July 2010

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?

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.

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.

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/

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?

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.

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.

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.

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.

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.