December 2013

California Department of Public Health (CDPH) Director and State Health Officer Dr. Ron Chapman today warned people not to eat cashew cheese products manufactured by The Cultured Kitchen because they may be contaminated with Salmonella. Fifteen cases of illnesses have been reported in the Western United States, with twelve of the cases occurring in California. Three patients have been hospitalized and no deaths have been reported.

The Cultured Kitchen of West Sacramento, California has initiated a voluntary recall of all flavors of its cashew cheese products with expiration dates on or before April 19, 2014, due to the risk of contamination with Salmonella. The products were sold in natural food stores throughout Northern California and Northern Nevada, and at farmers markets in Sacramento County.

The cashew cheese products were sold in eight-ounce plastic containers in the following flavors: Herb, smoked cheddar, pepper jack, habanero cilantro lime, basil pesto and white cheddar.

While the cashew cheese products are no longer being sold at retail facilities, CDPH is concerned that consumers may still have some of these products in their homes.

The Davidson County Health Department is investigating reports of illness in three children likely due to E. coli infection, the agency said this afternoon.

Two Tyro Middle School students have been hospitalized with recent bouts of severe bloody diarrhea. It is reported that they suffer from hemolytic uremic syndrome (HUS).  A case of E. coli has been identified in a third child who hasn’t been hospitalized and doesn’t attend the same school as the Tyro students, the Health Department says.

“We are asking anyone in the community who has been sick during the month of December with severe or bloody diarrhea to please call the Davidson County Health Department at (336) 242-2300. If you are still sick, please seek medical care.” said Monecia Thomas, the Davidson County Health Department health director.

E. coli are naturally occurring bacteria that normally live in the intestines of people and animals. While most E. coli are harmless, some produce Shiga toxin.

Shiga toxin-producing E. coli are found in animals, especially ruminant livestock, such as sheep, deer, goats and cows. Transmission can occur following contact with these animals or their feces or following consumption of undercooked meats or unpasteurized foods or drinks, according to the Health Department.

Symptoms of E. coli include:

• Severe abdominal cramps

• Acute diarrhea, including bloody diarrhea

• Vomiting

• Low-grade fever

• A type of kidney failure called hemolytic uremic syndrome

Early medical attention can help minimize the severity on an E. coli infection.

The Finney County Health Department, along with the Kansas Department of Agriculture (KDA) and the Kansas Department of Health and Environment (KDHE), continues investigating an outbreak of gastrointestinal illness that appears to be associated with the Jimmy John’s Gourmet Sandwiches restaurant in Garden City, Kan.

The Finney County Health Department and KDHE are contacting diners by telephone and an online survey to determine who has been ill. As of 12 p.m. Friday, Dec. 27, more than 110 cases of illness among persons who reported eating food from this restaurant have been reported. Symptoms experienced include diarrhea, vomiting, nausea and muscle aches.

KDA’s Food Safety and Lodging program has conducted an inspection of the restaurant and has been working closely with Jimmy John’s employees to respond to this outbreak.

An online survey has been developed, and anyone – whether they have been ill or not – who ate food from the Jimmy John’s in Garden City between Dec. 10 and Dec. 24, 2013, is urged to complete the survey, which can accessed at https://www.surveymonkey.com/s/gardencityillness.

“We are suspecting that this outbreak has been caused by norovirus,” said D. Charles Hunt, State Epidemiologist at KDHE. Hunt said this is based on the symptoms of illness being reported, the large number of persons reported to be ill, and the period of time between food being eaten and the onset of illness, or incubation period.

Norovirus typically causes gastrointestinal illness – such as nausea, vomiting, abdominal pain, diarrhea and low-grade fever – and is easily passed from person to person or through food that has been contaminated during preparation. It often causes large outbreaks, affecting a large percentage of persons who were exposed.

The best way to prevent norovirus is proper hand washing, excluding ill persons from preparing food, and proper cleaning and sanitizing of food preparation areas.

Members of the public who need to contact local health officials about this outbreak can call the Finney County Health Department at (620) 272-3600.

