April 2013

Setting up the Food Safety News booth today in Baltimore and reconnecting with food safety friends from around the world made me forget for a moment that perhaps food poisoning was still going on – but it is.

Health district officials say Salmonella is to blame for an outbreak at one of the most popular restaurants in Las Vegas, although the exact source is still unknown.  Southern Nevada Health District officials say more than three dozen patrons reported Salmonella food poisoning symptoms after dining at Firefly on Paradise Road. The restaurant was shuttered Friday and remains closed while health officials investigate.  Health district official Amy Irani said Monday that 39 patrons reported symptoms, and 10 said they sought medical attention. Symptoms included diarrhea and vomiting.

An East Topeka Mexican restaurant and meat market has been forced to temporary close after more than 20 people reportedly became sick after eating its food.  Carniceria Camecuaro, 1016 S.E. 6th, has been closed since Sunday after the Kansas Department of Agriculture advised it to shut down.  Carniceria Camecuaro will remain closed while KDA conducts follow-up inspections and directs potentially contaminated food to be thrown out. The staff also has to undergo further training regarding food safety codes. Depending on how that goes, the establishment could be open within the week, said Charlie Hunt, epidemiologist with the Kansas Department of Health and Environment.  KDA and KDHE, which handles food-borne illness outbreaks, were advised of the issue Sunday when a local hospital reported at least four people suffering from food poisoning after eating at the restaurant, Hunt said.  Additional complaints have come in, he said, estimating that more than 20 people were affected by the restaurant’s food. Based on interviews, he said, the culprit looks to be the pork carnitas.  Although the investigation continues, the current hypothesis was that the food-borne illness was caused by a bacterium known as staphylococcus aureus, Hunt said.

In December 2009 the Minnesota Department of Health (MDH) uploaded results of molecular testing by Pulsed Field Gel Electrophoresis (PFGE) of an E. coli O157:H7 isolate cultured from a patient stool specimen to PulseNet, a national database of molecular subtyping or “fingerprinting” of foodborne disease causing bacteria.  The Minnesota isolate was assigned PulseNet 2-enzyme pattern designation EXHX01.0248/EXHA26.0569.   PulseNet staff quickly identified 13 additional isolates in patients residing in 11 states.

The Centers for Disease Control and Prevention (CDC) and state investigators identified 25 patients residing in 17 states (California, Colorado, Florida, Hawaii, Iowa, Indiana, Kentucky, Michigan, Minnesota, Nebraska, Nevada, Ohio, Oklahoma, South Dakota, Tennessee, Utah, and Washington) as being part of the outbreak.  Illness onsets ranged from October 3, 2009 to January 31, 2010.  Twelve patients were hospitalized, 1 developed Hemolytic Uremic Syndrome, and 1 patient, my client, Robert Danell, died.  Of the 22 cases interviewed, 14 (64%) reported eating steak at a family-style restaurant.  Among the 8 patients who did not report eating steak, 7 ate ground beef in multiple states, including Minnesota.

A settlement of Robert’s claim was reached today.  A portion of the settlement will go to a St. Cloud school scholarship.

In August 2012, the Canadian Food Inspection Agency (CFIA) isolated E. coli O157:H7 in a sample of Tanimura & Antle romaine lettuce collected on August 8, 2012.  This finding prompted CFIA to issue a “Health Hazard Alert” notice on August 17, 2012 warning the public to not consume Tanimura & Antle brand romaine lettuce, UPC 0 27918 20314 9.[1]  The alert was expanded to include additional distribution information on August 20, 2012.  The U.S. Food and Drug Administration (USDA) posted a notice that on August 19 Tanimura & Antle was recalling “Wrapped Single Head Romaine.”[2]  Genetic testing by Pulsed Field Gel Electrophoresis (PFGE) identified the strain of E. coli O157 found in the Tanimura & Antle sample as “ECXA1.1775/ECBN1.0012.”  See PFGE, Attachment No. 1.  This was a rare strain, not seen in Canada since 2009.  The CFIA announcement noted that there had been “no reported illnesses associated with consumption of this product.”  Unfortunately, this assessment would prove to be tragically incorrect.  Two Canadians—a person in Ontario and a person in Alberta were identified as being infected with strain ECXA1.1775/ECBN1.0012.  Gail Bernacki was the Alberta resident identified as being a genetic match to the E. coli O157 strain found in Tanimura & Antle romaine lettuce.

On August 23, 2012, Mrs. Bernacki experienced onset of vomiting and diarrhea.  Her stool specimen collected at Rockyview General Hospital on August 26 was culture positive for E. coli O157:H7.  She eventually died on January 16th, 2013, leaving her husband, three children and a large, loving family.

