February 2012

michigan-state-university.jpgIn past Jimmy John’s sprout E. coli and Salmonella cases, young people – especially college students – seem to have been disproportionately hit. With at least three Jimmy John’s in East Lansing, and one student sick, I wonder how many of the 2, or 7, will be part of the count.

The Michigan departments of Community Health (MDCH) and Agriculture and Rural Development (MDARD) are issuing a public health alert regarding illness shiga toxin producing Escherichia coli (E. coli) from infections among people who have reported raw clover sprouts consumption in mid and southeast Michigan. At this time, MDCH is recommending that people avoid consumption of raw clover sprouts until further information about the origin of the contaminated sprouts is available.

Michigan currently has two confirmed E. coli O26 cases and five suspect cases. The illness onset dates range from February 6 – 12, 2012. All seven people reported consumption of raw sprouts at Jimmy John’s sandwich shops in mid and southeast Michigan. Of the seven cases, there have been two known hospitalizations. Those affected range in age from 19-50.

MDCH is working closely with local health departments, MDARD, the Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA) to determine the source of the sprouts. The two confirmed Michigan cases have the same genetic fingerprint as cases reported earlier this month in a CDC-led investigation in other states that was linked to raw clover sprouts consumption at Jimmy John’s restaurants.

Sprouts are the germinating form of seeds and beans and are frequently eaten raw in sandwiches and salads. Past sprout-related outbreaks of foodborne illness have been linked to seeds contaminated by animal manure in the field, during storage, or as a result of poor hygienic practices in the production of sprouts. In addition, the warm and humid conditions required to grow sprouts are ideal for the rapid growth of bacteria.

Jimmy John.jpg

So says Jimmy himself:

“I agree wich ya, we no longer serve sprouts, sprout supplies were inconsistent.”

I guess so.

Multistate Jimmy John’s Restaurants Raw Clover Sprouts 2011

14 Sickened (possibly 19) – On February 15, 2012, the Centers for Disease Control announced an ongoing investigation into illnesses linked to the consumption of raw clover sprouts consumed at Jimmy John’s Restaurants in several states. The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Michigan (2), Arkansas (1), and Wisconsin (1). Among 11 ill persons with information available, 10 (91%) reported eating at a Jimmy John’s sandwich restaurant in the 7 days preceding illness. Ill persons reported eating at 9 different locations of Jimmy John’s restaurants in 4 states in the week before becoming ill. One Jimmy John’s restaurant location was identified where more than one ill person reported eating in the week before becoming ill. Among the 10 ill persons who reported eating at a Jimmy John’s restaurant location, 8 (80%) reported eating a sandwich containing sprouts, and 9 (90%) reported eating a sandwich containing lettuce. Currently, no other common grocery stores or restaurants are associated with illnesses. Preliminary traceback information has identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John’s restaurant locations where ill persons ate. FDA and states conducted a traceback that identified two separate sprouting facilities; both used the same lot of seed to grow clover sprouts served at these Jimmy John’s restaurant locations. On February 10, 2012, the seed supplier initiated notification of sprouting facilities that received this lot of clover seed to stop using it. Investigations are ongoing to identify other locations that may have sold clover sprouts grown from this seed lot. http://www.cdc.gov/ecoli/2012/O26-02-12/index.html

Sprouters Northwest, Jimmy John’s Restaurants Clover Sprouts 2010

7 Sickened – Sprouters Northwest of Kent, Washington, issued a product recall after the company’s clover sprouts had been implicated in an outbreak of Salmonella Newport in Oregon and Washington. At least some of the cases had consumed clover sprouts while at a Jimmy John’s restaurants. Jimmy John’s Restaurants are a restaurant chain that sells sandwiches. Concurrent with this outbreak, a separate Salmonella outbreak (Salmonella, serotype I 4,5,12,i- ; see Multistate Outbreak, Tiny Greens Organic Farm, Jimmy John’s Restaurants), involving alfalfa sprouts served at Jimmy John’s restaurants was under investigation. The recall of Northwest Sprouters products included: clover; clover & onion; spicy sprouts; and deli sprouts. The Sprouters Northwest products had been sold to grocery stores and wholesale operations in Washington, Oregon, Idaho, Alaska, British Columbia, Saskatchewan, and Alberta. The FDA inspection found serious sanitary violations. http://www.foodsafetynews.com/2011/01/jimmy-johns-will-switch-to-clover-sprouts/, http://www.oregonlive.com/business/index.ssf/2011/01/jimmy_johns_switches_to_clover.html, http://www.thepacker.com/opinion/fresh-produce-opinion/jimmy_johns_sprout_switch_remains_puzzling_122028204.html

