December 2012

Norovirus Outbreaks on rise on both sides of the Atlantic.

The BBC reports that ‘Vomiting Larry’ is busy being sick over and over again in an experiment to test just how far the winter vomiting bug can travel when it makes you ill.

Lucky for Larry, he is not a constantly retching human – but a simulated vomiting system that shows the virus can travel an impressive 3m (9.8ft) in a projectile episode, according to his creators at the British Health and Safety Laboratory.

The Centers for Disease Control and Prevention (CDC) estimates that noroviruses cause nearly 21 million cases of acute gastroenteritis annually, making noroviruses the leading cause of gastroenteritis in adults in the United States.  According to a relatively recent article in the New England Journal of Medicine:

The Norwalk agent was the first virus that was identified as causing gastroenteritis in humans, but recognition of its importance as a pathogen has been limited because of the lack of available, sensitive, and routine diagnostic methods. Recent advances in understanding the molecular biology of the noroviruses, coupled with applications of novel diagnostic techniques, have radically altered our appreciation of their impact. Noroviruses are now recognized as being the leading cause of epidemics of gastroenteritis and an important cause of sporadic gastroenteritis in both children and adults.

Of the viruses, only the common cold is reported more often than a norovirus infection—also referred to as viral gastroenteritis.

To learn more about norovirus, visit http://www.about-norwalk.com.

Einstein Bros. issued a recall Monday of a smoked salmon product that the Lakewood, Colo.-based bagel chain sells, saying its supplier notified it of a potential bacteria threat in the food.

Potential Listeria-positive products have been identified and we can confirm that Delifish S.A. has issued a voluntary recall of cold smoked salmon products potentially containing Listeria monocytogenes placed on the market in the USA produced from lots 249 through 291, manufactured between September 5 2012 and October 17, 2012. There have been no complaints or illnesses reported. Listeria monocytogenes is an organism, which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, listeria infection can cause miscarriages and stillbirths among pregnant women.

Product was possibly distributed in the CA, VA, OH, IL, FL, GA, TX, DE, NJ, NY, PA, and Puerto Rico and reached consumers through retail stores. Under the following brand names Black Bear of the Black Forest Smoked Salmon (1 lb., UPC # 810230000493, Lots = 249 thru 291), Food Service Cold Smoked Salmon Trim 1 lb. Lot #’s = 249 thru 291, Einstein Darn Good 4 oz. Retail package UPC # 099892315200, Lot #’s = 249 thru 291, Food Service Whole Smoked Side 3-5 lb. pack food service Lot# ‘s 249 thru 291, Silver Source Smoked Salmon Foodservice 2-3 lb. smoked fillet Lot# ‘s = 249 thru 291, Royal Fjord Smoked Toppers 6oz, UPC = 810230000561, Lot #’s = 249 thru 291, and Royal Fjord Sliced Smoked Salmon Loin, 12-14 oz. Item # 42925 Lot #’s= 249 thru 291 and HEB 4 oz. smoked salmon Package UPC 041220630417 Lot #’s= 249 thru 291

The voluntary recall is carried out as a precautionary measure in cooperation with the U.S. Food and Drug Administration and is based on Listeria detection in a few of the recalled batches. No other products supplied by Delifish or Marine Harvest USA are involved in this case.

Photo: Product Labels

At least 120 people were suspected to have fallen ill in a Salmonella Virchow outbreak tied to the On the Border restaurant in Vancouver, Washington.  That case count included 43 laboratory-confirmed patients and another 77 who exhibited symptoms and had a corresponding exposure history at On the Border. Thus far, the only Salmonella Virchow illnesses reported in the country connected back to On the Border, including patients from Oregon and California who were traveling to the area.  Six were hospitalized.

Customers suffering from a Salmonella Virchow infection ate at On the Border between September 20 and October 8, 2012. The restaurant voluntarily closed between October 9 and 15 as health officials investigated the cause of the outbreak.  The restaurant reopened on October 15.

Environmental testing did not aid health officials in identifying the cause of a Salmonella Virchow outbreak that occurred at an On the Border. As with many foodborne illness outbreaks, the cause will likely remain undetermined.

