June 2012

Romaine_Lettuce_Crop.jpgThe CBC reported yesterday that romaine lettuce is the likely source of an E. coli O157:H7 outbreak in Miramichi in April that sickened 18 at a Jungle Jim’s Restaurant. Dr. Eilish Cleary, the chief medical officer of health, said all of those in the study who were sick with E. coli O157:H7 appear to have consumed romaine lettuce.

“The lettuce was used in salads, as an ingredient in wraps and hamburgers and as a garnish. These results indicate a strong likelihood that contaminated lettuce was served at the restaurant,” Cleary said in a statement.

According to the CBC, the federal agency became aware that cases matching the E. coli O157:H7 strain involved in the Miramichi outbreak had also been identified in Quebec AND CALIFORNIA.

So, is the California case an ill person who ate lettuce in Canada and came to California, or ate lettuce in California – and where did the lettuce come from – California?  Canada?  Some where else?

Well, according to the CBC:

The lettuce is no longer in the marketplace and the investigation has been closed, the department said.

Boy, don’t you feel better now?

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Florida sees spike in Shigella too.

James Mulder of the Syracuse Post-Standard reported to today that the Onondaga County Shigella outbreak has increased to 21 confirmed cases and 13 probable cases.  This is up nine from last week.

Dr. Cynthia Morrow, the county’s health commissioner, said her department has not yet pinpointed the source of the outbreak.

Many of those infected developed fever, painful bloody or mucous diarrhea and stomach cramps a day or two after being exposed to the bacteria, called Shigella. The illness usually clears up in five to seven days. Severe cases need to be treated with antibiotics.

About half of those infected are children under age 10, Morrow said.

The bacteria are present in the stool of the infected person. It can be spread to someone else if an infected person does not wash his or her hands before handling food and touching other people.

Morrow said her investigators suspect the infection is being spread through a combination of contaminated food and person-to-person transmission.

People with symptoms should contact their health providers and keep track of what they ate in the four days before becoming ill, Morrow said.

I have seen a few of these outbreaks over the last decade:

Also, according to the Santa Rosa Florida Health Department, cases of Shigellosis are on the rise. The health department has been receiving reports of one or two cases almost on a daily basis and most are in small family clusters and in-home daycare facilities.

KOIN TV Sally Showman reported on a very interesting way of contracting Salmonella.

SalmonellaLabDish.jpgA teenager was sickened by a strain of Salmonella that originated inside a Clark College microbiology lab earlier this month. 

“We believe the child could have been infected one of two ways,” Catherine Kroll, an epidemiologist with the Clark County Public Health Department (CCPH) said. “The first could be that the person working in the lab became ill and brought that home… Or that person brought home items that were used in the lab, such as pens and pencils and those were then used by the child.”

Clark College spokeswoman Barbara Kerr released a written statement last Friday morning:

“This type of incident has never happened before in our nearly 79-year history, but one time is one too many. We appreciate the opportunity to work closely with Clark County Public Health to ensure that we are implementing best practices in our classrooms.  The safety of our students always comes first.”

CCPH did a review of Clark College lab procedures after the case of salmonella was reported. 

“One of the big recommendations we made involved taking personal items in and out of the lab,” Kroll said.  “Often, students will bring pens and pencils from home and use them in the laboratory, and what we’ve recommended, is that Clark College actually purchase pens and pencils and keep them in the lab and not have students take them back and forth.”

You have to wonder how often this really does happen?  Earlier this year the CDC reported that it had collaborated with public health officials in several states to investigate a multistate cluster of Salmonella Typhimurium infections associated with exposure to clinical and teaching microbiology laboratories.  Apparently, between August 20, 2010 and June 29, 2011, a total of 109 individuals infected with strain X of Salmonella Typhimurium were reported from 38 states: AK (2), AL (4), AZ (4), CA (3), CO (1), FL (1), GA (6), IA (1), ID (2), IL (4), IN (2), KS (4), KY (4), MA (4), MD (3), MI (3), MN (9), MO (2), NC (1), ND (1), NE (2), NH (1), NJ (3), NM (3), NV (1), NY (4), OH (3), OK (1), OR (1), PA (9), SC (2), SD (1), TN (2), TX (1), UT (4), WA (5), WI (4), and WY (1). Among persons with available information, illness onset dates range from August 20, 2010 to June 14, 2011, 2011. Infected individuals ranged in age from less than 1 year to 91 years old, and the median age was 21 years. Sixty-one percent of patients were female. Twelve percent of patients were hospitalized. One death was reported.