Genetic testing by Pulsed Field Gel Electrophoresis (PFGE) showed that Gail Bernacki was infected with E. coli O157:H7 strain ECXA1.1775/ECBN1.0012.  See Bernacki Completed NDR Interview Form, Alberta Health Services, Attachment No. 2.  CFIA analyzed a “partial head of Tanimura and Antle Romaine Lettuce UPC 0 27918 20314 9” from the Bernacki home on September 2012.  E. coli O157:H7 was not isolated in the uneaten portion of the lettuce but it is clear that the contaminated product was in the Bernacki home and that a portion had been consumed.  See CFIA Report of Analysis, Food Products Sampling Submission, Attachment No. 3.

Noted foodborne illness epidemiologist, Dr. John Kobayashi, reviewed the facts of the outbreak and Mrs. Bernacki’s E. coli O157:H7 infection.  Dr. Kobayashi opined on a more probable than not basis that Gail Bernacki was ill with an E. coli O157:H7 infection and that the source of her infection was Tanimura and Antle Romaine, which was contaminated with E. coli O157:H7.  See Expert Report of John Kobayashi, MD, Attachment No. 4.

Suit will be filed in Federal Court in California.  Download complaint.

There were no “Innocent Sellers” in this tragedy.  Retailers in Colorado have both a moral and legal responsibility to those who were sickened, and the families of those who died, after consuming Listeria-tainted cantaloupe.

The 2011 Listeria Cantaloupe outbreak was the most deadly in the United States in nearly 100 years.  Colorado was by far the hardest hit of the 28 states involved.  Download Outbreak Summary and Exhibits No. 1, No. 2, No. 3, No. 4No. 5 and No. 6.

The final report of the CDC totaled 147 persons infected with any of the five outbreak-associated subtypes of Listeria monocytogenes from 28 states. The number of infected persons identified in each state was as follows: Alabama (1), Arkansas (1), California (4), Colorado (40), Idaho (2), Illinois (4), Indiana (3), Iowa (1), Kansas (11), Louisiana (2), Maryland (1), Missouri (7), Montana (2), Nebraska (6), Nevada (1), New Mexico (15), New York (2), North Dakota (2), Oklahoma (12), Oregon (1), Pennsylvania (1), South Dakota (1), Texas (18), Utah (1), Virginia (1), West Virginia (1), Wisconsin (2), and Wyoming (4).

Among persons for whom information was available, reported illness onset ranged from July 31, 2011 through October 27, 2011. Ages ranged from <1 to 96 years, with a median age of 78 years. Most ill persons were over 60 years old. Fifty-eight percent of ill persons were female. Among the 145 ill persons with available information on whether they were hospitalized, 143 (99%) were hospitalized. Thirty-three outbreak-associated deaths were reported: Colorado (9), Indiana (1), Kansas (3), Louisiana (2), Maryland (1), Missouri (3), Montana (1), Nebraska (1), New Mexico (5), New York (2), Oklahoma (1), Texas (2), and Wyoming (2). Among persons who died, ages ranged from 48 to 96 years, with a median age of 81 years. In addition, one woman pregnant at the time of illness had a miscarriage. Ten deaths not attributed to listeriosis occurred among persons who had been infected with an outbreak-associated subtype.

Ultimately, the entire chain of distribution[1] – from farm to grocer (including auditors) – bears responsibility for this outbreak.  Who is more responsible – the farmer who grew the product, the auditor who looked the other way, or the retailer who simply cared that there was something on the shelf to sell?  That will be up to a jury to decide.

Few of us when we buy something like a cantaloupe in a grocery store could ever imagine that a grocer would ever claim that it has no moral or legal responsibility for selling you a product that sickened you or killed you husband or wife.  This is especially true when the grower is not financially responsible – bankrupt.  The moral issues aside, here are the legal reasons why a retailer will not escape responsibility or liability.

Strict Liability of Distributors and/or Sellers of the Products, “Innocent Sellers”

Continue Reading Why Retailers in Colorado are Ultimately Responsible for Selling Listeria-Tainted Cantaloupe that Sickened 40 – Killing Nine

Five additional ill persons have been reported from California (1), Colorado (1), Florida (2), and Ohio (1).

The CDC announced an additional five ill, bringing the total to 32 individuals infected with the outbreak strain of STEC O121 reported from 18 states. The number of ill persons identified in each state is as follows: Alabama (1), Arkansas (1), California (1), Colorado (1), Florida (2), Illinois (2), Indiana (2), Michigan (3), Mississippi (1), New York (4), Ohio (4), Pennsylvania (1), South Dakota (1), Texas (3), Utah (1), Virginia (1), Washington (1), and Wisconsin (2).  81% of ill persons are 21 years of age or younger.  35% of ill persons have been hospitalized. Two ill people developed hemolytic uremic syndrome (HUS), a type of kidney failure, and no deaths have been reported.