The Salmonella strain at the center of the outbreak, Salmonella Virchow, is a relatively rare strain in the U.S. The Washington State Department of Health has posted these illnesses on PulseNet, a national epidemiology network, in an effort to track other potential Salmonella Virchow outbreaks around the country.

261 Ill, 3 Deaths, 94 Hospitalizations in 24 States

CDC collaborated with public health officials in many states and the U.S. Food and Drug Administration (FDA) to investigate a multi-state outbreak of Salmonella Typhimurium and Salmonella Newport infections linked to cantaloupe originating from Chamberlain Farms Produce, Inc. of Owensville, Indiana.

Public health investigators used DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that may be part of this outbreak.  They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 261 individuals infected with the outbreak strain of Salmonella Typhimurium and Salmonella Newport were reported from 24 states:  Alabama (25), Arkansas (6), Florida (1), Georgia (13), Illinois (36), Indiana (30), Iowa (9), Kentucky (66), Maryland (1), Michigan (8), Minnesota (2), Mississippi (7), Missouri (17), Montana (1), New Jersey (2), North Carolina (5), Ohio (5), Oklahoma (1), Pennsylvania (2), South Carolina (4), Tennessee (8), Texas (2), Virginia (1), and Wisconsin (9).

Among 257 persons for whom information was available, illness onset dates ranged from July 6, 2012 to September 16, 2012.  Ill persons ranged in age from less than 1 year to 100 years, with a median age of 47 years.  Fifty-five percent (55%) of ill persons were female.  Among 163 persons with available information, 84 (51%) reported being hospitalized.  Three deaths were reported in Kentucky.  Results of antibiotic susceptibility testing indicated that this strain of Salmonella is susceptible to commonly prescribed antibiotics.

From August 14-16, 2012 investigators from the U.S. Food and Drug Administration (FDA) collected samples of cantaloupe at Chamberlain Farms.  They also took samples in the farm’s cantaloupe packinghouse from surfaces that would likely harbor bacteria.  This action was taken in cooperation with the Indiana State Department of Health.  FDA samples of cantaloupe collected at Chamberlain Farms showed the presence of Salmonella Typhimurium with an indistinguishable DNA fingerprint as the outbreak strain.  These samples also showed the presence of Salmonella Newport with a DNA fingerprint that was from the same outbreak strain that sickened 30 people in the states of Illinois, Indiana, Michigan, Missouri, Ohio, Virginia, and Wisconsin.  The link was supported by trace back information collected by state officials in Indiana and Illinois which showed that patients consumed cantaloupe bought at stores supplied by Chamberlain Farms.

On October 3, 2012 the FDA released FDA Form (Inspectional Observations) for Chamberlain Farms.  Federal inspectors observed poor sanitary practices at the firm’s cantaloupe packing shed.  A third Salmonella serotype, Anatum, was isolated in samples obtained via environmental swabs collected from various locations and surfaces in the shed.  FDA inspectors noted that food contact surfaces were not constructed or designed in a manner to allow appropriate cleaning.  Multiple locations of the conveyor rollers and belts had accumulated black, green and brown buildup.  There was standing water in the shed.  The firm’s garbage receptacle was overflowing with garbage constituting an attractant, breeding place, or harborage for pests.

And, this outbreak happened one year after the Listeria cantaloupe outbreak left 147 sick with over 33 dead.

127 infected with Salmonella Braenderup and 16 with Salmonella Worthington

On August 29, 2012 the CDC announced that local, state and federal agencies were conducting an investigation into the source of an apparent outbreak of Salmonella serotype Braenderup.  Results of their collaborative efforts implicated mangoes as the likely source of the outbreak.  By October 11, 2012, the day the CDC declared the outbreak to be over a total of 127 persons infected with the outbreak strain of Salmonella Braenderup had been reported from 15 states.  The number of ill persons identified in each state was as follows: California (99), Delaware (1), Hawaii (4), Idaho (1), Illinois (2), Maine (1), Michigan (1), Montana (1), Nebraska (1), New Jersey (1), New York (3), Oregon (1), Texas (2), Washington (8), and Wisconsin (1).

