE patterns that match at least one of the patterns of E. coli strains found in Topp’s brand frozen ground beef patties. Ill persons reside in 8 states [Connecticut (2), Florida (1), Indiana (1), Maine (1), New Jersey (9), New York (13), Ohio (1), and Pennsylvania (12)].

Thirty-three (89%) of 37 patients with a detailed food history consumed ground beef. Seven illnesses have confirmed associations with recalled products because the strain isolated from the person was also isolated from the meat in their home. The first reported illness began on July 5, 2007, and the last began on September 24, 2007. Among thirty-three ill persons for whom hospitalization status is known, twenty-one (64%) were hospitalized. Two patients developed a type of kidney failure called hemolytic uremic syndrome (HUS). No deaths have been reported. Eighteen (45%) patients are female. The ages of patients range from 1 to 77 years; 50% are between 15 and 24 years old.