RNC Chairman, Michael Steele, supports S 510 - Well, he should

CNN reports that Republican National Committee Chairman Michael Steele was forced to cancel an appearance Friday before a national meeting of black journalists due to - you guessed it - food poisoning.

"While traveling out West the Chairman came down with a bad case of food poisoning," an RNC spokesman said in an email to CNN. "He is disappointed to miss the opportunity to take part in this valuable dialogue and looks forward to engaging with NABJ in the very near future."

Steele had been in New Mexico on Thursday to attend a fundraiser for GOP gubernatorial nominee Susana Martinez.  Query, what foods were served?

The RNC spokesman told CNN that Steele had not been to the hospital, but that the chairman had consulted a doctor.  Did he get a stool culture?

Perhaps Mr. Steele will lend his support for S 510?

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Senator Reid Promises E. coli Survivor Action on S. 510

Linda Rivera, a Nevada woman who contracted E. coli from cookie dough and has been battling for her life for the past fifteen months, has been promised the Senate will move on the pending food safety bill, S. 510--the FDA Food Safety Modernization Act. A constituent of Senate Majority Leader Harry Reid (D-NV), Rivera has also become a key advocate for a food safety bill that has been languishing in the Senate for months. Her story has been featured on CNN, Food Safety News, and in the Washington Post.

In a letter to the Rivera family, Reid promised in September 2009 that the Senate would take up the bill last fall. The legislation was unanimously approved by committee in mid-November, but came to a halt behind health care reform. Reid called the Rivera family again this week to promise a vote on the pending food safety bill before the August recess.

This video clip shows Richard Rivera, Linda's husband, giving his take on the pending legislation. In his words, if lawmakers, "could imagine their wife or their mother in bed for the last fifteen months fighting for her life," maybe they would finally act on the legislation that will save many lives.

Published this morning on Food Safety News.

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Relative Risk between Raw or Pasteurized Milk - a large glass of reality

I get a lot of emails on raw milk – most are from raw milk promoters, producers or consumers who liken me to the devil or at least a pawn of big business. So, when I got a more subtle and interested question, I was pleased to respond. The question in essence was about the relative risk between drinking raw or pasteurized milk. Here is the response:

Your question was referred to me as one of the contributors on Real Raw Milk Facts.  Here’s some links specific to your question about the statistics. It is hard to get good numbers, but we used several sources and feel that the 70% is about right (it includes queso fresco cheeses, which the raw milk proponents sometime object to; if you exclude the "bathtub cheese," raw milk is still causing over 50% of the outbreaks while only 1-3% drink it according to surveys with higher end estimates of the number of raw milk drinkers).

1. This document shows the FTCLDF FOIA analysis that is quoted in an earlier Marler Blog piece. It starts at about page 10.

2. These links will bring you to tables showing line listings of outbreaks, both pasteurized and raw milk.

3. CSPI’s 2008 report also cites the 70% statistic. There is a spotlight on raw dairy on page 8:

4. CDC powerpoint with breakdown on reported raw and pasteurized dairy outbreaks (note that they are revising this to include a large pasteurized milk outbreak that occurred in the prison system in California - 1,644 cases that are not shown in the analysis).

And, there is always my recent update on raw milk outbreaks of 2010.

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IAFP Speech - "Is Ingredient a 10-letter word for financial disaster?"

After being in the fog of Seattle for the better part of the day working on my slides for the International Association for Food Protection conference (with a little bit of help), I am looking forward to an excuse to go to sunny California next week.

Slide 10 - Larry King Video - http://www.marlerblog.com/2009/11/articles/lawyer-oped/larry-king-and-e-coli-o157h7-deaths/

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Shiga Toxin E. coli O157:H7, antibiotics and hemolytic uremic syndrome (HUS) in children

I get asked frequently about the correlation between the use of antibiotics and the onset of hemolytic uremic syndrome (HUS) – that is, does the use of antibiotics with an E. coli O157:H7 infection cause a child who would not otherwise develop HUS to in fact develop it?

First, everyone knows that I am not a doctor. That being said, in nearly 18 years of representing families who have suffered through HUS, I have seen cases where children received no antibiotics and suffered HUS and I have seen the reverse.

In 2000 when Wong CS, Jelacic S, Habeeb RL, Watkins SL, Tarr PI., published “The risk of hemolytic-uremic syndrome after antibiotic treatment of Escherichia coli O157:H7 infections” in the N Engl J Med 2000;342:1930-6, physicians (and lawyers) took notice. In pertinent part the article found:

In up to 15% of North American children infected with Escherichia coli O157:H7, hemolytic-uremic syndrome (HUS) develops because of systemic absorption of Shiga toxins produced by the organism. Although antibiotics have been shown in vitro to enhance release of these toxins from injured bacteria their effect on the development of HUS in people infected with E. coli O157:H7 is unknown.

In children with stool cultures positive for E. coli O157:H7, is antibiotic therapy associated with an increased risk of HUS, independent of the severity of the initial diarrheal illness?

The study’s criteria for HUS were met in 10 (14%) of the 71 subjects. HUS developed in 5 (56%) of 9 children who received antibiotic therapy and in 5 (8%) of 62 children who did not (p <% 0.001). Children who received antibiotic therapy were comparable to those who did not with respect to age, sex and the baseline clinical and laboratory features of their illness.

Multivariate analysis showed that the risk of HUS was associated significantly with what were considered to be 2 surrogate markers of disease severity: initial peripheral white blood cell count (p = 0.02) and time elapsed from the day of symptom onset to the day on which stool cultures were obtained (p = 0.008). Risk was directly proportional to the white blood cell count and inversely proportional to the interval between onset of illness and stool cultures. It was inferred from the latter finding that patients with more severe illness were evaluated earlier than those with less severe illness. The relative risk of HUS among the children who were given antibiotic therapy, when adjusted for these 2 variables, was 17.3 (95% confidence interval 2.2-137, p = 0.007).

Although this study is subject to the selection and confounding biases inherent in observational research, it offers compelling evidence of a link between antibiotic therapy and the development of HUS in diarrheal illness caused by E. coli O157:H7. The strength of the association and the biologically plausible effect of antibiotics on the amount of Shiga toxin available for absorption from the intestine support the inference of causality.

Although HUS develops in patients infected with E. coli O157:H7 with or without antibiotic treatment, it occurs much more frequently when antibiotics are given. The findings of this study strongly suggest that these drugs should be withheld in children with acute diarrheal illness until stool cultures confirm growth of an organism for which antibiotic therapy is indicated (e.g., Campylobacter pylori).

In JAMA in 2002 (Aug 28;288(8):996-1001) questions were raised by Safdar N, Said A, Gangnon RE, Maki DG. In part the comment found:

The use of antibiotics for treatment of Escherichia coli O157:H7 infection has become controversial since a recent small study found that it may increase the risk of hemolytic uremic syndrome (HUS). However, other larger studies have reported a protective effect or no association.

To determine whether antibiotic therapy for E coli O157:H7 enteritis increases the risk of HUS.

PubMed and MEDLINE computer searches were performed for studies published from January 1983 to February 2001 using the key words hemolytic uremic syndrome, risk factor, antibiotics, and Escherichia coli O157:H7. Reference lists of relevant publications were reviewed, and 12 experts in the field were contacted to identify additional reports. No language restrictions were applied to the search.

Studies were included if they reported a series of patients with documented E coli O157:H7 enteritis, some of whom developed HUS; had clear definitions of HUS; and had adequate data delineating the relationship between antibiotic therapy and the occurrence of HUS. Nine of the 26 identified studies fulfilled these criteria.