According to KTIV this morning:

We’ll have to wait a while longer to learn the details of a lawsuit being filed by a former employee of Dakota Dunes-based Beef Products Incorporated. Bruce Smith has postponed a news conference he had scheduled for this afternoon at company headquarters. No explanation was given for the postponement and no new date was given. Smith says he lost his job because of the controversy over Lean, Finely Textured Beef and said he is suing a “national news broadcasting company,” and other individuals involved.

I was hoping to get a copy of the complaint and a book.

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062512-map.jpgAccording to the CDC, epidemiologic, laboratory, and traceback findings have linked this outbreak of human Salmonella infections to contact with chicks, ducklings, and other live baby poultry from Estes Hatchery in Springfield, Missouri.

A total of 66 persons infected with the outbreak strain of Salmonella Montevideo have been reported from 20 states.

The number of ill persons identified in each state is as follows: Alaska (1), California (2), Colorado (1), Georgia (1), Illinois (1), Indiana (8), Iowa (2), Kansas (10), Kentucky (1), Massachusetts (1), Missouri (22), Nebraska (5), Nevada (1), New York (1), North Carolina (1), Ohio (1), Oklahoma (4), South Dakota (1), Vermont (1), and Wyoming (1).

16 Ill persons have been hospitalized. One death was reported in Missouri, but Salmonella infection was not considered a contributing factor in this person’s death.

35% of ill persons are children 10 years of age or younger.

Hmmm, where have I heard this before?  Right, the CDC:

As of June 7, 2012, a total of 123 persons infected with outbreak strains of Salmonella Infantis, Salmonella Newport, and Salmonella Lille have been reported from 25 states. The number of ill persons identified in each state is as follows: Alabama (4), Delaware (1), Georgia (5), Illinois (1), Indiana (3), Kansas (1), Kentucky (5), Louisiana (1), Massachusetts (1), Maryland (1), Maine (3), Michigan (1), Nebraska (1), New Jersey (1), New York (16), North Carolina (12), Ohio (30), Pennsylvania (10), Rhode Island (1), South Carolina (1), Tennessee (8), Texas (2), Vermont (1), Virginia (6), and West Virginia (7). 26 ill persons have been hospitalized. One death has been reported in New York, but it is unclear whether infection contributed to this death. 36% of ill persons are children 10 years of age or younger.

As of October 4, 2011, a total of 68 individuals infected with the outbreak strain of Salmonella Altona were been reported from 20 states. The number of ill persons identified in each state is as follows: Georgia (1), Illinois (1), Indiana (1), Kentucky (6), Maryland (5), Michigan (1), Minnesota (1), Mississippi (1), New Hampshire (1), New York (4), North Carolina (9), Ohio (12), Pennsylvania (6), South Carolina (1), Tennessee (3), Texas (2), Virginia (7), Vermont (1), Wisconsin (1), and West Virginia (4). 19 were hospitalized. No deaths were reported. In addition, a total of 28 individuals infected with the outbreak strain of Salmonella Johannesburg were reported from 15 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), Georgia (2), Indiana (1), Kansas (1), Kentucky (2), Maine (1), New York (4), North Carolina (4), Ohio (3), Pennsylvania (1), South Carolina (1), Tennessee (3), Vermont (2), and West Virginia (1). 9 were hospitalized. No deaths have been reported.

According to KTIV TV, a “former BPI employee will file a civil lawsuit following the controversy surrounding lean, finely textured beef — or LFTB” (a.k.a. Pink Slime).  “[T]he civil suit he’ll file against a ‘national news broadcasting company,’ and other individuals involved.”  Here is the press release that propmted the story:

“PINK SLIME” Press Release

You are invited to attend:

webst9197.pngFormer Beef Products (BPI) EHS Director, Bruce Smith, will be holding a press conference on June 26, 2012, commencing at 1:30 pm at Sterling Green Estates Meeting Room, 320 Dakota Dunes Blvd., Dakota Dunes, South Dakota, to announce his filing of a civil lawsuit against a national news broadcasting company and other prominent individuals involved in the “pink slime” ground beef controversy Smith now refers to as March Meat Madness Month 2012 in his new book on the subject entitled Pink Slime Ate My Job, a soon to be released non-fiction account from an insider’s standpoint, published by Rauttnee Publishing Company. Smith is one of nearly 1,000 employees who lost their jobs after BPI was forced to close three of its four lean beef production plants following the ‘viral’ explosion of the “pink slime” news story beginning in March 2012. Copies of the lawsuit will be provided to those attending, along with an introduction to Smith’s new book about the “pink slime” saga from the insider’s viewpoint.

Contact: Lisa K. Smith, Public Relations Manager, Rauttnee Publishing Company, Phone: 605-422-0174, Email: rauttneepublishing@hotmail.com

Lawsuit or book PR move?