In 2002, I wrote an Op-ed for the Denver Post entitled: “Put me out of business. Please.”

For this trial lawyer, E. coli has been a successful practice – and a heart-breaking one. I’m tired of visiting with horribly sick kids who did not have to be sick in the first place. I’m outraged with a food industry that allows E. coli and other poisons to reach consumers, and a federal regulatory system that does nothing about it….

… And, with a little luck, it will force one damn trial lawyer to find another line of work.

From the Jack in the Box E. coli outbreak of 1993 until the 2002 ConAgra E. coli outbreak, at least 95% of Marler Clark revenue was E. coli cases linked to hamburger.  Today, it is nearly zero.  That is success.  To the beef industry – thank you for meeting the challenge.  The millions spent on interventions, and the countless hours of food safety professionals, made the difference.

That all being said, there is still much the industry can do.  Shiga-toxin producing E. coli will always be an issue.  Listeria and antibiotic resistant Salmonella and Campylobacter, and other bad bugs we do not even know about, lurk around the corner.  The industry cannot let up.  Even with the success there still have been isolated tragedies like Stephanie Smith and Abby Fenstermaker who remind you the battle will likely always have to be fought.

But, for now, hats off to you.

In two outbreak in 2013 at least 550 sickened and it could be 38.5 times that.*

In the second Foster Farms outbreak of 2013, the CDC reports a total of 416 individuals infected with the outbreak strains of Salmonella Heidelberg have been reported from 23 states and Puerto Rico. Most of the ill persons (74%) have been reported from California. The number of ill persons identified in each state is as follows: Alaska (1), Arkansas (1), Arizona (18), California (310), Colorado (9), Connecticut (1), Delaware (1), Florida (4), Idaho (4), Illinois (1), Kentucky (1), Louisiana (1), Michigan (3), Missouri (5), North Carolina (1), Nevada (10), New Mexico (2), Oregon (10), Puerto Rico (1), Texas (10), Utah (2), Virginia (3), Washington (16), and Wisconsin (1).

Epidemiologic, laboratory, and traceback investigations conducted by local, state, and federal officials indicate that consumption of Foster Farms brand chicken is the likely source of this outbreak of Salmonella Heidelberg infections.

An earlier outbreak of Salmonella Heidelberg linked to Foster Farms was first announced February 14, 2013.  That outbreak sickened 134.  The current outbreak was first announced October 8, 2013 when the number of ill was only 278.  It is now 418.  At that time FSIS threatened Foster Farms with removing inspectors because sanitary conditions at its three facilities were so poor that they posed a “serious ongoing threat to public health.”  FSIS officials had found a “high frequency of SalmonellaHeidelberg positives and specifically a high frequency of one or more outbreak strains” in the three plants. The letters also cited “fecal material on carcasses” and “findings of poor sanitary dressing practices, insanitary food contact surfaces, insanitary non food contact surfaces and direct product contamination” at the plants.  See Notices of Intended Enforcement: ONETWO and THREE that FSIS sent to Foster Farms.

Neither Foster Farms nor FSIS have recalled any chicken despite illnesses beginning in February and continuing through the end of November. (Red arrows denote CDC/FSIS announcements of outbreaks)

See also Consumer Report’s chicken testing and the Pew Charitable Trusts, FSIS’s Weakness in Salmonella Regulation.

If you want a little insight into the legal history of Salmonella as a non-adulterant, read these:

FSIS’s and Foster Farms’ Reason for NOT Recalling Salmonella Chicken: “Shit Happens!”

Butz, Supreme Beef and FSIS’s Salmonella Policy – A Bit(e) of History

And, why some meat with Salmonella gets recalled and some not:

Why does the FSIS like Foster Farm’s Salmonella better than Cargill’s Salmonella?

*According to the CDC, for every one person who is a stool-culture confirmed positive victim of Salmonella in the United States, there a multiple of 38.5 who are also sick, but remain uncounted. (See, AC Voetsch, “FoodNet estimate of the burden of illness caused by nontyphoidal Salmonella infections in the United States,” Clinical Infectious Diseases 2004; 38 (Suppl 3): S127-34).