Among persons for whom information is available, illness onset dates ranged from July 3, 2012 to September 1, 2012. Ill persons ranged in age from less than 1 year to 86 years, with a median age of 33 years. Fifty-six percent of ill persons were female. Among 101 persons with available information, 33 (33%) reported being hospitalized, and no deaths were reported.

The CDC also noted that in August 2012 public health officials investigated an outbreak of Salmonella Worthington in 16 patients residing in 3 states.  Ill persons were reported from similar states and during the same time period as seen in the Salmonella Braenderup outbreak. Eighty-nine percent of ill persons with Salmonella Worthington who were interviewed reported consuming mangoes in the week before their illnesses began.  One person counted as an outbreak case in the Salmonella Braenderup outbreak was co-infected with Salmonella Worthington, a finding that suggested a possible connection between the two outbreaks.

Product traceback initially led investigators to mangoes distributed by Splendid Products of Burlingame, California.  The company issued a recall of certain lots of Daniella brand mangoes on August 29th which was followed by an FDA warning to consumers the next day.  The mangoes were sold between July 12, 2012 and August 29, 2012 at various stores throughout the United States.  FDA investigators traced the mangoes to Agricola Daniella, a mango supplier with multiple farms and a single packing house located in Sinaloa, Mexico.  Three other distributors were identified, Coast Citrus Distributors, Inc. of San Diego, Food Source Inc. of Edinburg, Texas, and GM Produce Sales of Hidalgo, Texas.  Recalls of mangoes by firms supplied by these distributors were issued.

The FDA issued a second warning on September 13th after FDA laboratories had isolated Salmonella in mangoes from Agricola Daniella.  Agricola was place on “Import Alert” which meant their mangoes would be denied admission into the United States until such time they could show they were not contaminated with Salmonella.

The causal link between one of our clients, Dorothy Pearce’s, Salmonella infection and Daniella mangoes is clear.  On August 8, 2012 Mrs. Pearce purchased mangoes at the Haggen Grocery Store located in Stanwood, Washington.  Public health investigators at the Snohomish Health District confirmed that this store received a shipment of Daniella mangoes from Charlie’s Produce.  Mrs. Pearce experienced symptom onset on August 20, 2012.  Her stool specimen collected on August 22nd was positive for Salmonella at PACLAB Network Laboratories.  The Washington Department of Health (WDOH) Public Health Laboratory (PHL) serotyped her isolate as Salmonella Braenderup.  The WDOH PHL conducted Pulsed Field Gel Electrophoresis (PFGE) on Mrs. Pearce’s isolate (Specimen ID#21096).  Results showed that Mrs. Pearce was infected with JBPX01.0101, the strain associated with the Daniella mango outbreak.   Mrs. Pearce spent 10 days in the hospital and still has not yet regained her pre-illness 92 year old vigor.

Most states that allow for punitive damages provide that punitive damages may be awarded if defendant’s conduct is found to be so willful and wanton as to evidence conscious disregard for rights of others.   Read the below and you be the judge.

The FDA, the CDC and state and local public health officials in September 2012 began investigating a multi-state outbreak of Salmonella Bredeney infections eventually linked to peanut butter made by Sunland Inc. of Portales, New Mexico.

CDC collaborated with public health officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Salmonella Bredeney infections linked to Trader Joe’s Valencia Peanut Butter, manufactured by Sunland, Inc. of Portales, New Mexico.

Public health investigators used DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 42 individuals infected with the outbreak strain of Salmonella Bredeney were reported from 20 states: Arizona (1), California (7), Connecticut (3), Illinois (1), Louisiana (1), Massachusetts (3), Maryland (1), Michigan (1), Minnesota (1), Missouri (2), New Jersey (2), New Mexico (1), New York (2), Nevada (1), North Carolina (3), Pennsylvania (2), Rhode Island (1), Texas (5), Virginia (2), West Virginia (2).

Among 39 persons for whom information was available, illness onset dates ranged from June 14, 2012 to September 21, 2012. Ill persons ranged in age from less than 1 year to 79 years, with a median age of 7 years. Sixty-one percent of ill persons were children under the age of 10 years. Fifty-nine percent of ill persons were male. Among 36 persons with available information, 10 (28%) reported being hospitalized, and no deaths were reported.