Two authors (N.S. and A.S.) independently reviewed each report identified by the searches and recorded predetermined information relevant to the inclusion criteria. A pooled odds ratio was calculated using a fixed-effects model, with assessment of heterogeneity among the studies.

The pooled odds ratio was 1.15 (95% confidence interval, 0.79-1.68), indicating that there does not appear to be an increased risk of HUS with antibiotic treatment of E coli O157:H7 enteritis. Incomplete reporting of data in individual studies precluded adjustment for severity of illness.

Our meta-analysis did not show a higher risk of HUS associated with antibiotic administration. A randomized trial of adequate power, with multiple distinct strains of E coli O157:H7 represented, is needed to conclusively determine whether antibiotic treatment of E coli O157:H7 enteritis increases the risk of HUS.

So, good readers, what is the answer to the question – “In E. coli O157:H7 cases, is antibiotic therapy associated with an increased risk of HUS, or not?

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Senate, it is time to pass S 510. Do it for Linda!

Linda has been hospitalized since May 2009 due to a severe E. coli O157:H7 infection.  The below is a picture I took of her yesterday. Three weeks ago she appeared to be suffering from a bowel blockage, but it was decided that it was medication induced. Since then she has been in ICU and was recently moved to a regular floor. She has been in and out of responsiveness. Her pain medications are way down. The doctors seem perplexed as to why she is having so much mental difficulties. I was with her for 3-4 hours and at times she both recognized me, smiled and said a word or two, and at other times she would look right through me.

It breaks your heart.

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Ideas for safer food at churches?

I am in San Francisco today to visit with a client who is still suffering the devastating impact of an E. coli O157:H7 infection fifteen months after first becoming ill.  She still remains hospitalized - today in rehab, but a few days ago in was in ICU.

Checking my emails this morning, I found this one that I thought I would share with readers.  The person who wrote it will be checking back here for your thoughts.

Dear Mr. Marler & Associates,

Thank you for the work you do. I found your website as I am preparing to teach a food safety class to the church that I attend and am a member of. I have worked in the food service industry in a wide range of jobs from prep cook to executive chef and I’ve taught culinary arts to high school students. I am a certified ServSafe instructor. Currently I am a stay at home mom and personal chef and I am very involved in my church. We are growing and have close to 200 regular attenders. I am writing you because I want to know if you have any specific information that I should relay to the members of the church who prepare food.

The class is this Saturday and I will be preparing for it through this week. We have a lot of well intentioned people who have no idea what the safe food practices are. It is going to be the most
challenging class I’ve ever taught since most of those in attendance are much older than I am and have been handling food the same way for years.

I thank you for the video clips. I plan on showing a couple of them to relate the relevance of this issue. I also thank you for all of the information on your site.

Where we are, we aren’t under the local food codes because churches are exempt. I would think that is not a good idea and there should be some tightening of that law to include "churches who serve food to more than ‘x’ guests are not exempt." Do you have experience with churches being sued? I explained to the board at our church that we can still be sued even though we don’t have to follow the regulations.

Thank you for your time. I hope to hear from you soon.

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I know the Recession is bad, but "Reptile food may have sickened people in 17 states?"

AP’s Mary Clare Jalonick reports that reptile owners who have been feeding rats, mice and chicks to their pets may be at risk for Salmonella poisoning.

The company that sells the reptile food, Mice Direct, announced a recall of the frozen rats, mice and chicks Tuesday, saying that human illnesses possibly related to the frozen reptile feed have been reported in 17 states.  The company says the recall is based on Food and Drug Administration sampling of the frozen mice.

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Public Radio - Progress Slows for Food Safety Legislation

From KBIA Public Radio Missouri:

Time is running out for new food safety regulation legislation to receive a senate debate. If it becomes law, regulations in the Senate Food Safety Modernization Act would drastically affect the way food safety is monitored in the United States. The legislation would standardize regulation for imported food products and it would give the Food and Drug Administration more authority to impose rules on food producers and manufacturers. But, special interest groups like the Missouri Farm Bureau are working to keep the act out of the senate until they can make tweaks to support their industry, and with limited time left in this packed legislative session, Congress may be back to square one before the year’s end. Garret Hawkins is with the Missouri Farm Bureau. He says stricter rules for industrial farmers should mean a built-in safety net in case a false claim is made about the original source of food-borne pathogen outbreak.

“TOMATOES for example, where there was a scare but, it turned out to be another crop as the source of the problem. Producers lost tens of millions of dollars, and there wasn’t any thing there to recover the market losses. Trying to interject some common sense is one of the goals that we have.”

As food safety inspection stands right now, many consumers may be surprised at how infrequent food manufacturing entities are inspected. Bill Marler is a leading food poisoning attorney from Seattle. He says if a version of the Food Modernization Act were around before the two-thousand-nine Peanut Butter Corporation salmonella bacteria outbreak, it would have never happened—sparing almost six-hundred people from illness, and nine from death.

“I’m always shocked that peanut factory might inspected once every five or six years, or a juice manufacturing facility may get inspected you know—never.”

An unlikely source of adversarial action is from small food producers. Marler says this division of the food industry has the wrong impression. The federal government doesn’t care to regulate small growers who sell directly to consumers. But some small growers who occasionally sell to large food brokers feel they should be exempt from the proposed law. Marler cites the massive 2006 E. coli outbreak in packaged spinach as an example.

“Had that producer sold that product to a local farmer’s market, that person wouldn’t have had to register, because they’re selling it on a local basis. But when you sell that product into a broader stream of commerce, it has the potential of sickening hundreds and taking down an entire industry. Which is what this whole bill is designed to prevent.”

This month, President Obama released a statement listing his administration’s accomplishments in food safety, but he asks for more action, reminding legislators of the Food Modernization Act’s languishing status. In 2009, The Missouri Department of Health and Senior Services reported 1639 illnesses and seven deaths related to common food borne pathogens in Missouri.

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$500,000 Setlement Reached in Hepatitis A Class Action

According to the Quad-City Times, anyone who received immunizations as a result of possible exposure to hepatitis A at a McDonald’s restaurant in Milan, Ill., can make a claim in a $500,000 settlement that is pending approval in Rock Island County Circuit Court.  The settlement, titled Patterson v. JKLM, Inc. d/b/a McDonald’s, is pending in the 14th Judicial Circuit Court of Rock Island County.  A hearing will be 2:30 p.m. Sept. 16. At the hearing, the court will consider whether to grant final approval of the proposed settlement.

The plaintiff, Quad-City area resident Cody Patterson, acting on behalf of himself and others, filed the suit July 21, 2009. It names the McDonald’s at 400 W. 1st St. and the restaurant’s owner, Kevin Murphy, as defendants.  Compensation includes the cost of obtaining the shots and the value of lost time required to get the shots. The class does not include claims for those who became ill with the virus or employees of JKLM Inc.  The suit claims to represent all of those who may have contracted or have been exposed to the illness while eating at the McDonald’s in June and July. Murphy said in a statement that he didn’t learn until July 13 about hepatitis A affecting the restaurant, his employees and customers.  The suit claims Patterson ate food or drank a beverage from the restaurant eight or more times in June and July. It does not detail the extent of his illness.

In July 2009, the Rock Island County Health Department said that people who had dined at the restaurant between June 1 and July 15, 2009, may have been exposed to hepatitis A. The health department recommended that anyone who had eaten at the restaurant between those dates obtain immunoglobulin injections, or IG shots, to prevent hepatitis A.

Patterson is seeking compensation from JKLM Inc. for everyone who allegedly was exposed to the virus and who subsequently obtained the injections at the health department clinic or a private health care provider between July 15 and Aug. 31, 2009. The health department provided free inoculations to people who ate at the restaurant from July 6-10 and July 13-14, 2009. Two employees there were confirmed as having the disease.