Looking at the Salmonella Tuna Scrape (they really need a better name for it) outbreak numbers yesterday, it got me spending some of my day at work today looking at CDC data over the last few years on outbreak surveillance, investigations, announcements and governemnt or business recalls. 

Looking at the data, it is fairly clear that most – but not all – outbreaks are not figured out until far into the epi curve or not until the outbreak is winding down.  It raises the question how we can arm, local, state and federal investigators with the tools to figure out outbreaks earlier and prevent more illnesses. 

In addition, I still have that nagging issue of recall effectiveness.  Again, many – but not all – recalls are not effective at stopping the consumption of the “recalled” tainted product – consumers consume it first.  What tools do pubic health officials, food manufacturers, retailers and consumers need to know so they know what has been recalled and what has not been?

Peanut Corporation of America Salmonella Outbreak 2009 As of April 20, 2009, 714 persons infected with the outbreak strain of Salmonella Typhimurium have been reported from 46 states. The number of ill persons identified in each state is as follows: Alabama (2), Arizona (14), Arkansas (6), California (81), Colorado (18), Connecticut (11), Florida (1), Georgia (6), Hawaii (6), Idaho (17), Illinois (12), Indiana (11), Iowa (3), Kansas (2), Kentucky (3), Louisiana (1), Maine (5), Maryland (11), Massachusetts (49), Michigan (38), Minnesota (44), Missouri (15), Mississippi (7), Montana (2), Nebraska (1), New Hampshire (14), New Jersey (24), New York (34), Nevada (7), North Carolina (6), North Dakota (17), Ohio (102), Oklahoma (4), Oregon (15), Pennsylvania (19), Rhode Island (5), South Dakota (4), Tennessee (14), Texas (10), Utah (8), Vermont (4), Virginia (24), Washington (25), West Virginia (2), Wisconsin (5), and Wyoming (2). Additionally, one ill person was reported from Canada.  Infection may have contributed to nine deaths: Idaho (1), Minnesota (3), North Carolina (1), Ohio (2), and Virginia (2). Among the persons with confirmed, reported dates available, illnesses began between September 1, 2008 and March 31, 2009.  Recall: January 28, 2009 (red bar).

PCA_typhimurium_epi_042909.jpgJimmy John’s Salmonella Sprout Outbreak 2009 As of May 7, 2009, 235 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 14 states. The number of ill persons identified in each state is as follows: Nebraska (111), Iowa (35), South Dakota (38), Michigan (19), Kansas (8), Pennsylvania (7), Minnesota (5), Ohio (3), Illinois (2), Virginia (2), West Virginia (2), Florida (1), North Carolina (1), and Utah (1).  Among the 234 persons with known illness onset dates, illnesses began between February 1 and April 15, 2009.  Recall: March 3, 2009 (red bar).

Sprout-2009-05-08_epi.jpgWright County Egg Salmonella Outbreak 2010 In July 2010, CDC identified a nationwide sustained increase in the number of Salmonella Enteritidis isolates with PFGE pattern JEGX01.0004 uploaded to PulseNet.  From May 1 to November 30, 2010, a total of 3,578 illnesses were reported.  Based on the previous 5 years of reports to PulseNet, the CDC would expect approximately 1,639 total illnesses to occur during this same period. This means there are approximately 1,939 reported illnesses that are likely to be associated with this outbreak.  There was one death.  Recall: August 13, 2010 (red bar).

2010-Egg-120210_epi.jpgJimmy Johns Salmonella Sprout Outbreak 2010 From November 1, 2010, through February 9, 2011, 140 individuals infected with the outbreak strain of Salmonella serotype I 4,[5],12:i:-, whose illnesses began (onset dates) since November 1, were reported from 26 states and the District of Columbia. The number of ill persons identified in each state and the District of Columbia with the outbreak strain is as follows: Arkansas (1), California (1), Colorado (1), Connecticut (1), District of Columbia (1), Georgia (1), Hawaii (1), Iowa (1), Illinois (70), Indiana (13), Kentucky (1), Louisiana (1), Massachusetts (2), Maryland (1), Missouri (23), Nebraska (1), Nevada (1), New Jersey (1), New York (2), North Carolina (1), Oregon (1), Pennsylvania (4), South Carolina (1), South Dakota (1), Tennessee (2), Virginia (2), and Wisconsin (4). Among 138 persons for whom information is available, reported illness onset dates range from November 1 to January 18, 2011.  Recall: December 29, 2010 (red bar).