Testing conducted by the New Jersey Department of Health, Virginia Division of Consolidated Laboratory Services, and Washington State Department of Agriculture laboratories isolated the outbreak strain of Salmonella Bredeney from opened jars of Trader Joe’s Valencia Creamy Peanut Butter collected from case-patients’ homes.

On September 20, FDA, the CDC and the state of California briefed Trader Joe’s on the status of the investigation, and the company voluntarily removed the suspected product from their store shelves. Trader Joe’s has also posted a customer advisory on their internet page and initiated a recall.

On September 23, FDA and CDC briefed Sunland Inc. on the status of the investigation and the company voluntarily recalled the almond butter and peanut butter products that were manufactured on the same product line as Trader Joe’s Valencia Creamy Salted Peanut Butter between May 1 and September 24, 2012.

On October 4, Sunland Inc. expanded its ongoing recall to include all products made in the Sunland nut butter production facility between March 1, 2010 and September 24, 2012. The company added 139 products to the recall, bringing the total number of products recalled by Sunland Inc. to 240. On October 12, Sunland Inc. expanded its ongoing recall to include raw and roasted shelled and in-shell peanuts sold in quantities from 2 ounces to 50 pounds, which are within their current shelf life or have no stated expiration date.

On October 5, the FDA announced that environmental samples taken in the Sunland Inc. nut butter production facility showed the presence of Salmonella. Subsequent analysis determined that Salmonella Bredeney with a DNA fingerprint that is the same as the outbreak strain was present in the samples.  Additionally, FDA analysis confirmed that peanut butter made in the Sunland nut butter facility showed the presence of Salmonella with a DNA fingerprint that is the same as the outbreak strain of Salmonella Bredeney. Testing conducted by the Washington State Department of Agriculture laboratory isolated the outbreak strain from an opened jar of Trader Joe’s Valencia Creamy Peanut Butter collected from a case-patient’s home.

As part of the continuing investigation, the FDA also inspected the Sunland Inc. production facilities, which include a building in which peanuts are processed and a separate building in which nut butters are made. On October 13, FDA announced that testing has found the presence of Salmonella in raw peanuts from the peanut processing facility. Environmental samples taken from this building showed the presence of Salmonella.

The FDA has now made the observations from its recent inspection of Sunland Inc. publicly available. This inspection was conducted between September 17 and October 16, 2012, and became part of the investigation of the Salmonella Bredeney outbreak linked to peanut butter made by Sunland Inc.

During this inspection investigators found that conditions in the company’s facility, the company’s manufacturing processes, and the company’s testing program for Salmonella may have allowed peanut butter that contained Salmonella to be distributed by the company. The FDA found that between June of 2009 and August of 2012, Sunland Inc. had distributed, or cleared for distribution, portions of 11 lots, or daily production runs, of peanut or almond butter after its own testing program identified the presence of at least one of nine different Salmonella types (Arapahoe, Bredeney, Cerro, Dallgow, Kubacha, Mbandaka, Meleagridis, Newport, and Teddington) in those lots. Two of these lots showed the presence of the outbreak strain of Salmonella Bredeney.

Five product samples collected and analyzed by FDA from Sunland Inc. showed the presence of Salmonella, but had not been identified as containing Salmonella by Sunland Inc.’s internal testing. Among those products were peanut butter and shelled raw peanuts. Two of these samples showed the presence of the outbreak strain of Salmonella Bredeney. Additionally, during its inspection of the plant in September and October 2012, the FDA found the presence of Salmonella in 28 environmental samples. Three of these samples showed the presence of the outbreak strain of Salmonella Bredeney.

Additionally, investigators found that employees improperly handled equipment, containers, and utensils used to hold and store food. Employees handling peanut products wiped gloved hands on street clothes and other times failed to wash their hands or change gloves. There were no hand washing sinks in the peanut processing building production or packaging areas and employees had bare-handed contact with ready-to-package peanuts.

There were no records documenting the cleaning of production equipment. The super-sized bags used by the firm to store peanuts were not cleaned despite being used for both raw and roasted peanuts. There was a leaking sink in a washroom, which resulted in water accumulating on the floor, and the plant is not built to allow floors, walls and ceilings to be adequately cleaned.