If the settlement is approved, the judgment will release JKLM Inc. from all claims for damages caused to all persons allegedly exposed to the hepatitis A virus while dining at the restaurant and who subsequently obtained IG shots.

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2010 Pasteurized Milk Problems?

Since posting the 2010 list of raw (unpasteurized) dairy-related problems, I’ve been asked about pasteurized dairy products. In a previous review, outbreaks from pasteurized milk products were found to be very uncommon considering the large number of people who drink them.

Statistics from the CDC and State Health Departments comparing raw and pasteurized dairy products linked to reported foodborne disease outbreaks (1973-2006) show that raw milk and Mexican-style queso fresco soft cheeses (usually made from raw milk) caused almost 70% of the reported outbreaks even though only 1-3% of the population consumes raw dairy products. If raw and pasteurized milk were equally risky, it would be expected that there would be far more pasteurized outbreaks since the number of people drinking conventional milk is so much higher.

Yet, pasteurized milk can carry the same pathogens as raw dairy products if 1) they are inadequately pasteurized (failure of process) or 2) contaminated after processing. Although uncommon, pasteurized milk is not immune to problems, and has been the source of serious illnesses and death. In 2007, three men in Massachusetts died after drinking pasteurized milk distributed from a local dairy. The milk was contaminated with Listeria in the bottling area of the facility in which it was produced.

So, what about the safety of pasteurized milk in 2010? No pasteurized fluid milk outbreaks have been reported to my knowledge this year. In contrast, we continue to see problems with Mexican-style cheeses (e.g., Queso fresco), including those made with pasteurized milk. Mexican-style cheese produced illegally using raw milk is sometimes called “bathtub cheese” because of the unsanitary conditions found in their production. Investigators have literally found these illegal cheeses produced in home bathtubs.

However, legal, retail Mexican-style soft cheeses should be safe. Or, not?

Food safety experts recommend that susceptible persons including pregnant women, the elderly, and immunocompromised persons avoid soft cheeses because of the risk of listeriosis. Despite efforts to prevent contamination, soft cheeses, including Mexican-style soft cheeses, are vulnerable to post-pasteurization contamination with Listeria monocytogenes.

2010 recalls and illnesses due to Mexican-style soft cheeses made with pasteurized milk:

Queseria Bendita Recalls Queso Fresco, Panela, and Requeson Because of Possible Health Risk
Yakima, WA
February 2010 (Possible link to human illness)

Del Bueno Amends Recall of Queso Fresco Cheese Because of Possible Health Risk
Grand View, WA
April 2010

Azteca Linda Corp. Recalls QUESO FRESCO and QUESO HEBRA Because of Possible Risk of Health
Brooklyn, NY
July 2010

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Has the nail been driven into the coffin of the conventional wisdom that grass-fed beef is safer than grain-fed beef?

In 2008 I posted, “Grass-Fed vs Grain-Fed Beef and the Holy Grail: A Literature Review,” in which I raised the question if grass-fed beef is safer that grain-fed. My concern was, as I said, that Quotes like these were becoming more common on the Internet and recent media reports:

“Products from grass-fed animals are safer than food from conventionally-raised animals.” Eatwild, 2008

“Research has shown that the strains of E. coli most devastating to humans are the product of feedlots, not cows. This is due to the animals being forced to eat an unnatural diet, and not their natural choice, grass.” Grass-Fed Beef: Safer and Healthier, Animal Welfare Approved, June 15, 2008

My conclusion of the literature review was: In summary, the scientific evidence at this time does not support a broad conclusion that grass feeding significantly reduces the risk of E. coli O157:H7 or other dangerous foodborne pathogens from entering the food chain. However, more research is needed to better understand the influence of diet, especially the use of different types of grains in animal feed.

Now a recent abstract entitled, “Contamination Rates and Antimicrobial Resistance in Bacteria Isolated from “Grass-Fed” Labeled Beef Products” by Jiayi Zhang, Samantha K. Wall, Li Xu, Paul D. Ebner in Foodborne Pathogens and Disease, once again puts into question the conventional wisdom that somehow grass-fed cows are safer than grain-fed cows. Here is the abstract in part:

Abstract: Grass-fed and organic beef products make up a growing share of the beef market in the United States. While processing, animal handling, and farm management play large roles in determining the safety of final beef products, grass-fed beef products are often marketed as safer alternatives to grain-finished beef products based on the potential effects of all-forage diets on host microbiota.

We conducted a series of experiments examining bacterial contamination rates in 50 beef products labeled as “grass-fed” versus 50 conventionally raised retail beef products.

Coliform concentrations did not differ between conventional and grass-fed beef (conventional: 2.6 log10 CFU/mL rinsate; grass-fed: 2.7 log10 CFU/mL rinsate). The percentages of Escherichia coli positive samples did not differ between the two groups (44% vs. 44%). Enterococcus spp., were frequently isolated from both grass-fed beef products (44%) and conventional beef products (62%; p = 0.07). No Salmonella or E. coli O157:H7 isolates were recovered from any of the meat samples. Enterococcus spp. isolates from conventional beef were more frequently resistant to daptomycin and linezolid (p < 0.05). Resistance to some antimicrobials (e.g., chloramphenicol, erythromycin, flavomycin, penicillin, and tetracyline) was high in Enterococcus spp. isolated from both conventional and grass-fed beef.

There were no differences in the percentages of antimicrobial resistant E. coli isolates between the two groups. Taken together, these data indicate that there are no clear food safety advantages to grass-fed beef products over conventional beef products.

Perhaps more research is still needed. The sample size of this recent study was small. Perhaps Food Safety News should do a larger one?

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PCA is about to Pay $12,750,000, but Stewart Parnell is not in Jail

Bryan Gentry reported yesterday that “[t]he victims of a salmonella outbreak that was traced to Lynchburg-based Peanut Corp. of America nearly 18 months ago could finally see some money next month. On Wednesday a U.S. District Court judge in Roanoke agreed to speed up the process of approving the personal injury claims received in PCA’s bankruptcy case.”

In January 2009 salmonella was found in a jar of peanut butter made by PCA. That led to the recall of thousands of food products, several lawsuits and PCA’s bankruptcy.

Last fall, the bankruptcy court set up a $12 million fund using money from Peanut Corp. insurance policies to pay the personal injury claims of people who had been sickened by the salmonella. Eventually 123 claims were submitted by people who had suffered from salmonella poisoning or whose relatives had died from it.

According to court documents, most claims are valued at $100,000 or less. One is valued at more than $2 million. Eight of the claims involve wrongful death claims, and 44 involve minors who became sick.

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Australian Food Safety Conference, 7-9 September and NZFSA Conference, 13-14 September

Although I just returned to the States, I will soon be packing my bags again to speak in Australia and New Zealand on food safety.

New Zealand - Facing food safety challenges to reputation and consumer confidence

Technology changes, new production methods, and advances in packaging, storage and distribution of food change what we eat and the way we eat it. Solutions to old problems can also present challenges.  NZFSA Conference 2010 examines these issues and looks at how we can work together to promote a food safety culture that will cope with change and challenge, keep New Zealand consumers safe and give confidence to overseas buyers.  If you are involved in food you have a role to play in keeping it safe. You need to be at the Crowne Plaza Hotel in Auckland on 13 and 14 September if you:

• run or manage a medium-to-large size food production, processing, manufacture, import, export or sales business
• represent a food industry organisation or sector
• supply equipment, product or services to food businesses
• are an academic whose field involves food research, technology, public health or safety
• work as a food regulator in government or local government
• are passionate about safe food.