Jimmy-Johns-2010-021011_epi.jpgCargill Ground Turkey Salmonella Outbreak 2011 A total of 136 persons infected with the outbreak strain of Salmonella Heidelberg were reported from 34 states with illness onset dates between February 27 and September 13, 2011. The number of ill persons identified in each state was as follows: Alabama (1), Arkansas (1), Arizona (3), California (7), Colorado (4), Connecticut (1), Georgia (2), Illinois (16), Indiana (2), Iowa (2), Kansas (3), Kentucky (2), Louisiana (1), Massachusetts (4), Maryland (1), Michigan (12), Minnesota (2), Mississippi (2), Missouri (7), Nebraska (2), Nevada (1), New Jersey (1), New York (3), North Carolina (4), Ohio (12), Oklahoma (2), Oregon (1), Pennsylvania (8), South Dakota (3), Tennessee (2), Texas (18), Utah (1), Vermont (1), and Wisconsin (4).  One death was reported.  Among persons for whom information was available, illnesses began on or after February 27, 2011.  Recall: August 3, 2011 (red bar).

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Pine Nuts Salmonella Outbreak 2011 A total of 43 individuals infected with the outbreak strain of Salmonella Enteritidis were reported from 5 states. The number of ill persons identified in each state with the outbreak strain was as follows: Maryland (1), New Jersey (2), New York (28), Pennsylvania (8), and Virginia (4).  Among 43 persons for whom information was available, illnesses began on or after August 20, 2011.  Recall:  October 26, 2011 (red bar).

Pine Nuts - 111711epi.jpgDog Food Salmonella Outbreak 2012 A total of 22 individuals infected with the outbreak strain of Salmonella Infantis have been reported. Twenty ill persons have been reported from 13 states. The five new cases are from: Alabama (1), California (1), Illinois (1), New York (1), and South Carolina (1).  Additionally, two ill persons have been reported from Canada.  Among persons for whom information is available, illnesses began between October 2011 and May 11, 2012.  Recall:  April 2, 2012 (red bar).

Dog-Food061312-epi.jpgSo, readers and subscribers, what are the solutions to getting on top of outbreaks earlier and making recalls actually recalls? 

The goal of course it to avoid the outbreak and the recall in the first place.

One other pet peeve, many of the people who are sickened in an outbreak are never told by local, state or federal health authorities that they are part of an outbreak.  Why is that?

The CDC reported this week that a total of 390 persons infected with the outbreak strains of Salmonella Bareilly (376 persons) or Salmonella Nchanga (14 persons) have been reported from 27 states and the District of Columbia.  Of those sickened, 47 people have been hospitalized – fortunately no deaths have been reported. 

Investigation efforts of state, local, and federal public health agencies, including the FDA, indicate that a frozen raw yellow fin tuna product, known as Nakaochi Scrape, imported from India by Moon Marine is the likely source of this outbreak.  Moon Marine recalled nearly 60,000 pounds of its Scrape on April 18, 2012.  The CDC made its first announcement that a Salmonella outbreak was occurring on April 4, 2012.  Salmonella illness onset dates range from January 1, 2012 to June 3, 2012.

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Since the Moon Marine recall (see red line above) and CDC announcement, over 100 of the 390 people have consumed the “recalled” Scrape and become ill.  In its announcement this week the CDC also warned that, although the numbers of new cases have declined substantially since the peak in April 2012:

the outbreak may continue at a low level for the next several months since some food establishments may be unaware that they received recalled product and continue to serve this frozen raw yellow fin tuna product, which has a long shelf life.

Over 100 sickened AFTER the outbreak and recall were announced?  Do Scrape eaters have a death wish – hmm, perhaps do not answer that.  However, you have to ask yourself why a food establishment would be unaware that it received the recalled product and continue to sell it or serve it to unsuspecting customers?  It also does not speak well of the recall itself if food establishments – likely grocery stores and restaurants – keep serving tainted Scrape months after a confirmed Salmonella outbreak linked to a recalled product.  So much for FDA’s “mandatory recall authority.”  Why is the FDA not mandating that Moon Marine contact each food establishment and pick up the Scrape?

Perhaps it is time for a bit more transparency from India to your sushi roll?  Perhaps if the FDA named the food establishments that received the Scrape from Moon Marine they would know not to serve it and consumers would know where not to eat it?  FDA’s sister agency FSIS has been doing exactly that for nearly four years.

On August 18, 2008 after years of hand wringing, the FSIS finally put public health before “proprietary” business interests when it made the following rule:

9 C.F.R. § 390.10 Availability of Lists of Retail Consignees during Meat or Poultry Product Recalls

The Administrator of the Food Safety and Inspection Service will make publicly available the names and locations of retail consignees of recalled meat or poultry products that the Agency compiles in connection with a recall where there is a reasonable probability that the use of the product could cause serious adverse health consequences or death.  The full rule can be reviewed at: http://www.fsis.usda.gov/OPPDE/rdad/FRPubs/2005-0028F.pdf

So, FDA, what is your plan?