Finally, investigators found that raw materials were exposed to potential contamination. Raw, in-shell peanuts were found outside the plant in uncovered trailers. Birds were observed landing in the trailers and the peanuts were exposed to rain, which provides a growth environment for Salmonella and other bacteria. Inside the warehouse, facility doors were open to the outside, which could allow pests to enter.

So, what’s your judgment?

Over the last month we reached confidential settlements for victims of one of the largest Salmonella outbreaks of 2012.

Local, state, the CDC and the U.S. Food and Drug Administration (FDA) collaborated in an investigation of a multistate outbreak of Salmonella Bareilly and Salmonella Nchanga infections, which was ultimately shown to be associated with consumption of an imported frozen raw yellow fin tuna product, known as Nakaochi Scrape, from Moon Marine USA Corporation. Nakaochi Scrape is tuna backmeat that is scraped from the bones of tuna and may be used in sushi, sashimi, ceviche, and similar dishes.

Salmonella Bareilly and Salmonella Nchanga are unusual serotypes of Salmonella in the United States. Public health investigators used DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that were counted as outbreak associated cases.  They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 425 individuals infected with the outbreak strains of Salmonella Bareilly or Salmonella Nchanga. Four hundred and ten persons infected with the outbreak strain of Salmonella Bareilly were reported from 28 states and the District of Columbia. The number of ill persons infected with the outbreak strain of Salmonella Bareilly identified in each state was as follows: Alabama (5), Arkansas (1), California (8), Colorado (1), Connecticut (11), District of Columbia (3), Florida (1), Georgia (20), Illinois (30) Indiana (1), Kansas (1), Louisiana (6), Massachusetts (36), Maryland (39), Missouri (4), Mississippi (2), Nebraska (2), New Hampshire (2), New Jersey (39), New York (62), North Carolina (12), Pennsylvania (37), Rhode Island (6), South Carolina (5), Tennessee (4), Texas (14), Virginia (33), Vermont (1), and Wisconsin (24).

Fifteen persons infected with the outbreak strain of Salmonella Nchanga were reported from 7 states. The number of ill persons infected with the outbreak strain of Salmonella Nchanga identified in each state was as follows: Georgia (2), Maryland (1), New Jersey (3), New York (6), Texas (1), Virginia (1), and Wisconsin (1).

Illness onset dates ranged from January 1 to July 7, 2012.  Ill persons ranged in age from less than 1 year to 86 years, with a median age of 30 years; 60% of patients were female. Among 326 persons with available information, 55 (17%) reported being hospitalized. No deaths were reported.

Interviews of ill persons conducted by states in March and April, 2012 suggested consumption of sushi made with raw tuna as a source of these infections. By April 11, 2012, 43 (81%) of 53 ill persons interviewed with a detailed questionnaire reported eating sushi. This proportion was significantly higher when compared with results from a survey of healthy persons in which 5% reported eating “sushi, sashimi, or ceviche made with raw fish or shellfish” in the 7 days before they were interviewed. Of the 43 ill persons reporting eating sushi, 39 (91%) reported eating a sushi item containing tuna and 36 (84%) reported eating a sushi item containing “spicy tuna.”

Several methods were used to evaluate the association between tuna and illness in this outbreak. On March 29, 2012, a study was launched to estimate the frequency of consumption of tuna and “spicy tuna” among all sushi eaters. Investigators assembled a comparison group from 1) diners who ate at one of the cluster restaurants or grocery stores or 2) a restaurant where a single ill person, who was judged to have a reliable memory, recalled consuming sushi only once in the week before illness. Records were collected on sushi orders that were placed at the same time of day (lunch or dinner) and as close to the date when the ill person ate at the restaurant.

On April 9, 2012, preliminary results of the comparison study using information available from 4 illness clusters at restaurants or grocery stores showed that the proportion of sushi orders that contained tuna as an ingredient averaged 61% (ranging from 43% to 71%). The proportion of sushi orders that contained “spicy tuna” as an ingredient averaged 37% (ranging from 29% to 53%). These data suggested there was an association between illness and consumption of sushi made with tuna, and specifically “spicy tuna.”