About half of samples tested had at least one bacteria resistant to three or more classes of antibiotics; bacteria were more resistant to antibiotics approved for use in chicken production

In its most comprehensive tests of meat and poultry to date, Consumer Reports found bacteria that could make consumers sick on nearly all of the 316 raw chicken breasts purchased at retail nationwide. The full report, “The High Cost of Cheap Chicken,” is featured in the February 2014 issue of Consumer Reports and online at www.ConsumerReports.org.

While Consumer Reports has consistently been testing chicken for more than 15 years, this is the first time it has looked at the contamination rates for six different bacteria – enterococcus (79.8 percent), E. coli (65.2 percent), campylobacter (43 percent), klebsiella pneumonia (13.6 percent), salmonella (10.8 percent), and staphylococcus aureus (9.2 percent). It also evaluated every bacterium for antibiotic resistance and found that about half the chicken samples harbored at least one multidrug-resistant bacteria.

As part of this investigation, the Consumer Reports National Research Center recently conducted a nationally representative survey of 1,005 respondents about their understanding of labels and their handling and cooking habits for chicken.

The survey found that more than half of respondents thought that “natural” chickens did not receive antibiotics or genetically modified feed and more than one-third thought “natural” was equal to “organic,” all of which are not true.

”Our tests show consumers who buy chicken breast at their local grocery stores are very likely to get a sample that is contaminated and likely to get a bug that is multidrug resistant.

When people get sick from resistant bacteria, treatment may be getting harder to find,” said Dr. Urvashi Rangan, a toxicologist and Executive Director of the Consumer Reports Food Safety and Sustainability Center.  “Our survey also shows that consumers are making buying decisions based on label claims that they believe are offering them additional value when that is not in fact the case. The marketplace clearly needs to change to meet consumer expectations.”

Consumer Reports’ study comes at a time when 48 million people are falling sick and 3,000 dying in the United States each year from eating tainted food, with more deaths being attributed to poultry than any other commodity, according to the Centers for Disease Control and Prevention.

Other highlights from Consumer Reports’ findings include:

• The majority of samples tested positive for one of the common measures of fecal contamination – Enterococcus and E. coli. More advanced testing showed that 17.5 percent of the E. coli are the type (known as ExPEC) that have genes that make these bacteria more likely to cause urinary tract infections.

• About half of chicken samples contained at least one bacterium resistant to three or more antibiotics, commonly referred to as multidrug-resistant bacteria or “superbug.” Slightly more than 11 percent contained two or more multidrug-resistant bacteria.

• Bacteria were more resistant to antibiotics approved for use in chicken production for growth promotion and disease prevention than those not approved for those uses.

• One sample was a Foster Farms chicken breast from a plant associated with the recent outbreak. The sample contained a Salmonella Heidelberg that was a match to one of the outbreak strains. Consumer Reports released its results about this sample in October 2013 immediately after it was confirmed.

Since 1998, Consumer Reports’ tests of chicken have shown salmonella rates have not changed much, ranging between 11 and 16 percent.

”We know especially for salmonella, other countries have reduced their rates. In fact, systemic solutions were implemented throughout the European Union. Government data show that in 2010, 22 countries met the European target for less than or equal to 1 percent contamination of two important types of salmonella in their broiler flocks. There is no reason why the United States can’t do the same,” concludes Rangan.

For more information on what has been done in Europe and different sustainability practices, visit www.ConsumerReports.org/cro/chicken0214.

What the Government Can Do



“We are looking to the government to ensure the safety and sustainability of the entire food supply,” said Rangan.  “We need to attack the root causes of the problems. Without a government focus on effective solutions, meat safety will continue to be compromised.”