Australia - From Red Tape to Real Value

The theme will explore a variety of issues that affect food safety and examine the relationship between regulatory agencies and the food industry in reducing risks associated with the food supply including how to manage food safety consistently in the global marketplace.  The conference program has been structured to allow delegates to meet with industry peers and colleagues from around the world to exchange knowledge and best practice and to discuss and debate the questions faced every day.  Program session topics:

• What’s on the menu? Setting the agenda
• The Food Regulatory System Under Review
• Global Food Safety
• Emerging Food Safety Challenges
• Integrated Food Safety Management
• Adding Value to Food Regulation

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Lawsuit filed in Wisconsin Salmonella Case

Jessica Stephen of the Kenosha Wisconsin News reported yesterday on the lawsuit we filed on behalf of “a Pleasant Prairie woman sickened in a recent salmonella outbreak connected to” the Baker Street Restaurant & Pub.

According to the lawsuit, Dzinovic and her boyfriend ate at the restaurant on June 17. By June 21, Dzinovic was sick. Her symptoms worsened, until she finally went to a hospital June 24.  Tests confirmed she was infected with salmonella enteritidis, the same strain local health officials have since found in 28 other people from the Kenosha County area.

According to the Kenosha County Division of Health “not all the people who got sick had eaten at Baker Street… Investigators could not tell how many of the 28 people who had confirmed salmonella got sick because of food at the restaurant, Bosovich said. But, she said, enough of them had a connection to the pub to make it a focus of investigation.”

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Outbreaks, illnesses and recalls linked to raw (unpasteurized) dairy products, United States, 2010 (through July 23, 2010)

There have been nine at least since January that have been reported.  Also, there are others - like an Campylobacter outbreak in Massachusetts that the state has not yet announced.  But, here are some details so far on most of the known outbreaks (click on image to download details):

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Your Salad - Is the convenience worth the risk? Is irradiation the silver bullet?

While I was “vacationing” in Greece and Italy over the last weeks, Fresh Express was recalling even more romaine lettuce salad products because of potential E. coli contamination (an earlier Salmonella recall occurred two months ago).  Of course, that does not count a Fresh Express outbreak that did sicken people in April and no recall occurred.  Also, in July Ready Pac Foods Inc. recalled 702 cases of Spinach following a positive test for E. coli O157:H7.  The recalls followed random positive result for E. coli O157:H7 and Salmonella conducted by a third-party laboratory for the Food and Drug Administration.

In the recalls, no illnesses related to the recalled products have been reported. However, earlier this year shredded romaine lettuce processed by Freshway Foods, Sidney, Ohio, was contaminated with E. coli O145, a less-known strain, sickening at least 30 people in five states.  In that outbreak we still do not know the name of the farm in Yuma that grew the lettuce.

In the middle of the 2006 Spinach E. coli O157:H7 outbreak, I asked the following question – “Is convenience worth the risk?”:

When you're eating a bag, you may be eating parts of ten, twenty, thirty, forty bunches of spinach or lettuce. You have a couple of pieces of bad heads of lettuce or bad bunches of spinach and it gets massively processed in a big facility that gets spread out among hundreds if not thousands of bags. Perhaps we've reached a point where all of us need to strike a new balance between what is convenient and what is risk.

Of course, buying non-bagged product – or, even growing your own – is no guarantee that the product is not contaminated.

Perhaps it is time to engage in an open discussion on irradiation? Over a year and a half ago, I penned, "Pros and Cons of Commercial Irradiation of Fresh Iceberg Lettuce and Fresh Spinach: A Literature Review."

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No more travel writing from this lawyer

Just landed in Boston from Rome a few hours ago and I have already been dealing with client legal issues and legal arguments with lawyers - some of them a bit hot I am afraid.  My vacation is clearly over.  OK, one more photo of the Umbria countryside.

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No tour at the Roman Abbitoire

The temperature here in Rome was hovering near 100 as we wandered from the Spanish Steps to the Coliseum and other Roman ruins.  It seems wherever you turn you were either walking over or bumping into something that dated from the turning point between B.C. and A.D.  We ducked out of the heat outside the city by visiting the Catacombs just outside the city wall along the Appian Way - not my daughter Sydney's favorite stop.

After yet another great and long lunch, walking back to the car, I saw the below statue perched on top of an arch:

I asked the guide the significance.  He explained that it was a former Roman Abbitoire that dated back a few hundred years or more and was no longer active.  And, I was hoping for a tour.

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Baker Street Restaurant in Kenosha possibly linked to 26 Salmonella Illnesses

Baker Street Restaurant & Pub has closed because of a suspected salmonella outbreak. Diane Bosovich, the Kenosha Department of Health’s assistant director of nursing, said the restaurant was closed Tuesday as a precaution after some people who contracted the bacterial illness revealed they had eaten there. She said on Wednesday afternoon there was no determination about whether the restaurant was tied to the illness.

The Kenosha County Health Department said Wednesday it has confirmed 26 cases salmonella.

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Fresh Express Recalls Romaine Lettuce Due to E. coli O157:H7 Risk

Fresh Express is voluntarily recalling certain Romaine lettuce salad products with expired Use-by Dates of July 8 - 12 and an "S" in the Product Code because they may have the potential to be contaminated with E. coli O157:H7. No other Fresh Express salads are included in the recall.

No illnesses have been reported in association with the recall. The precautionary recall action is being conducted to reach retailers as well as consumers. Consumers should check their refrigerators for Fresh Express Romaine salads with Use-by Dates of July 8 - 12 and an "S" in the Product Code. Retailers should check their inventories and store shelves to confirm that none of the product is mistakenly present or available for purchase by consumers. Fresh Express customer service representatives have already contacted a majority of retailers and are in the process of confirming that the recalled product is not in the stream of commerce.

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When in Rome - as they say

It is good to see that Marler Blog is translated via Google here in Rome:

Also, one of my recent posts, "Lawyers, Microbiologists, and Safe Food," was recently posted on Le Blog d’ Albert Amgar in French – “ Les avocats, les microbiologistes et la sécurité des aliments."

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CDC makes us worry about Salmonella in Eggs too

Sitting down for breakfast in our last day in Athens, I decided to check my Centers for Disease Control and Prevention's (CDC's) alert.  This popped right out - "The CDC estimates that nearly 3 million eggs sold each year are contaminated with Salmonella bacteria."

There are approximately 192 egg producing companies with flocks of 75,000 hens or more, which represent about 95% of all the layers in the United States. As of July 1, those producers have new FDA guidelines they must follow:

- Buy chicks and young hens only from suppliers who monitor for Salmonella bacteria

- Establish rodent, pest control, and biosecurity measures to prevent spread of bacteria throughout the farm by people and equipment

- Conduct testing in the poultry house for Salmonella enteritidis. If the tests find the bacterium, a representative sample of the eggs must be tested over an eight-week time period (four tests at two-week intervals); if any of the four egg tests is positive, the producer must further process the eggs to destroy the bacteria, or divert the eggs to a non-food use

- Clean and disinfect poultry houses that have tested positive for Salmonella enteritidis

- Refrigerate eggs at 45 degrees F during storage and transportation no later than 36 hours after the eggs are laid (this requirement also applies to egg producers whose eggs receive a treatment, such as pasteurization).

Small farmers, those with less than 3,000 hens or those who sell directly to consumers, aren’t affected by the new regulations (I assume that the same bothersome statistics apply, however). Farmers with less than 50,000 hens but more than 3,000 will begin compliance on July 10, 2012, unless the eggs are treated in some way, or pasteurized.

Yesterday is was Mexican food, today eggs.  I'll stick with coffee this morning.

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What would Pericles do?