State and local public health and regulatory officials worked with the U.S. Food and Drug Administration (FDA) to conduct a traceback investigation of tuna. Investigators visited restaurants and grocery stores associated with ill persons and collected information about the ingredients used in “spicy tuna” recipes. Raw tuna was found to be a common ingredient used to make “spicy tuna” among all 5 restaurant or grocery store clusters for which ingredient information was available. FDA selected 4 of the clusters, which were located in Connecticut, Rhode Island, Texas, and Wisconsin, as the focus of the initial traceback investigation. All 4 establishments received the same imported frozen raw Nakaochi Scrape tuna product from a single tuna processing facility in India, Moon Fishery Pvt Ltd.

On April 13, 2012, Moon Marine USA Corporation (also known as MMI) of Cupertino, California voluntarily recalled 58,828 pounds of a frozen raw yellow fin tuna product, labeled as Nakaochi Scrape AA or AAA. A Seafood HACCP (Hazard Analysis and Critical Control Point) inspection was conducted by FDA April 19–24, 2012 at the Moon Fishery Pvt Ltd. processing facility in Aroor, India. Based on the initial tour of the facility, inspectors identified several seafood HACCP deficiencies, such as lack of controls for histamine at receipt of product, lack of controls for Clostridium botulinum at storage, and several significant sanitation observations of concern. A copy of the inspection observations document is available.

During the investigation, samples of the implicated product were collected for laboratory testing. On April 24, 2012, the Wisconsin Department of Health Services announced that the Department of Agriculture Trade and Consumer Protection laboratory had found Salmonella Bareilly contamination in recalled yellow fin tuna and in a spicy tuna roll made with the recalled tuna.

On April 26, 2012, FDA announced finding the outbreak strain of Salmonella Bareilly from two samples taken from unopened packages of recalled Nakaochi Scrape tuna from Moon Marine USA Corporation. One of the samples also yielded another type of Salmonella with a PFGE pattern indistinguishable from a cluster of Salmonella Nchanga infections. Based on an epidemiological link and results of laboratory testing, CDC combined the Salmonella Bareilly investigation with an ongoing Salmonella Nchanga investigation, and the 2 associated PFGE patterns were grouped together as the “outbreak strains.”

By May 17, 2012, laboratory testing conducted by state public health laboratories in Connecticut, Maryland, Massachusetts, Pennsylvania, South Carolina, and Wisconsin isolated Salmonella from 53 (96%) of 55 samples taken from intact packages of frozen yellow fin tuna scrape from Moon Marine USA Corporation or from sushi prepared with the implicated scrape tuna product. Of the 41 Salmonella isolates for which PFGE results are available, 36 samples yielded the outbreak strain of Salmonella Bareilly, and 12 samples yielded the outbreak strain of Salmonella Nchanga. Seven samples yielded the outbreak strains of both Salmonella Bareilly and Salmonella Nchanga.

On May 10, 2012, Moon Fishery (India) Pvt. Ltd., the manufacturer of the frozen yellow fin tuna Nakaochi Scrape, expanded the voluntary to include its 22-pound boxes of “Tuna Strips”, Product of India, marked as “AA” or “AAA Grade” because the product has the potential to be contaminated with Salmonella. The recall was announced after FDA laboratories isolated the outbreak strain of Salmonella Bareilly from a sample of tuna strips from Moon Fishery (India) Pvt Ltd collected as part of increased surveillance efforts. The shipment in question did not enter into U.S. commerce and no human illnesses were associated with this product.

In 2012 the CDC collaborated with public health and regulatory officials in several states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Listeria monocytogenes infections (listeriosis). Joint investigation efforts indicated that ricotta salata cheese was the likely source.

Public health investigators used DNA “fingerprints” of Listeria obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that were part of this outbreak. They used data from PulseNet, the national subtyping network made up of state and local public health laboratories and federal food regulatory laboratories that performs molecular surveillance of foodborne infections.

