April 2014

Here we go again.

The Marion County Public Health Department announced that visitors to an Indianapolis business during three Saturdays in April may have been exposed to Hepatitis A.

Anyone who visited and drank tea prepared at the Teavana store, 8702 Keystone Crossing, on Saturdays, April 5, 12 and 19 should watch for signs and symptoms of Hepatitis A. The public is advised to watch for signs and symptoms of Hepatitis A and contact a health care provider immediately if any symptoms are present.

Marion County Public Health Department director Dr. Virginia A. Caine says Hepatitis A is caused by a virus that inflames the liver. Hand washing is the best way to prevent the spread of Hepatitis A. Thorough hand washing after using the bathroom and before eating or preparing food can help lower the risk of getting the virus.

Signs and symptoms include:

  • Nausea
  • Vomiting
  • Loss of appetite
  • Abdominal pain
  • Fever
  • Jaundice (yellowing of the skin or eyes)

Not everyone infected by the virus will exhibit all of these symptoms. Some people, especially children, may have no symptoms at all. However, all infected persons can transmit the disease to others.

People who visited and drank tea prepared at the store on Saturday, April 5 and Saturday, April 12 are beyond the incubation period of the virus and should watch for signs and symptoms of Hepatitis A. Anyone who visited the store and drank tea on Saturday, April 19 is still within the incubation period and should receive vaccine or immune globulin to prevent the disease. Those age 40 and under should receive Hepatitis A vaccine, while people over the age of 40 should receive immune globulin.

The Marion County Public Health Department will offer vaccine or immune globulin free of charge for individuals who visited the store and drank tea on Saturday, April 19. They should call the health department’s immunization program at 317-221-2122 to find out which district health office they should visit to receive the vaccine or immune globulin free of charge.

Food Safety News writers James Andrews and Cookson Beecher came home from the April 26 Washington Press Association awards banquet with nine awards, all of them in the daily news category.

Here are the awards James received: First prize, Personality Profile, “Keene Remembered for Commitment to Public Health, Unconventional Style.” Second prize, General Features, “Beef Research Money Tied to Record Low Cattle Population.” Honorable mention, Agriculture/Environment, “As California Begins Regulating Fracking, Agricultural Concerns Arise.”

Here’s what Cookson took home: First place, Agriculture/Environment, “Girl Fights E. Coli from Raw Milk as Medical Bills Mount.” First place, Government, “Organics ‘Thrown Under the Bus’ in Farm Bill Extension, Say Industry Advocates.” Second place, Health, “Two Sides of the Coin for Food Safety of Cut Leafy Greens.” Third place, Agriculture, “Concerns About Animal Welfare, Food Safety Spur Industry Changes.” Third place, Health/Medicine, “Dessert Followed by a Hepatitis A Shot?” Honorable mention, Consumer Affairs, “Shoppers Can Pick up Food-Safety Clues at Farmers Markets.”

James Andrews, former managing editor and Seattle-based reporter for Food Safety News, holds degrees in Environmental Journalism and English from Western Washington University and has previously worked as a science writer for the National Park Service. His work has been mentioned on ABC World News, the Huffington Post and Esquire’s Eat Like a Man blog. He currently freelances for Food Safety News.

Cookson Beecher spent 12 years working as an agricultural and environmental reporter for Capital Press, a four-state newspaper that covers agricultural and forestry issues in the Pacific Northwest before coming on board as a freelancer for Food Safety News. Previous to her job with Capital Press, she was the editor of the Courier Times in Skagit County, WA. She received her B.A in political science from Hunter College in New York City, and, before moving West, she worked for publishing companies in midtown Manhattan. In the 1970s and 1980s, she and her family lived in North Idaho, where they built a log home and lived a “pioneer life” without running water and electricity for almost 10 years. She currently lives in rural Skagit County of Washington state and is co-owner of Pioneer Dahlias.

WWL’s report on the recent debate over raw milk Bill HB 247 likely says it all why there is unlikely to ever be an ability for public health and raw milk proponents to ever find common ground. Here are the highlights:

So, what, a few kids die, I want to do whatever I want to do.

Ciera Majors spoke to the House Agriculture Committee in favor of the measure that would allow farmers to sell raw milk to consumers.

“The only argument that the opposition has for this bill is ‘death of a child, death of a child,'” said Majors. “Trust me! I want to protect my children. I wanted to give them a healthy product so much so that I bought two cows.”