In order to reduce rates of bacterial contamination as European counterparts have done and preserve the effectiveness of antibiotics, Consumers Union, the policy and advocacy arm of Consumer Reports, calls on the U.S Department of Agriculture (USDA), Congress, and the Food and Drug Administration (FDA) to do the following:

• Congress should give the USDA authority to mandate a recall of meat and poultry products, especially when product from a plant matches that of a human outbreak strain. Currently, it cannot mandate any recall.

• The FDA should prohibit antibiotic use in food animals except for the treatment of sick ones. FDA’s action last week giving voluntary guidance to drug companies to end labeling of antibiotics for growth promotion uses is an important first step, but is far from what is needed overall. An effective way to ensure that antibiotics are only used to treat sick animals is for Congress to pass the Preservation of Antibiotics for Medical Treatment Act.

• The USDA should classify strains of salmonella bacteria that are resistant to multiple antibiotics and known to have caused disease as “adulterants,” so that inspectors look for those strains routinely and when found, the products cannot be sold.

• The USDA should move quickly to set strict levels for allowable salmonella and campylobacter in chicken parts. The agency expects to put that proposal out for public review and feedback this year. As part of this process, the USDA should publish a list of meat products like chicken parts for which it has no performance standards and indicate a timetable for establishing them. We say these standards can’t come soon enough.

• The USDA’s proposed rule to increase maximum line speeds and reduce the number of USDA inspectors at slaughter plants should be dropped.

• The National Organic Program should eliminate the loophole allowing antibiotics to be used in the chicken eggs up until the first day of life in organic chicken broilers.

• USDA should ban the use of the “natural” claim, which is not a meaningful label, and require claims on meat to be certified and inspected.

What Consumers Can Do



Consumer Reports advises consumers to follow these tips to ensure proper handling and cooking of chicken:

• Wash hands when handling any type of meat or poultry – frozen or fresh – before touching anything else and wash them for at least 20 seconds with hot soapy water – even if it means multiple washings.

• Use a cutting board designated strictly for raw meat and poultry. When done, place it in the dishwasher directly from the counter or wash with hot soapy water.

• Don’t run chicken under the faucet before cooking.

• When cooking, use a meat thermometer and always cook chicken to 165°F.

• When shopping, buy meat last; keeping chicken cold delays bacteria overgrowth.  Place chicken in a plastic bag to prevent other items from contamination.

• Buy chicken raised without antibiotics to help preserve the effectiveness of these drugs; avoid meaningless labels like “natural” and “free range”.

Note: Support for this project was provided by The Pew Charitable Trusts. Any views expressed are those of Consumer Reports and its advocacy arm, Consumers Union, and do not necessarily reflect the views of The Pew Charitable Trusts.
  See also Pew’s Weaknesses in FSIS’s Salmonella Regulation.

The U.S. Food and Drug Administration (FDA), the Centers for Disease Control and Prevention (CDC) and USDA’s Food Safety and Inspection Service (FSIS) will present a webinar on progress toward attributing foodborne illnesses to food sources on Friday, January 10, from 2 p.m. to 3 p.m. (EST).

The webinar, titled “Are Outbreak Illnesses Representative of Sporadic Illnesses?,” will describe the most recent activities of the Interagency Food Safety Analytics Collaboration (IFSAC), a tri-agency partnership focused on projects related to attribution of foodborne illnesses. As part of the webinar, presenters will share an analysis for comparing the characteristics of illnesses associated with foodborne outbreaks with those that are not linked to outbreaks.

The webinar is open to the public at no charge. To register for the presentation, visit http://ifsac-webinar-201401.eventbrite.com and sign up by January 6. Registrants will receive a confirmation email with the webinar agenda and instructions on how to participate.

For those unable to attend the webinar, a recording of the event will be posted online. This webinar is the second in the IFSAC webinar series. For information from the first one, visit Interagency Food Safety Analytics Collaboration (IFSAC) Webinar: Improving the Categories Used to Classify Foods Implicated in Outbreaks.