A total of 22 persons infected with the outbreak strain of Listeria monocytogenes were reported from 13 states and the District of Columbia. The number of ill people identified in each location was as follows: California (3), Colorado (1), District of Columbia (1), Maryland (3), Massachusetts (1), Minnesota (1), Nebraska (1), New Jersey (3), New Mexico (1), New York (1), Ohio (1), Pennsylvania (2), Virginia (2), and Washington (1).

Among persons for whom information is available, dates that illness was diagnosed ranged from March 28, 2012 to October 6, 2012. Twenty ill persons were hospitalized. Nine of the illnesses were related to a pregnancy; three of these were diagnosed in newborns. The other 13 ill persons ranged in age from 30 years to 87 years, with a median age of 77 years, and 54% were female. Four deaths were reported, one each from Minnesota, New York, Nebraska, and California. In Nebraska and California, public health officials determined that the deaths were related to listeriosis. In Minnesota and New York, public health officials did not report listeriosis as a cause of death because it was not listed as such on the death certificates. One fetal loss also was reported.

Epidemiologic, laboratory, and traceback investigations conducted by officials in local, state, and federal public health, agriculture, and regulatory agencies indicated that Frescolina Marte brand ricotta salata cheese imported from Italy and distributed by Forever Cheese, Inc. was the likely source of this outbreak of listeriosis.  FDA isolated the outbreak strain of Listeria from a sample of uncut Frescolina Marte brand ricotta salata cheese, which was imported from Italy and distributed by Forever Cheese, Inc. The outbreak strain was also isolated from other types of soft cheese that had already been cut and repackaged.

This is what one of my clients had in her arm for weeks as she fought Listeria from cheese with powerful antibiotics:

Over the years we have investigated, and pieced together, several leafy green outbreaks that are never publicly announced despite being the cause of severe illness.  Here is an outbreak from 2009 that should have prompted a multi-state public health warning and recall, but was instead quietly put under the “leafy green cone of silence” as a food safety leader adeptly calls these non-announcements.  The Denver Post had a few things to say about this outbreak earlier this year too.

In mid-September 2009, the Colorado Department of Public Health and Environment (CDPHE) identified two cases of E. coli O157:H7 cases with “matching” PFGE patterns.  In conjunction with local health officials, CDPHE began an investigation of the two Colorado cases.  During the early stages of the investigation, CDPHE officials were notified that Minnesota was reporting a person with an E. coli O157:H7 infection, also with a matching PFGE pattern.  Ultimately, it would be revealed that the cluster of E. coli O157:H7 infections with matching PFGE patterns encompassed 10 ill individuals in six states, Colorado (2) Connecticut (1), Iowa (2), Minnesota (3), Missouri (1), and North Carolina (1).

The cluster of illnesses sparked a multi-state investigation, conducted primarily by CDPHE, Minnesota Department of Health (MDH), Minnesota Department of Agriculture (MDA), Iowa Department of Public Health (IDPH) and the North Carolina Department of Health and Human Services (NCDHHS.)  The investigation by CDPHE revealed that the two Colorado cases had dined at the same restaurant in Pueblo, Colorado, Giacomo’s, on the same day, September 6, 2009.  In fact, both of the ill restaurant patrons had consumed a house salad, containing iceberg and romaine lettuce.  See April 30, 2010 CDPHE Report, Attachment No. 1.  Based on information coming in from other states, CDPHE officials conducted traceback on the lettuce and noted:

The restaurant in question obtains their romaine and iceberg lettuce from U.S. Foodservice under the name Cross Valley Farms.  This is an exclusive brand of U.S. FoodService.  US Foodservice receives both their romaine and iceberg lettuce from Tanimura and Antle in Salinas, CA.

See Email from Jennifer Sadlowski, 11/13/09, Attachment No. 2.

The investigation soon revealed a link to the same romaine lettuce for other states’ ill persons as well.  Both Iowa cases, and one of the three Minnesota cases ate at the same restaurant in Omaha, Nebraska on September 5, 2009.  See Attachment No. 3, CDPHE Records, 004, 0011.  These three all consumed lettuce at the restaurant.  See Attachment No. 4, CDPHE Records, 0013-0014.  Minnesota’s supervising epidemiologist Kirk Smith wrote in an email on October 28, 2009 with respect to the Colorado and Nebraska restaurants:  “invoices showed that they both get the same brand of romaine lettuce (Cross Valley Farms.).”  See Attachment No. 5, CDPHE Records, p. 0020.