The outbreak strain of STEC O121 has been identified in two different Farm Rich brand frozen products collected from the homes of two ill persons.  The Outbreaks Section of the U.S. Department of Agriculture Food Safety and Inspection Service (USDA-FSIS) Eastern Laboratory identified the outbreak strain from individually wrapped Farm Rich brand frozen mini pizza slices from an opened package collected from an ill person’s home in Texas.  The New York State Department of Health, Wadsworth Center Laboratory, identified the outbreak strain from an opened package of Farm Rich brand frozen chicken quesadillas from an ill person’s home.

On April 4, 2013, Rich Products Corporation expanded its recall to include all Farm Rich, Market Day, and Schwan’s brand frozen food products produced at its Waycross, Georgia plant between July 1, 2011 and March 29, 2013 due to possible contamination with E. coli O121.  The recalled products had “Best By” dates ranging from January 1, 2013 to September 29, 2014.  Download PDF of retail establishments: 025-2013, Frozen Chicken Quesadilla and Other Snack Products (E. coli O121).

If I buy a book on Amazon, I can track it from purchase to delivery.  We can not do the same with cucumbers?  So, where were the tainted cucumbers sold in the 18 states where there are ill people?

CDC is collaborating with public health officials in many states and the U.S. Food and Drug Administration (FDA) to investigate an outbreak of Salmonella Saintpaul infections linked to imported cucumbers supplied by Daniel Cardenas Izabal and Miracle Greenhouse of Culiacán, Mexico and distributed by Tricar Sales, Inc. of Rio Rico, Arizona.

Public health investigators are using the PulseNet system to identify cases of illness that may be part of this outbreak. In PulseNet, the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC, DNA “fingerprints” of Salmonella bacteria are obtained through diagnostic testing with pulsed-field gel electrophoresis, or PFGE, to identify cases of illness that may be part of this outbreak.

A total of 73 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 18 states. The number of ill persons identified in each state is as follows: Arizona (9), California (28), Colorado (1), Idaho (2), Illinois (3), Louisiana (1), Massachusetts (1), Maryland (1), Minnesota (8), Nevada (1), New Mexico (2), North Carolina (1), Ohio (1), Oregon (2), South Dakota (2), Texas (6), Virginia (2), and Wisconsin (2).

Among persons for whom information was available, illness onset dates range from January 12, 2013 to April 6, 2013. Ill persons range in age from less than 1 year to 80 years, with a median age of 23 years. Sixty percent of ill persons are female. Among 51 persons with available information, 14 (27%) ill persons have been hospitalized. No deaths have been reported.

The cucumber that is.

With Arizona, California, Colorado, Idaho, Illinois, Louisiana, Massachusetts, Maryland, Minnesota, Nevada, New Mexico, North Carolina, Ohio, Oregon, South Dakota, Texas, Virginia, and Wisconsin leading the way, the CDC is reporting a Salmonella Saintpaul outbreak.  So far a total of 73 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 18 states.  27% of ill persons have been hospitalized, and no deaths have been reported.

According to the CDC, preliminary information indicates that consumption of imported cucumbers is the likely source of infection for the ill persons.  On April 24, 2013, the U.S. Food and Drug Administration placed Daniel Cardenas Izabal and Miracle Greenhouse of Culiacán, Mexico in import alert.

This is not the first problem with cucumbers.

In the spring of 2011 Spanish cucumbers were originally blamed for an outbreak of E. coli O104 that sickened several hundred and killed over 50 in Europe.  The outbreak was eventually linked to Fenugreek seed sprouts.

Also in the spring of 2011 cucumbers grown in North Carolina were recalled due to Salmonella.  Fortunately, no one was sickened.

Outbreaks linked to cucumbers seem to be a bit rare.

An outbreak of microsporidia, Enterocytozoon bieneusi occurred in 2006 among 135 persons hotel guests and staff in Varmland County, Sweden.  Cheese sandwiches and salad contained cucumber slices. Investigators found that washed, pre-sliced cucumbers sealed in plastic bags and imported from Spain were used in both the cheese sandwiches and the salad. Because the pre-sliced cucumbers were not processed further at the hotel, investigators hypothesized that contamination occurred before harvest, either by contaminated manure, manure compost, sewage sludge, irrigation water, runoff water from livestock operations or directly from wild and domestic animals. The cucumbers could not be traced back to the farm.

A few outbreaks in the United States seem to be likely, but not conclusively, linked to cucumbers.

Michigan Banquet Facility Green Salad and Cucumber 2008 – A confirmed outbreak of Norovirus occurred among people who had eaten green salad or cucumber while at a banquet facility in Michigan.