After hiking around the Parthenon in the heat of the day (tried to do it early, but there was a four hour strike by workers) and watching the changing of the guards in front of the Parliament Building, we headed back to the hotel and discussed where to eat tonight.  The consensus, after a week and a half in Greece, was to try something different.  Being that we are in the birthplace of Democracy, the majority vote was to try for Mexican food.  I am not sure Pericles had veto power, but after reading this from the CDC, I say no to Mexican food tonight.  According to a CDC Press Release:

Salsa and Guacamole Increasingly Important Causes of Foodborne Disease

Nearly 1 out of every 25 restaurant-associated foodborne outbreaks with identified food sources between 1998 and 2008 can be traced back to contaminated salsa or guacamole, more than double the rate during the previous decade, according to research released by the Centers for Disease Control and Prevention today at the International Conference on Emerging Infectious Diseases.

"Fresh salsa and guacamole, especially those served in retail food establishments, may be important vehicles of foodborne infection," says Magdalena Kendall, an Oak Ridge Institute for Science and Education (ORISE) researcher who collaborated on the CDC study. "Salsa and guacamole often contain diced raw produce including hot peppers, tomatoes and cilantro, each of which has been implicated in past outbreaks."

To better assess the role of these popular foods in outbreaks, Kendall and her colleagues searched all foodborne outbreaks reported to the CDC for those with salsa, guacamole or pico de gallo as a confirmed or suspected food vehicle and analyzed trends in the proportion of all outbreaks with identified food sources.

CDC began conducting surveillance for foodborne disease outbreaks began in 1973, yet no salsa- or guacamole-associated (SGA) outbreaks were reported before 1984. Restaurants and delis were the settings for 84 percent of the 136 SGA outbreaks. SGA outbreaks accounted for 1.5 percent of all food establishment outbreaks from 1984 to 1997. This figure more than doubled to 3.9 percent during the ten-year period from 1998 to 2008.

Inappropriate storage times or temperatures were reported in 30 percent of the SGA outbreaks in restaurants or delis and may have contributed to the outbreaks. Food workers were reported as the source of contamination in 20 percent of the restaurant outbreaks.

"Possible reasons salsa and guacamole can pose a risk for foodborne illness is that they may not be refrigerated appropriately and are often made in large batches so even a small amount of contamination can affect many customers," Kendall says. "Awareness that salsa and guacamole can transmit foodborne illness, particularly in restaurants, is key to preventing future outbreaks."

Risk can be lowered by following guidelines for safe preparation and storage of fresh salsa and guacamole to reduce contamination or pathogen growth.

"We want restaurants and anyone preparing fresh salsa and guacamole at home to be aware that these foods containing raw ingredients should be carefully prepared and refrigerated to help prevent illness," says Kendall.

Back to olives and Greek salads, and of course, Ouzo.

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No, this is not a travel blog

The Parthenon (Ancient Greek: Παρθενών) is a temple in the Athenian Acropolis, Greece, dedicated to of the Greek goddess Athena, whom the people of Athens considered their protector. Its construction began in 447 BC and was completed in 438 BC.

(View from dinner at the Hotel Bretagne)

Nine years.  They built it in nine years nearly 2,500 years ago?  Senator Harry Reid, if the cradle of democracy could do this in nine years, our Senate can pass S. 510 now.

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Ellensburg Day Care E. coli Outbreak is E. coli O26 linked

The E. coli outbreak that temporarily closed three Ellensburg day-care operations appears to be winding down, health officials said last Friday. However, press reports a few hours ago indicate that the outbreak strain that has sickened several children and adults is E. coli O26 not the more frequently diagnosed E. coli O157:H7.

The original source of the E. coli O26 is not yet known.

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."

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Never far from being reminded of my job

Sitting on my deck in the village of Oia on the Island of Santorini is about the last place I thought I would think about why my job is so important. I then received this email:

Hi Bill,

I hope you, your family and your terrific team in Seattle are doing well! I came across a "snippet" of you on Larry King-sort of vicariously when he announced his retirement-but it lead me to an interview you did along with Barbara Kowalcyk. I was very moved by her story, taken back to our own struggle with [our own daughter], and was reminded how lucky we were to dodge that bullet. I promptly looked into her organization...their goals...and ways to help spread their message. I hope to hear back very soon. If ever I may be able to help another family or support the work you do aside from your litigation, please don't hesitate to ask. Not a day goes by that I don't think how lucky we are to be traveling to colleges and planning [her] future.

You and your wonderful people "high in the sky" there in Seattle crossed my mind today!

All the Best,

[…..] Mom

I have had the honor in seventeen years to have represented (along with great lawyers and staff) thousands of people whose lives were forever changed because they ate food that a manufacturer did not take the proper precautions to remove a pathogen that then altered a life. I have had the privilege to have helped rebuild lives, or to have at least brought closure.

Even in Santorini, I am never far from being reminded of my job.

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Lawyers, Microbiologists, and Safe Food

There must be a good joke about a lawyer who sidles up to a bar and strikes up a conversation with the microbiologist on the next stool. I don't know the punch line, but rest assured it will have something to do with the microbiologist peering through a microscope, and the lawyer chasing ambulances. The punch line will insult both, but mostly the lawyer.

As with any joke, it will have some basis in reality. Microbiologists spend some time with microscopes, and while I've never literally chased an ambulance, I make my living representing people who have spent time inside ambulances.

My parents were teachers, so I took my education very seriously and aspired to become a lawyer. I studied my share of science, but I gravitated toward law and politics, and it would be some years before science became a crucial component in my work. I studied political science, English and economics at Washington State University (WSU) and while still in school, I was elected to the Pullman City Council--the youngest person and first WSU student to be elected to that office. I went on to law school at Seattle University, receiving my law degree in 1987 and from there I joined a Seattle law firm.

Six years later, my career took off when I represented many of the families injured by the infamous outbreak of E. coli O157:H7 linked to undercooked hamburgers at a chain of restaurants in the USA. Eventually the company settled for millions of dollars, which helped those families deal with the medical consequences to their loved ones, and enabled me to set up my own firm, and a new direction.

My firm specializes in cases involving foodborne illness. As the founding partner, I oversee a staff of about 20, including seven lawyers. Over the years we have represented thousands of people and families injured by E. coli, Salmonella and other potentially harmful microbes, and we are involved in virtually every outbreak across the USA. In many respects, my job is similar to other lawyers--dealing with clients and opposing lawyers, gathering information, negotiating settlements, and sometimes trying cases in court. The main difference is that I am also deeply involved in consumer education and in the political effort to reduce the risk of foodborne illnesses.

My days usually begin before 5 a.m., when I spend 90 minutes or so responding to emails, monitoring developments in my firm, and posting new items on my personal blog--Marlerblog.com, and several other informational sites that have become an important part of my work. By the nature of my specialty, I rely heavily on advances in science. My job would be far more difficult, if not impossible, without the advances made in food safety and microbiology.

The most obvious way we interact with scientists is through culture and isolation of bacteria, the very foundation of foodborne illness detection and surveillance. Molecular microbiology methods, such as pulse field gel electrophoresis (PFGE), allow us to build solid claims on behalf of our clients. To represent our clients, we must be able to trace a foodborne illness to its source, whether that is a pizza parlor in Florida or a meat processing plant in Nebraska, and that source must be established with enough certainty that a jury is left with little doubt about the source of an outbreak illness.

Until just a few years ago, this was difficult to establish. Outbreaks of Salmonella or E. coli O157:H7 or other serious illnesses were generally investigated by interviewing victims and searching for a common denominator--a local restaurant or scouts club or church event. In a complex society, it was difficult to detect widespread outbreaks, let alone trace those outbreaks to a specific source. PFGE changed everything. This method establishes a DNA "fingerprint" that distinguishes specific strains, confirming that these people were sickened by this batch of hamburger or that batch of peanut butter.