Multistate Outbreak, Tiny Greens Organic Farm, Jimmy John’s Restaurants Alfalfa Sprouts 2010

140 Sickened – On December 17, the Illinois Department of Health announced that an investigation was underway into an outbreak of Salmonella, serotype I4,[5],12:i:-. Many of the Illinois cases had eaten alfalfa sprouts at various Jimmy John’s restaurants in the Illinois counties of: Adams, Champaign, Cook, DuPage, Kankakee, Macon, McHenry, McLean, Peoria, and Will counties. The sprouts were suspected to be the cause of the illnesses. On December 21, Jimmy John Liautaud, the owner of the franchised restaurant chain, requested that all franchisees remove sprouts from the menu as a “precautionary” measure. On December 23, the Centers for Disease Control revealed that outbreak cases had been detected in other states and that the outbreak was linked with eating alfalfa sprouts while at a nationwide sandwich chain. On December 26, preliminary results of the investigation indicated a link to eating Tiny Greens’ Alfalfa Sprouts at Jimmy John’s restaurant outlets. The FDA subsequently advised consumers and restaurants to avoid Tiny Greens Brand Alfalfa Sprouts and Spicy Sprouts produced by Tiny Greens Organic Farm of Urbana, Illinois. The Spicy Sprouts contained alfalfa, radish and clover sprouts. On January 14, 2011, it was revealed that the FDA had isolated Salmonella serotype I4,[5],12:i:- from a water runoff sample collected from Tiny Greens Organic Farm; the Salmonella isolated was indistinguishable from the outbreak strain. The several FDA inspections of the sprout growing facility revealed factors that likely led to contamination of the sprouts. http://www.cdc.gov/salmonella/i4512i-/122810/index.html

CW Sprouts, Inc., SunSprout Sprouts, “restaurant chain (Chain A),” a.k.a. Jimmy Johns 2009

256 Sickened – In February, Nebraska Department of Health and Human Services officials identified six isolates of Salmonella Saintpaul. Although this is a common strain of Salmonella, during 2008, only three cases had been detected in Nebraska and only four subtypes of this outbreak strain had been identified in 2008 in the entire USA. As additional reports were made, a case control study was conducted; alfalfa sprout consumption was found to be significantly related to illness. The initial tracebacks of the sprouts indicated that although the sprouts had been distributed by various companies, the sprouts from the first cases originated from the same sprouting facility in Omaha, Nebraska. Forty-two of the illnesses beginning on March 15 were attributed to sprout growing facilities in other states; these facilities had obtained seed from the same seed producer, Caudill Seed Company of Kentucky. The implicated seeds had been sold in many states. On April 26, the FDA and CDC recommended that consumers not eat raw alfalfa sprouts, including sprout blends containing alfalfa sprouts. In May, FDA alerted sprout growers and retailers that a seed supplier, Caudill Seed Company of Kentucky, was withdrawing all alfalfa seeds with a specific three-digit prefix.  Many of the illnesses occurred at “restaurant chain (Chain A).” http://www.cdc.gov/salmonella/saintpaul/alfalfa/, http://www.whas11.com/news/iteam/Salmonella-Outbreak-Linked-to-Louisville-Seed-Company-83577137.html, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5818a4.htm, See PDF linking outbreak to Jimmy John’s a.k.a. “restaurant chain (Chain A)”

Jimmy John’s Restaurant Alfalfa Sprouts and Iceberg Lettuce 2008

28 Sickened – Several University of Colorado students from one sorority became ill with symptoms of bloody diarrhea and cramping. Additional illnesses were reported. E. coli O157:NM(H-) was determined to be the cause. Consumption of alfalfa sprouts at the Jimmy John’s Restaurants in Boulder County and Adams County were risk factors for illness. In addition, the environmental investigation identified Boulder Jimmy John’s food handlers who were infected with E. coli and who had worked while ill. The health department investigation found a number of critical food handling violations, including inadequate handwashing. The fourteen isolates from confirmed cases were a genetic match to one another. http://www.thedenverchannel.com/news/17669936/detail.html