This understanding of the connection to Cross Valley Farms lettuce is consistent with the records generated by Minnesota Department of Agriculture as well.  MDA officials kept a “Daily Outbreak Summary” throughout the investigation.  The update for October 21, 2009 states in reference to the CO and NE restaurant, “From comparing the invoices of these two restaurants, they both use Cross Valley Farms Romaine in salads that the cases ate.”  The October 30, 2009 update says “The restaurants in CO and NE that are associated with the cases in those states served Cross Valley Farms whole romaine lettuce heads.  Cross Valley Farms is a label of U.S. Foodservice.  The romaine for CO came from a U.S. Foodservice distributor in Denver, the romaine for NE came from a U.S. Foodservice distributor in Omaha.”  See Attachment No. 6, MDA Records, 0045-0047.

For the remaining members of the cluster for whom information was available, investigation also suggested romaine lettuce as the source. All of this led the lead investigators to conclude that romaine lettuce from Tanimura and Antle, distributed by U.S. Foodservice was the source of the cluster of E. coli O157:H7 infections.  The email from Minnesota’s Dr. Smith sums it up well while imploring CDC to further investigate the cluster:

Briefly, there are three people (2 Iowa residents and one Minnesota resident) who ate at the same exact Italian restaurant in Omaha, Nebraska on September 5.  Two Colorado residents ate (independently) at the same Italian restaurant in Pueblo [CO].  The Nebraska and Colorado restaurants are not part of the same chain.   All of the 5 cases had salads, and invoices from the two restaurants showed that they both get the same brand of romaine lettuce (Cross Valley Farms).  Again – rock solid…. (emphasis added).

See Attachment No. 7, Email IDPH Records, 0019.

For further information, See the full CDPHE Records, Attachment No. 8; Minnesota Department of Agriculture Records, Attachment No. 9; Iowa Department of Public Health Records, Attachment No. 10; Pueblo County Health Department Records, Attachment No. 11; Minnesota Department of Health Records, Attachment No. 12; North Carolina Department of Health and Human Services Records, Attachment No. 13; and Missouri Department of Health Records, Attachment No. 14.

The excuses you hear from both government and industry vary, but two themes are the same:

1.  By the time the outbreak is figured out all the product has been consumed so why announce the outbreak or recall the product since there is no more product in the market.

2.  The FDA and CALFERT no longer have the manpower to do a complete traceback to the specific field where the leafy greens were grown.

My thought is that the public has a right to know what has sickened them.  Consumers with knowledge help the marketplace weed out growers, shippers and retailers that manufacture and sell tainted food.  Knowing that allows consumers to “vote with their pocketbook.”  As for the lack of manpower for surveillance, outbreak investigation and traceback, I tend to agree that we need more resources.  Being able to trace an outbreak to a likely source allows for learning how to prevent the next one.

What are your thoughts?

British News reports a new strain of Methicillin-resistant Staphylococcus aureus (MRSA) has been found in British milk.  The new strain, MRSA ST398, has been identified in seven samples of bulk milk from five different farms in England.  The discovery, from tests on 1,500 samples, indicates that antibiotic-resistant organisms are gaining an increasing hold in the dairy industry.

The disclosure comes amid growing concern over the use of modern antibiotics on British farms, driven by price pressure imposed by the big supermarket chains. Intensive farming with thousands of animals raised in cramped conditions means infections spread faster and the need for antibiotics is consequently greater.

Three classes of antibiotics rated as “critically important to human medicine” by the World Health Organisation – cephalosporins, fluoroquinolones and macrolides – have increased in use in the animal population by eightfold in the last decade.

The more antibiotics are used, the greater the likelihood that antibiotic-resistant bacteria, such as MRSA, will evolve.

Experts say there is no risk of MRSA infection to consumers of milk or dairy products so long as the milk is pasteurized.

The risk comes from farmworkers, vets and abattoir workers, who may become infected through contact with livestock and transmit the bug to others.