PulseNet is a nationwide network of state and local public health agencies, coordinated by the Centers for Disease Control, which enables epidemiologists and public officials to detect national outbreaks that might normally be missed. So both the science and bureaucracy surrounding PFGE help us to represent our clients far more effectively.

There are other less obvious, but equally important ways in which we use microbiology. The popular misconception of my work goes something like this: somebody feels they have been injured or damaged, so they hire a lawyer, who argues the case before a judge and jury who awards them a great deal of money. Case closed. In fact our work is much more complicated.

Every day, we hear from people who believe they have been sickened by foodborne illness. They have a stomach ache, or diarrhea, or their grilled cheese sandwiches "tasted funny" or "didn't look right." They read in the newspaper about an outbreak of foodborne illness linked to grilled cheese sandwiches, and they say: "Ah ha! Obviously, that's what made me sick." So they call us. Some of those people have legitimate claims, but most are not supportable. The illnesses may be psychosomatic, or coincidental, or downright fraudulent, and the first task of a good lawyer is to sift through the claims and determine which cases are sound.

As I mentioned, most claims are not supportable, and we reject the great majority. When lawyers fail to use good judgment in assessing these claims, there are repercussions throughout the system. No lawyer can make a living by arguing false or fraudulent claims; it merely wastes his own time and money, that of his clients and the courts, and that of the companies forced to defend them. Pursuing illegitimate claims undermines the system, so that the food industry is more likely to deny legitimate claims by people who have actually been sickened by their products. This, in turn, makes it more difficult to push through important measures that would improve food safety. In the long run, pursuing false claims only increases the risk that more people will get sick.

Our first task is to weed out the fraudulent complaints and thereby increase the chances of achieving success with the legitimate ones. For foodborne illness claims, we have developed a series of legal and scientific screens, derived from years of experience. Here are some of the factors we consider:

Incubation period: When claimants say the hamburger they ate this morning sickened them, they are generally out to lunch. Incubation periods--the time between eating and the onset of symptoms--are only ranges, and wide ranges at that. But they are still important. So, the claimant who says she got E. coli O157:H7 from today's hamburger simply does not have a winnable case, because of the incubation period for E. coli O157:H7 (one to ten days, typically two to five days). In 2004, a claimant who had stopped for a cheese sandwich contacted us saying: "within two hours of eating that sandwich I became very ill," he wrote. "My fever went up from 98.6 to 100.2; I got diarrhea, stomach cramps, headache and chills. I am still very sick... can you please help me?" The answer was, no. Based on incubation periods, this person's lunch from this restaurant is most likely not the source of his illness. The major culprits--Salmonella, Shigella, Campylobacter, or E. coli O157:H7--all are subject to incubation periods longer than two hours, which rules out the cheese sandwich.

Smell and taste: other potential claimants complain that something they ate tasted funny, or didn't smell right. We try to be sympathetic, but most bacteria are odorless and tasteless, and customers who suspect a meal because it tasted funny are usually wrong. Others file what we call "gross-out" claims. In one case, a consumer complained that she had opened a box of "buffalo wings" and "an unusually shaped piece caught my eye... when I saw that the piece had a beak, I got sick to my stomach. My lunch and Diet Coke came up and I managed to christen my carpet, bedding and clothing. I want them to at least pay for cleaning my carpet etc. What do you think?" We thought she chose wisely not to eat the wings, but this is probably not a legitimate personal injury claim.

Health department investigations: while statutes and regulations vary from state to state, most health departments monitor outbreaks of foodborne illness. In most cases, a positive lab result from a human sample triggers a report to the local health authority and some type of follow-up investigation. The length, breadth, and documentation vary depending on the pathogen involved, the type of food, the number of persons who may be sick, the local jurisdiction, and other factors. Usually, the results of the investigation are either made public by the health authorities or can be obtained through public records.

It is difficult for food-processing companies to dispute such investigations. Rarely has a defendant avoided liability where the local health department concluded that the defendant's food was the source of an outbreak. In general, public health officials are extremely cautious not to prematurely assign blame for an outbreak. They operate with a much higher burden of proof than the civil justice system. Most epidemiologists require 95 percent confidence in a particular conclusion, while a jury requires only 51 percent confidence. Take, for example, the E. coli outbreak at a school in eastern Washington State in 1998. Local and state health officials concluded that the source of the outbreak was a ground-beef taco meal prepared and served at the school. We represented the families of 11 children who were identified as victims of the outbreak. All but one of them attended the school. Four of the children developed hemolytic uremic syndrome (HUS), which resulted in varying degrees of permanent kidney damage. However, the child with the most severe injuries did not attend the school and did not eat the implicated meal. Health officials concluded that she had been infected through exposure to her sister or another student--a secondary infection. The school district disagreed, but in doing so, the district had to challenge the health department's conclusions. The case went to trial, and testimony by health department officials proved to be crucial in the jury's decision in favor of the plaintiffs.

Health officials will not report a confirmed outbreak, or pinpoint a restaurant or supplier as its source, without being virtually certain of that conclusion. Without 95 percent confidence, based largely on PFGE and other biological analyses, they are likely to identify outbreaks as possible but not certain. That standard of evidence works both ways; if health officials conclude that an outbreak did not come from a particular source, plaintiffs face an uphill battle to prove their case.

Prior health inspections: most state and local health departments enforce health regulations by inspecting restaurants and other food services, and imposing fines or other sanctions for violations. These inspections provide an important tool for establishing the source of an outbreak. Documents may include reports of prior incidents or accusations of food contamination, and those documents can be acquired through the discovery process or through public record requests.

Health department documents may provide evidence of improper food handling, suggesting how food may have become contaminated. They may help document a history of improper techniques and code violations that can serve as a tool for limiting a defendant's trial options. Such documentation can lead to an early and favorable settlement, and a history of repeated violations can build a case for punitive damages.

When consumers claim to have been sickened by restaurant meals, health officials or lawyers may find contaminated leftovers, but that is unusual. Far more frequently, lawyers will build their cases on a documented pattern of health code violations. For example in 2001, a young girl suffered a particularly severe E. coli O157:H7 infection. She had eaten a hamburger at a California fast-food chain. But, by the time health officials investigated, the original case of frozen hamburgers was long gone, and officials did not find any food on site that tested positive for E. coli. However, a thorough review of the restaurant's current and prior inspections revealed a crucial flaw in the firm's cooking method. In six reports spanning three years, health officials had warned the restaurant of the dangers of cross contamination. The matter settled shortly after the presentation of this information.

Clearly, advances in microbiology have helped the world understand which pathogens cause illnesses, foods that are vehicles for transmission of pathogens, and how those illnesses can be avoided. Those advances make it easier for public health and the legal system to trace an outbreak of illness to its source, and to impose sanctions that encourage food processors to minimize risk. This is one of the ways that science and the law conspire to make the world a safer and better place to live.

The author would like to thank the Society for Applied Microbiology for permission to reprint this article, which first appeared in the June 2010 issue of Microbiologist Magazine.

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14 more hit with E. coli in Colorado - no link to raw milk or bison?

Little Sailors Child Development in Northglenn, Colorado have been linked to an E. coli outbreak that has affected more than a dozen people. The Tri-County Health Department has announced that 14 people, 13 children and a teacher have been diagnosed with a mild strain of E. coli. The source of the first infection has not yet been discovered.

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Senator Reid, it is time to move S 510 to a vote - do it for Linda

I assume by now that Senator Reid or his staff has viewed Val Willingham’s CNN interview with Linda and her husband (both his constituents). Senator Reid, the time has come to move on S 510.