Hey, email me if we have missed any significant outbreaks on http://www.outbreakdatabase.com/

Chefs and home cooks bring their best goodies to the table during the holidays. But no one wants a bout of food poisoning or too many unhealthy party snacks to dampen their holiday spirit. Join us for a lively and informative Twitter chat with questions and answers about holiday food safety.

Food safety experts from CDC, the U.S. Department of Agriculture, the U.S. Food and Drug Administration, the International Food Information Council Foundation, along with guest food connoisseurs will host a Twitter chat for consumers with easy-to-remember tips for a safer and healthier holiday season. You are invited to this lively and informative question-and-answer chat on how to be food-smart and food-safe over the holidays. Follow @CDCgov on Twitter and use the hashtag #CDCchat to participate.

What We’ll Be Chatting About?

From finger foods to turkey and dressing, there is never a time of year when food is more of a focus. Here are a few topics to expect:
•    Food safety during the holidays. Holiday entertaining: party giver or guest?  Stay clear of “Buffet Bandits”—food hazards that can rob your holiday enjoyment. Learn how  to be the host of the season by practicing safe and healthy food preparation.
•    Foods and germs: fact and fiction. Raw cookie dough and some eggnog recipes are yummy holiday treats that may contain raw eggs. But, eating and drinking raw eggs can lead to food poisoning. Learn about this, other foods and germs, and what’s fact and  fiction.
•    Who’s at risk?  Pregnant women, children under five years old, older adults, and people with weakened immune systems are particularly at-risk from germs that cause food poisoning.
•    Simple steps, big rewards. Don’t make your holiday party ground zero for an outbreak! Remember these simple steps: wash hands and surfaces often, avoid cross-contamination, cook foods to proper temperatures, and refrigerate promptly.
•    Holiday tips for safer eating. People in vulnerable stages and ages of life should not eat soft cheeses, such as feta, brie, and queso fresco, unless they have labels that say they are pasteurized. Unpasteurized products can contain harmful bacteria and can cause infections such as listeriosis. Check the facts and join the chat for more recommendations that everyone can use.

Wait—What’s a Twitter chat?

Twitter chats are scheduled gatherings of people on Twitter to discuss anything that interests them, using a # hashtag to keep track of the conversation. There are chats for everything from blogging on art to agriculture to, yes, health!

Twitter chats offer participants a great way to network and share knowledge. It’s similar to a chat room in that it’s a topic-driven conversation happening in real time; it just happens to take place on Twitter.

Not using Twitter? No problem.

Just visit https://twitter.com/CDCgov and click “Sign Up” to get started.

How to Participate

Join us Wednesday, December 18, from 3–4 PM ET. Sign in by 2:45 PM ET.

To follow the conversation, search for the #CDCchat hashtag on Twitter. You may also use a third-party service such as Tweetchat. Be sure to use #CDCchat when you participate.

Spread the word

We’d also appreciate it if you could help us spread the word about the Twitter chat:

Promote the event on your Twitter and Facebook profiles.

•    Retweet #CDCchat announcements from @CDCgov.

•    Share the CDC Facebook event on your page.

•    Participate in the chat.

Test Your Food Safety Knowledge

1.    Outbreaks caused by which pathogen typically peak following Thanksgiving?
2.    What safe minimum internal temperature is recommended for cooking turkey?
3.    No one wants to spend Christmas running to the bathroom because the ham was bad. Once cooked, what temperature should you keep hot food at or above (all temperatures in °F)?
4.    Mmmm… leftovers.  How long can you safely freeze turkey leftovers? (Pieces, not whole turkey.)
5.    Which U.S. president reportedly died from food poisoning? Bonus: What food reportedly was implicated?
6.    What online tool lets you search for outbreaks in each state?

Wanna know the answers? Tune in to the chat to find these answers and much more. But, if you can’t wait, the answers are shown below.

Hundred’s of people (there were a lot of guys with beards) from around the country came and and had a beer in honor of Bill.  The stories from family and friends made Bill seem alive for a couple of hours. Bill’s Foodborne Illness Outbreak Museum was on display – it even included a few donations from some lawyer.

Cheers to Bill