Majors argued that families should have the right to choose the foods they consume and provide for their children.

Marksville Representative Robert Johnson strongly opposes the bill. He told Majors that his problem with the measure is not that she milks her own cows and gives the raw milk to her children.

“My problem is that you don’t want DHH to do any kind of inspection, any kind of permitting process,” said Johnson. “And then you want to exempt yourself from any kind of liability just in case somebody messes up. And when you say child..’death of a child’..that’s a very serious thing to me.”

If I watch the farmer, I can see that microscopic bacteria does not get into the milk. It’s the consumers fault anyway.

One raw milk supporter, Audry Salvador, told Johnson it would be the responsibility of the consumer to make sure they are purchasing from a reputable farmer.

“I can watch everything they do if I want,” said Salvador.

Johnson said, “What about those who don’t?”

“That is their fault.”

Children that drink raw milk and then die go right to heaven.

“What about the child that dies that has no one to protect him,” Johnson asked.

“Well, before the age of reason they can go to Heaven,” said Salvador.

“That’s your answer?! Mr. Chairman I move that we voluntarily defer this bill,” Johnson said in extreme anger.

Raw milk is so safe that farmers should be immune from being sued if the milk poisons a consumer.

Johnson also tells Salvador he has a major problem with farmers being exempt from liability if someone gets sick from raw milk.

Listeria, E. coli, Campylobacter and Salmonella are still around and have caused raw milk outbreaks.

The sale of raw milk is illegal because it was thought to have carried certain diseases that have been eradicated in the United States since the turn of the century according to Ortego.

The vote was 9-6 and now heads to the House floor.

Perhaps the House or the Governor will have a different view of things.  Perhaps the House members should visit with the families at www.realrawmilkfacts.com

Trader Joe’s and Glass Onion Catering is facing 5 lawsuits brought on behalf of alleged victims of a 2013 E. coli outbreak. Public health officials traced the E. coli outbreak to salads made by Glass Onion Catering and sold at the grocery chain.

According to attorney Bill Marler, whose law firm represents 6 plaintiffs who allege that they fell ill with E. coli infections after eating salads sold at Trader Joe’s, the company was added as a defendant to two lawsuits previously filed against salad-maker Glass Onion Catering in California and in 3 new lawsuits filed Wednesday in California and Washington state. The plaintiffs allege in the lawsuits that Glass Onion Catering and Trader Joe’s sold food that was “not fit for human consumption, and not reasonably safe because it was contaminated with E. coli O157:H7”.

The Centers for Disease Control and Prevention, U.S. Food and Drug Administration and state and local health departments counted 33 people from 4 states who were confirmed ill with E. coli infections after consuming Glass Onion Catering salads and wraps sold at Trader Joe’s and other retail outlets in October and November of 2013. Two people, including one of the plaintiffs, developed hemolytic uremic syndrome, a complication of E. coli infection that can cause kidney failure and central nervous system impairment.

“Retailers need to be held accountable for what they sell,” said attorney Bill Marler. “In my opinion, over the last two decades retailers have begun to care less about the safety of what they sell just as long as it sells.  Retailers now try to push blame for the sale of tainted food that sickens customers onto everyone but the retailer. That needs to stop.”

I had the chance to speak at Avvo’s Lawyernomics Conference today.  The audience wanted to know how I built my practice.  It was really simple:

  • Find your passion
  • Learn everything you can about the topic
  • Work hard – very hard
  • Become an expert
  • Let your successes speak for themselves
  • Communicate effectively
  • Bottom Line – “Doing right by your clients will do right by your practice.”

Here is the PowerPoint.

As of April 21, 2014, a total of 132 persons infected with the outbreak strain of Salmonella Cotham have been reported from 31 states since February 21, 2012.

  • 58% of ill persons are children 5 years of age or younger.
  • 42% of ill persons have been hospitalized. No deaths have been reported.

Epidemiologic, laboratory, and traceback findings have linked this outbreak of Salmonella infections to contact with pet bearded dragons purchased from multiple stores in different states. Bearded dragons are popular pet lizards that come in a variety of colors.

Of the three isolates collected from ill persons, one (33%) was resistant to ceftriaxone, an antibiotic used to treat serious Salmonella infections.