221135-gop-candidates.jpgRomney does not seem like a sprout eater, but he might change his mind on that. Santorum likely thinks that sprouts are from the devil, and they likely are. Gingrich does not look like he eats many vegetables. Paul on the other hand, I could see eating sprouts as he swigs a large glass of raw milk.

So, I wonder how the candidates feel about food safety?

The Michigan departments of Community Health (MDCH) and Agriculture and Rural Development (MDARD) are issuing a public health alert regarding illness shiga toxin producing Escherichia coli (E. coli) from infections among people who have reported raw clover sprouts consumption in mid and southeast Michigan. At this time, MDCH is recommending that people avoid consumption of raw clover sprouts until further information about the origin of the contaminated sprouts is available.

Michigan currently has two confirmed E. coli O26 cases and five suspect cases. The illness onset dates range from February 6 – 12, 2012. All seven people reported consumption of raw sprouts at Jimmy John’s sandwich shops in mid and southeast Michigan. Of the seven cases, there have been two known hospitalizations. Those affected range in age from 19-50.  These illnesses are part of a six state Jimmy John’s “sproutbreak.”

E. coli O26 is a Shiga toxin-producing bacterium, similar to E. coli O157:H7. Illness caused by E. coli O26 can include symptoms of acute diarrhea, in particular, bloody diarrhea, and abdominal cramps with little or no fever. The illness usually lasts one week. In some people, especially young children, the elderly, or those who are immunocompromised, a more severe illness, such as hemolytic uremic syndrome (HUS), even death, is possible. Persons with HUS have kidney failure and often require dialysis and transfusions.

Special Concerns of the Elderly

elderly-couple.jpgThe occurrence of bacterial infection is a function of several major variables: (1) the virulence of the bacterial pathogen, that is, its ability to cause severe disease; (2) how the pathogen is transmitted to the “host”—for example, whether it is airborne, foodborne, blood borne, etc.; and (3) host susceptibility—i.e. how well the host can defend itself against the bacterial pathogen. Increased susceptibility, in turn, may result from two different processes: a bigger infectious dose in a given case of disease may cause a more severe infection, and physical characteristics particular to an individual host may render him or her less able to limit the spread of infectious microorganisms from the intestinal tract to the bloodstream.

Morbidity and mortality in the elderly from infectious disease is far greater than in other populations. For instance, death rates for infectious diarrheal disease alone are five times higher in people over 74 years of age than in the next highest group, children under four years of age, and fifteen times higher than the rates seen in younger adults. Published studies attribute the elderly’s heightened risks, both of infection and mortality due to enteric infectious disease, to several factors: (1) the aging of the gastrointestinal tract (reduced gastric acidity/reduced gastric mobility); (2) a higher prevalence of underlying medical disorders (co-morbidity factors); and (3) malnutrition and a decline in the immune response that leaves the host less able to defend itself against infectious agents.

Aging of the Gastrointestinal Tract—An Invitation to Infection

Inflammation and shrinkage of the gastric mucosa increase with age. These changes lead to low gastric acidity. In patients with gastric ulcer disease, the drugs used to treat the condition further block gastric acid production. Because stomach acids play an important role in limiting the number of bacteria that enter the small intestine, low gastric acidity increases the likelihood of infection if a pathogen is ingested with food or water.

Gastrointestinal mobility (peristalsis) decreases with age. Peristalsis, which is the mechanism that propels the stomach contents through the intestinal tract, is also the mechanical means for removing ingested, life-threatening pathogens. The risk of infection by potentially invasive pathogens corresponds with the duration of contact between the pathogen and the intestinal mucosa. Thus, a decrease in peristalsis delays the clearance of the pathogen from the intestinal tract and contributes substantially to the increased prevalence and severity of infection in the elderly. If the pathogen is E. coli O157:H7, decreased peristalsis allows the bacteria to multiply and produce more of the toxin that is absorbed in the gastrointestinal tract and leads to the aforementioned complications of an E. coli O157:H7 infection.