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Colorado Raw Milk Sickens 30

Yesterday between visits at ancient Minoan historical sites and churches that pre-date Columbus by 300 years, we did a bit of hiking in search of the Kri-kri, the Cretan goat. Clearly, something that looks difficult to milk.

I was reading this morning the press release from the Boulder County Department of Health that now a second child has been hospitalized with severe illness (likely hemolytic uremic syndrome) after becoming ill from drinking unpasteurized goat milk in June that came from Billy Goat Dairy in Longmont. The first child was hospitalized on June 27 and remains hospitalized. As of Thursday lab tests have confirmed that milk from the Billy Goat Dairy farm was contaminated with Campylobacter and goat feces carried E. coli O157:H7. Thus far 30 people have been sickened out of the 40 families that participate in the goat share program.

Direct from Boulder County Department of Health:

Pasteurizing milk does not cause lactose intolerance and allergic reactions. Both raw milk and pasteurized milk can cause allergic reactions in people sensitive to milk proteins. Pasteurization also does not reduce milk's nutritional value.

During pasteurization, the temperature of milk is raised to at least 161 degrees Fahrenheit for more than 15 seconds; it is then rapidly cooled. Pasteurization helps to extend milk’s shelf life and destroy many harmful bacteria, including E. coli, Salmonella, Campylobacter, and Listeria.

Campylobacter infection can cause fever, diarrhea, abdominal cramps, nausea, and vomiting and can lead to Guillain-Barré syndrome, permanent paralysis, and possibly death. E. coli infection can cause severe diarrhea, abdominal cramping, and vomiting. Serious cases of E. coli can lead to Hemolytic Uremic Syndrome, causing kidney failure and possibly death.

So far there has been only silence from the Raw Milk Industry, specifically David Gumpert at the Complete Patient and Sally Fallon at the Weston Price Foundation. My guess is that after some ten raw milk related outbreaks since January, they are keeping their heads down.

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First Colorado E. coli Lawsuit filed against Rocky Mountain Natural Meat

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More Buffalo Recalled in Nevada Due to E. coli O157:H7

The July 2 Recall has been expanded to include approximately 776 additional pounds of Bison Products that were distributed to a firm in Nevada for further processing.

FSIS became aware of the problem during the course of an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010. Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 case-patients have been identified in Colorado as well as 1 case-patient in New York with an indistinguishable PFGE pattern.

FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado. FSIS is continuing to work with the CDC, affected state public health partners, and the company on the investigation.  The products subject to recall bear the establishment number "EST. 20247" inside the USDA mark of inspection. These products were produced between the dates of May 21, 2010 through May 27, 2010.

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Ready Pac Foods Announces Voluntary Spinach Recall Because of E. coli O157:H7

Ready Pac Foods, Inc. of Irwindale, California is recalling 702 cases of the Baby Spinach variety of Spinach Temptations 6 oz. bagged salads with Use-by Dates of July 4 with Product Code I1707B, IR127121 and July 8 with Product Code I2007B, IR130373 because they could be contaminated by Escherichia coli O157:H7 (E. coli O157.H7).

The recall extends only to products with this Use-by Date or Product Code sold in the following states: California, Washington and Arizona. No other Ready Pac Foods, Inc. products are included in the recall.  No illnesses related to these products have been reported.

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I'm Vacationing as the President works on Food Safety

The rumors are flying around here on the Eastside of Crete that President Obama and family will be staying here in Elounda soon.  If true, I must admit that it is not that bad of an idea.  The weather is perfect, the water clear and warm, the food fresh and healthy and ancient history at every turn.

Whether he shows or not, it was good to see that he was working (press release below) when I was visiting historical sites.

Statement by the President on Food Safety

“A year ago today, the Food Safety Working Group, chaired by Health and Human Service Secretary Kathleen Sebelius and Secretary of Agriculture Tom Vilsack, announced key findings on how to upgrade the food safety system. Since then, my Administration has taken steps to reduce the prevalence of E. coli, implemented new standards to reduce exposure to Campylobacter, and issued a rule to control Salmonella contamination. Among other accomplishments, the FDA has conducted a pilot study on a tracing system, and HHS, in collaboration with USDA, has rolled out an enhanced and updated www.foodsafety.gov site to provide consumers rapid access to information on food recalls.

But there is more to be done. Today, I thank the House for its work and support efforts in the Senate to pass S. 510, the FDA Food Safety Modernization Act. This bipartisan bill would complement the work already undertaken by the Food Safety Working Group. The bill addresses longstanding challenges in the food safety and defense system by promoting a prevention-oriented approach to the safety of our food supply and provides the Federal Government with the appropriate tools to accomplish its core food safety goals.”

If you ever wonder why this food safety legislation is important, see CNN's Val Willingham's "A year later, 'heroic' E. coli survivor still battling."

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The Doctor, Sanjay Gupta, tries to get the Senate to move forward on Food Safety

Here is the transcript from Dr. Gupta's recent show on Health:

Welcome to a place where you can learn how to live longer and stronger. I'm your doctor. I'm also your coach.  First up, an exclusive story: Imagine a woman who almost died -- why -- because she ate raw cookie dough. Foodborne illnesses that becoming increasingly more common -- just how dangerous are they? We'll tell you. ..

Let's get started.

GUPTA:  Your food -- you're expected to be safe and the United States House has passed a food safety bill. The Senate is still in limbo on this. But I can tell you, it's become an urgent matter, which is why we're talking about it today.

In fact, just in the past two weeks, the CDC has been investigating a multi-state salmonella outbreak from frozen dinners. It sickened 37 people in 18 states.

Also, the USDA has reported a recall of 35,000 pounds of ground beef. Why? Due to possible E. coli contamination.

You know, these aren't just statistics. Foodborne illnesses like this can kill you and possibly make you very sick.

Linda Rivera did something that perhaps we have all done at one point or another. She took a little bite of raw cookie dough. But what happened to her after that is something that really no one could have predicted.

Here's our exclusive interview.

GUPTA:   Linda Rivera was living the good life -- a mother, wife, a special ed assistant. Linda was happy and healthy. But all of that changed in May of 2009.

LINDA RIVERA, FOOD POISONING VICTIM:  I felt like I had that cold, the flu, something like that.

GUPTA:  In fact, Linda got so sick her husband took her to the emergency room. There she was diagnosed with irritable bowel syndrome and sent home.

But the thing is: she didn't get any better.

RICHARD RIVERA, LINDA'S HUSBAND:  And I asked her if she's OK. And she said, "No, if I have to go through this one more day, I'll die." So, we took her in.

GUPTA:  The doctors told her she had contracted E. coli OH-157. That's a dangerous foodborne illness that can attack organs. The E. coli had settled into her colon and doctors now had to remove it. A few days later, Linda was told what gave her E. coli.

L. RIVERA:  Our attorney called us and said that it was cookie dough. I usually use a big tub, make lots of cookies at one time. Just a couple of bites, that's all it took.

BILL MALER, RIVERA'S ATTORNEY:  The reality is, about 60 percent, 65 percent of everybody who buys these products admits that they eat it raw. Seventy-six thousand people get E. coli O1587 every year, between 50 and 100 deaths every year. So in the scheme of bugs, it's -- it's a relatively low number, but it's a really nasty, nasty bug.

GUPTA:  For a whole year, Linda had lots of problems. Her kidneys shut down. She couldn't walk or talk. She went into cardiac arrest.

Three times, she was almost given her last rights. But she never gave up.

L. RIVERA:  OK. For 15 minutes ...

GUPTA:  Now in a rehab hospital in San Francisco, Linda is learning to live again.

DR. PHILLIP O'KEEFE, CALIFORNIA PACIFIC MEDICAL CTR.:  Her ability to deal with the pain and problems that she still has really been heroic.