Minnesota Banquet Facility Cucumber Salad 2006 – A confirmed outbreak of Norovirus occurred among people who had eaten cucumber salad at a banquet facility in Minnesota.

Best advice – support the FDA in its effort to do more inspections of produce imports and always scrub your vegetables under running water with a clean brush.

Food Safety News reports that twelve people in Minnesota have fallen ill with Salmonella poisoning after eating unpasteurized, homemade queso fresco, a Mexican-style cheese, according to a joint statement released by the state departments of health and agriculture, and the City of Minneapolis.

At least eight patients were hospitalized after eating the product, and another two were hospitalized from secondary infections after contact with infected individuals. All of those patients have since recovered.

The cases are connected to an individual who distributed the product from their home, as well as making home deliveries and possibly selling the product on a street corner near the East Lake Street area of Minneapolis.

Here is some information on Fresh Cheese Made Safely by Washington State University Department of Food Science and Human Nutrition.  Queso fresco has been made for generations. Traditionally, queso fresco is made using fresh dairy milk that has not been heat-treated or pasteurized. Using unpasteurized milk to make queso fresco can lead to serious illness.

HEAT TREATMENT OF FRESH UNPASTEURIZED MILK

To kill bacteria in milk heat milk to 145°F for 30 minutes

  • Place a cooking thermometer into the milk to measure its temperature.
  • Do not heat milk over 145°F. It may change the texture and flavor of the cheese.  Under 145°F will not kill all harmful bacteria.

SANITATION

To help prevent infection:

  1. Boil all cheese making equipment between uses, or Soak all cheese making equipment in a bleach-water solution.
  1. For best quality cheese, use new cheesecloth each time you make cheese. (Reuse cheesecloth only if it has been washed, then boiled or soaked 2 minutes in bleach-water.)

BLEACH WATER

  • Make a bleach-water solution by adding one tablespoon of bleach to one gallon of water.
  • Make a new bleach water solution each time you make cheese.
  • This recipe for bleach water can be doubled if necessary.

SAFE QUESO FRESCO RECIPE

  • Place one tablet Junket Rennett into one-half cup cold tap water until dissolved.
  • Mix one quart cultured buttermilk with two quarts heat-treated or pasteurized milk.
    1. Add 7 teaspoons white vinegar to the milk mixture.
    2. Mix well.
    3. Heat milk to 90° F. Remove pan from the heat.
    4. Add dissolved rennet and mix for about 2 minutes.
  • Let stand for 30-40 minutes until curd is firm.
  • Cut curd into 1-inch cubes and let stand for about 5 minutes.
  • Heat curds and whey to 115° F (without stirring), remove pan from the heat, then let stand for 5 minutes.
  • Pour mix through a colander lined with cheesecloth and allow to drain for 5 minutes.
  • Form curd into a ball and twist the cheesecloth gently to squeeze out the whey.
  • Break up curds into a bowl and add l and 3/4 teaspoons of salt.
  • Mix in salt and let stand for 5 minutes, then squeeze again as before.
  • Form the cheese. Remove from form. Refrigerate.

SALE OF QUESO FRESCO

If you are interested in becoming licensed to sell queso fresco, please contact your local health department or state department of agriculture.

Arizona, California, Colorado, Idaho, Illinois, Louisiana, Massachusetts, Maryland, Minnesota, Nevada, New Mexico, North Carolina, Ohio, Oregon, South Dakota, Texas, Virginia, and Wisconsin report Salmonella Saintpaul Illnesses.

A total of 73 persons infected with the outbreak strain of Salmonella Saintpaul have been reported from 18 states.

27% of ill persons have been hospitalized, and no deaths have been reported.

State public health officials are interviewing ill persons to obtain information regarding foods they might have eaten and other exposures in the week before illness.

Preliminary information indicates that consumption of imported cucumbers is the likely source of infection for the ill persons.

On April 24, 2013, the U.S. Food and Drug Administration placed Daniel Cardenas Izabal and Miracle Greenhouse of Culiacán, Mexico on Import Alert.

Cucumbers from these two firms will be denied admission into the United States unless the suppliers show that they are not contaminated with Salmonella.

Food Safety News reports that health officials in Wisconsin suspect three patients sickened by the same strain of E. coli O157:H7 contracted their illnesses after consuming raw milk, Wisconsin Department of Agriculture spokeswoman Raechelle Cline told Food Safety News Thursday.

All three patients reside in Manitowoc County, and they include a three year-old child and his or her mother.

Officials are currently testing samples of milk from the suspected dairy and will not identify it unless they prove a connection.

“Raw milk was the most likely commonality we’ve been able to identify,” Cline said.

The illnesses occurred in March, and the officials are unaware of any additional cases.

For more information about raw milk, visit www.realrawmilkfacts.com.