A Higher Prevalence of Underlying Medical Conditions—
Co-Morbidity Factors

Underlying medical conditions or disease (co-morbid factors) also contribute to the morbidity and mortality of infection in the elderly. Among hospitalized patients, those older than 65 develop pneumonia twice as often as younger patients due to poor nutrition, neuromuscular disease (poor cough reflex and aspiration), pharyngeal colonization, depressed level of alertness, endotracheal intubation, intensive care unit admission, nasogastric tube use, and antacid use. Pneumonia is the leading infectious cause of death in the elderly.

Atherosclerosis, another common co-morbid disease, compromises circulation and blood flow to the peripheral tissues and the skin, particularly in elderly individuals who are hospitalized and bedridden with an infectious illness. Unfortunately, it is the skin and the previously discussed mucous membranes that serve as the body’s first line of defense against invasion by infectious microorganisms. Loss of the integrity of the skin may result in the development of pressure ulcers, which are warm, moist mediums for infectious microorganisms to rapidly multiply and are associated with a number of infectious complications.

When an infectious microorganism, regardless of source, gains access to the bloodstream, the patient may develop systemic sepsis, also know as bacteremia. Bacteremia is most common in people who are already affected by, or are being treated for, some other medical problem (co-morbid disease); conversely, people in good health with strong immune systems rarely develop bacteremia. The main sources of bacteremia in elderly patients are the urinary tract, gastrointestinal tract, respiratory tract, and the skin. Other potential sources include surgical wounds, invasive tubes and catheters, intravenous lines—virtually any site where an invasive medical procedure has occurred. Bacterial organisms most likely to cause bacteremia include members of the Staphylococcus, Streptococcus, and Escherichia coli genera. Because bacteremia is far more prevalent in those with co-morbid conditions, which group is substantially populated by the elderly, the presence of co-morbid conditions is clearly a determinant of the mortality associated with infectious disease.

A Weakened Immune System—the Inability to Fight Off Infection

With advancing age come progressive weakness, decline, and dysfunction of the immune system. Many of the body’s natural physiologic responses to infection are therefore blunted in the elderly; and the intensity of many clinical signs and symptoms in an elderly patient with an infectious process are muted when compared to those in a younger person. This age-related decline contributes significantly to the increased risk of severe illness and mortality in elderly persons with infectious disease.

The effect of a weakened immune response on the health of an elderly person often manifests most apparently during periods of intense stress (e.g., surgery, sepsis, multiple organ failure, malnutrition, dehydration).

022412-map.jpgA total of 14 persons infected with the outbreak strain of STEC O26 have been reported from 5 states. The number of ill persons identified in each state is as follows: Iowa (5), Missouri (3), Kansas (2), Michigan (2), Arkansas (1), and Wisconsin (1). Among persons for whom information is available, illness onset dates range from December 25, 2011 to January 15, 2012. Ill persons range in age from 9 years to 49 years old, with a median age of 25 years old. One hundred percent of ill persons are female. Among the 12 ill persons, 2 (17%) were hospitalized. None have developed HUS, and no deaths have been reported.

Epidemiologic and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies have linked this outbreak to eating raw clover sprouts. Among the 11 ill persons with information available, 10 (91%) reported eating at a Jimmy John’s sandwich restaurant in the 7 days preceding illness. Ill persons reported eating at 9 different locations of Jimmy John’s restaurants in 4 states in the week before becoming ill. One location was identified where more than one ill person reported eating in the week before becoming ill. Among the 10 ill persons who reported eating at a Jimmy John’s restaurant location, 8 (80%) reported eating a sandwich containing sprouts, and 9 (90%) reported eating a sandwich containing lettuce. Currently, no other common grocery stores or restaurants are associated with illnesses.

Screen Shot 2012-02-14 at 5.55.33 PM.pngNew Jersey Department of Health reported that it currently has two residents that are ill in connection to a major outbreak caused by the consumption of raw milk from a Pennsylvania farm, Family Cow Dairy.