GUPTA:  Her husband Richard is right there with her, says he wouldn't wish this on anyone.

R. RIVERA:  Probably, any family to have to go through this. I mean, just -- it does tear your life away. Linda's probably the most giving and cheerful and optimistic woman you'll ever meet. And she gave and gave and gave. And to see what this has done to her just tore me apart.

GUPTA:  Linda is not going to give up. She says she has a lot to live for.

L. RIVERA:  I don't want this horrible disease to win. So I want the rest of the world to know about it. They need to know.

Don't take a chance with it. It's not worth it. You give up your life, you lose everything.

GUPTA:  I tell you, we did speak to Linda's husband this week and he says Linda is improving little by little. He figures at best, she's going to be in rehab for another six to eight months and then she'll go home and do outpatient rehab. She's also going to require a nurse's care for some time to come as well.

Foodborne contamination, cookie dough, that's what this is all from. Linda, we wish you well. 

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Despite at least two Buffalo or Bison Meat Recalls, are Manufacturers still exempt from E. coli Testing?

The most current version of FSIS Directive 10,010.1 that I could find while sitting in Heathrow Airport states in part:

Fabricated steaks and finely sliced beef (9 CFR 319.15(d)) do not meet the standard of identity for ground or chopped beef product and, therefore, would not be subject to E. coli O157:H7 sampling. Raw beef sausage products are not subject to FSIS’ E. coli O157:H7 sampling and testing. Ground buffalo or bison is also not a raw ground beef product subject to this FSIS verification sampling.

Exempting Buffalo or Bison from testing seems a bit curious because we have now had at least two recalls in the past three years, and given that Buffalo and Bison are known carriers of E. coli O157:H7.

  • In July 2007, Custom Pack, Inc., recalled approximately 5,920 pounds of ground beef and buffalo products because they may be contaminated with E. coli O157:H7. Each package bore the establishment number “Est. 5650” inside the USDA mark of inspection. The ground beef products were produced between June 1 and June 13, 2007, and were distributed to restaurants and institutions in Nebraska. The ground buffalo patties were produced on June 7, 2007, and distributed to restaurants and institutions in Colorado.
  • Now in July 2010, Rocky Mountain Natural Meats is recalling approximately 66,000 pounds of ground and tenderized steak bison products after FSIS became aware of the problem during the course of an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010. Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 case-patients have been identified in Colorado as well as 1 case-patient in New York with an indistinguishable PFGE pattern. FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado. These products were distributed to retail establishments nationwide and food service distributors in Utah and Arizona. While the sell-by dates for these products have passed, FSIS and the establishment are aware that consumers may also freeze the product before use and there is concern that some product may still be frozen and in consumers’ freezers. The products subject to recall bear the establishment number “EST. 20247” inside the USDA mark of inspection. These products were produced between the dates of May 21, 2010 through May 27, 2010.

I am about to board my flight. Does anyone know if this exemption is still in place? And, if it is, what is the rationale?

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Rocky Mountain Natural Meats Recalls Buffalo Due to E. coli Illnesses in Colorado and New York

Rocky Mountain Natural Meats, a Henderson, Colo. establishment, is recalling approximately 66,000 pounds of ground and tenderized steak bison products. 

FSIS became aware of the problem during the course of an on-going investigation into a cluster of E. coli O157:H7 illnesses in Colorado with illness onset dates between June 4, 2010 and June 9, 2010. Working in conjunction with the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration, the Colorado Department of Public Health and Environment and the New York Department of Health, 5 case-patients have been identified in Colorado as well as 1 case-patient in New York with an indistinguishable PFGE pattern. FSIS determined that there is an association between the ground bison products and the cluster of illnesses in the state of Colorado. FSIS is continuing to work with the CDC, affected state public health partners, and the company on the investigation.  Pack/Codes:

The following products are subject to recall:

· 16-ounce packages of “GREAT RANGE BRAND ALL NATURAL GROUND BISON.” These products have a “sell or freeze by” date of June 21, June 22 or June 24, 2010.

· 16-ounce packages of “NATURE’S RANCHER GROUND BUFFALO.” These products have a “sell or freeze by” date of June 22, 2010.

· 16-ounce packages of “THE BUFFALO GUYS ALL NATURAL GROUND BUFFALO 90% LEAN.”  These products have a lot number of 0147.

· 12-ounce packages of “GREAT RANGE BRAND ALL NATURAL BISON STEAK MEDALLIONS.”  These products have a “sell or freeze by” date of June 23 and June 24, 2010

· 12-ounce packages of “GREAT RANGE BRAND ALL NATURAL BISON SIRLOIN STEAKS.”  These products have a “sell or freeze by” date of June 20, June 23 and June 24, 2010

· 15-pound boxes of “ROCKY MOUNTAIN NATURAL MEATS, INC. BISON 10 OZ SIRLOIN STEAK.” These products went to restaurants and bear a Julian Code of 0141.

The products subject to recall bear the establishment number “EST. 20247” inside the USDA mark of inspection.   These products were produced between the dates of May 21, 2010 through May 27, 2010.

These products were distributed to retail establishments nationwide and food service distributors in Utah and Arizona. While the sell-by dates for these products have passed, FSIS and the establishment are aware that consumers may also freeze the product before use and there is concern that some product may still be frozen and in consumers’ freezers.

As I said to the Washington Post a few days ago about recalls:

When it comes to food recalls, the government doesn't estimate the average return rate.

William Marler, a Seattle lawyer who has represented plaintiffs in major food-poisoning cases since 1993, said food recalls generally are not effective, especially when they involve perishables, vegetables or meat, for example. "By the time they figure out they have an outbreak and they can connect it to a food, most of that food is already eaten," he said.

And when it comes to foods with a longer shelf life, Marler said people have often eaten the product and become sick after it has been recalled.

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Colorado Raw Milk E. coli O157:H7 and Campylobacter Outbreak Rises to 24

Even in London, I cannot seem to get away from Raw Milk. Not only was my discussion with Raw Milk Guru, David Gumpert, published at Simple, Good and Tasty today, but an intrepid reporter from Boulder called my cell phone at midnight London time to tell me that “Boulder County Public Health officials said Thursday that they have identified eight new cases of illness linked to raw goat's milk from the Billy Goat Dairy, bringing the total to 24.”

According to this morning’s paper, “A team of state and local health investigators visited the Longmont dairy Thursday morning to collect samples from the goats, whose unpasteurized milk is considered the source of campylobacter and E. coli O157 infections that were identified in 16 people earlier this week.  Epidemiologists continued to contact the 43 households that participate in the dairy's goat-share program to warn of potential health risks and check for symptoms Thursday. They were still waiting on responses from several households. ...

Two children were hospitalized in connection with the outbreak. One has been released; the other remains under observation, but health officials reported his condition is improving.

Boulder County Public Health ordered the dairy on Tuesday to stop distribution of its raw milk products while it investigates. …

The outbreak has stirred up debate about raw milk, which has been controversial.

Bill Marler is a food safety advocate who has represented dozens of people who have fallen ill as a result of consuming raw milk.

"I think raw milk has this sort of love of the small farmers, sort of natural cachet to it," Marler said. "The reality is that pasteurization is one of the scientific breakthroughs that works, and the alternative is you're going to get kids sick like this."

Marler said there has been a significant spike in raw milk contamination in the past six months, with 10 confirmed outbreaks of E. coli O157, salmonella and campylobacter across the United States."

I also had the pleasure of having breakfast/lunch with Jill Greenfield, a solicitor here in London who is handling the open farm E. coli O157:H7 outbreak from last summer that left dozens devastated.

I told her I would help for free if I got to wear a wig and a robe.

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