Currently 78 people in four states have become ill with campylobacteriosis, a gastrointestinal illness, from the consumption of the raw milk contaminated with bacteria. Pennsylvania Department of Health officials said Thursday that the total number of cases continued to increase. The department has identified 68 cases in Pennsylvania, five in Maryland, two in New Jersey and three in West Virginia.

The bottled raw milk products were distributed throughout Pennsylvania, including Montgomery, Bucks, Philadelphia, and Delaware counties, which all border the Delaware River. The raw milk from this farm was purchased in Pennsylvania. The sale or distribution of raw milk is banned in New Jersey.

While the majority of illness has occurred in Pennsylvania, residents in New Jersey, Maryland and West Virginia have also been affected. A 27-year-old male from Burlington County and a 3-year-old male from Gloucester County both got ill after consuming raw milk from the Family Cow Dairy in Pennsylvania.

The illness typically lasts one week. Some infected people do not have any symptoms. In those with compromised immune systems, Campylobacter occasionally spreads to the bloodstream and causes a life-threatening infection. Long-term complications may include contracting Guillain Barre Syndrome, which may result in paralysis and usually requires intensive care.

The source of this outbreak, Family Cow Dairy, has since been permitted by the Pennsylvania Department of Agriculture to resume bottling. It is important to note that this outbreak occurred despite the fact that Family Cow Dairy is licensed, inspected, and operating in compliance with Pennsylvania laws.

Here is a good overview on the statistics on raw milk risks – “CDC: Raw Milk Much More Likely to Cause Illness”

Also, see Real Raw Milk Facts Outbreak Tables and Reports.

And, for those who think campylobacter is just a “tummy ache,” please watch this video:

Raw Milk Risks: Mari Tardiff Campylobacter Illness from Marlerclark on Vimeo.

Listeria Death Collage.jpgEach of the above died because they ate a listeria-tainted cantaloupe in the United States of America in 2011.  And, these are only my clients, not all of the 36 who died.

To the growers, shippers, brokers, auditors and retailers who supplied those cantaloupes in the summer of 2001, shame on you.  You will have your day of reckoning in a court of law.  To the politicians and public officials, it is time to do your jobs.  To all of you, print this picture and vow that this will never happen again.

Here are all Six Parts of The Deadly 2011 Cantaloupe Listeria Outbreak – My View – Download PDF.

1taco-bell.gifTaco Bell – “Mexican-style fast-food restaurant chain” – Salmonella Outbreak

A 22-year-old Oklahoma woman who says she contracted salmonella after eating at Taco Bell has sued the fast-food company. Leah Smith claims she became sick while attending a University of Oklahoma football game last fall, two days after eating at a Taco Bell in Norman. She says she was sick for two weeks.

The Centers for Disease Control said last month that 16 people in Oklahoma are among 68 people who were infected with salmonella after eating at a “Mexican-style fast-food restaurant chain.”

1JimmyJohnsLogo.jpgJimmy John’s – E. coli Outbreak

An Altoona woman has become the second Iowan to sue Jimmy John’s sandwich chain over an outbreak of foodborne illness linked to sprouts. Mollie Horton, 23, filed the lawsuit Thursday in Polk County District Court. She said she fell ill Dec. 26, days after eating a sandwich from a Jimmy John’s party platter at a family gathering. Horton’s lawsuit said she removed the sprouts from the sandwich but nonetheless caught E. coli poisoning that caused her to be hospitalized for three days and sick for weeks. Testing showed her illness was the result of the strain linked to the outbreak, which sickened 12 people in five states. Federal authorities said last week that five of the 12 patients were from Iowa.

A Jimmy John’s spokeswoman declined to comment. But Horton’s attorney, Bill Marler, says the Illinois-based chain has finally pulled sprouts from its menu.

A Polk County woman sickened for weeks after eating tainted sprouts has filed a lawsuit accusing sandwich chain Jimmy John’s of serving unsafe food. On Tuesday, Heather Tuttle of Clive filed a separate lawsuit in Des Moines seeking damages for pain and suffering. Tuttle was diagnosed with E. coli poisoning after eating a turkey sandwich from a West Des Moines Jimmy John’s in West Des Moines last month. Her lawsuit describes weeks of excruciating cramps and diarrhea that required medical treatment.