In the past few days, restaurants from a Papa John’s in North Carolina to the La Fontana suburban New York restaurant to a Moose Jaw bar, are issuing hepatitis A warnings due to an ill worker putting customers at risk.

Hardly a month passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak. Absent vaccinations of food handlers, combined with an effective and rigorous hand-washing policy, there will continue to be more hepatitis A outbreaks. It is time for health departments across the country to require vaccinations of food-service workers, especially those who serve the very young and the elderly.

Hepatitis A is a communicable disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Hepatitis A is the only foodborne illness that is vaccine-preventable. According to the U.S. Centers for Disease Control and Prevention (CDC), since the inception of the vaccine, rates of infection have declined 92 percent.

CDC estimate that 83,000 cases of hepatitis A occur in the United States every year, and that many of these cases are related to food-borne transmission. In 1999, more than 10,000 people were hospitalized due to hepatitis A infections, and 83 people died. In 2003, 650 people became sickened, four died, and nearly 10,000 people got IG (immunoglobulin) shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but also businesses lose customers or some simply go out of business.

Although CDC has not yet called for mandatory vaccination of food-service workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of foodborne illness in the U.S.

Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S., despite FDA approval of hepatitis A vaccine in 1995. Widespread vaccination of appropriate susceptible populations would substantially lower disease incidence and potentially eliminate indigenous transmission of hepatitis A infections. Vaccinations cost about $50. The major economic reason that these preventive shots have not been used is because of the high turnover rate of food-service employees. Eating out becomes a whole lot less of a gamble if all food-service workers faced the same requirement.

According to CDC, the costs associated with hepatitis A are substantial. Between 11 percent and 22 percent of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs in providing post-exposure prophylaxis to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $433 to $1,492 per case for children younger than 18. In 1989, the estimated annual direct and indirect costs of hepatitis A in the U.S. were more than $200 million, equivalent to more than $300 million in 1997 dollars.  A new CDC report shows that, in 2010, slightly more than 10 percent of people between the ages of 19 and 49 got a hepatitis A shot.

Vaccinating an employee make sense.  It is moral to protect customers from an illness that can cause serious illness and death. Vaccines also protect the business from the multi-million-dollar fallout that can come if people become ill or if thousands are forced to stand in line to be vaccinated to prevent a more serious problem.

Email of the day.  This time I’ll be a bit more responsible.

The Baltimore City Health Department and Maryland Department of Health and Mental Hygiene continue to investigate an outbreak of gastroenteritis at the Baltimore Convention Center during the Food Safety Summit on April 8-10, 2014.  Currently, there are over 100 reported illnesses, mostly self-limited diarrhea.  We have heard from about 400 of approximately 1300 attendees.  There have been no associated hospitalizations or deaths reported.  We are working on evaluating possible exposures and doing testing at the Maryland state public health laboratory to attempt to identify an agent.  At the conclusion of the investigation, a summary report will be available.

If you did not have the opportunity to respond to the previous online survey before it was closed and would still like to, we have opened another link.  To protect the integrity of the data, please do not distribute this link or password to those who did not attend the Food Safety Summit.

If you have already completed the previous survey, please do not complete this one (the questions are the same).


If you have questions about the investigation, please contact the Division of Outbreak Investigation at 410-767-6700 or by email at DHMH.Outbreaks@maryland.gov.

Thank you,

Division of Outbreak Investigation
Office of Infectious Disease Epidemiology and Outbreak Response
Maryland Department of Health and Mental Hygiene
201 W. Preston Street, 3rd Floor
Baltimore, MD 21201

Office:  410-767-6700
Fax:  410-669-4215
Email:  DHMH.Outbreaks@maryland.gov

Infinite Herbs LLC of Miami, FL, is voluntarily recalling one lot of its 2.5-ounce packages of Organic Basil sold at Trader Joe’s because of potential contamination with Salmonella.

The recall only affects one specific lot of Infinite Herbs brand Organic Basil packaged in 2.5-ounce clamshells bearing the “Date Packed 02/21 20422″. The “Date Packed” information can be found on the back side label below the country-of-origin statement.

The product was only distributed to Trader Joe’s stores located in Florida, Georgia, Louisiana, North Carolina, South Carolina, Southern Virginia and Tennessee.

No illnesses have been reported in connection with this recall. However, due to the time required to trace an illness back to a specific food product, it is impossible to say if any illnesses have occurred.

The voluntary recall was initiated by Infinite Herbs after routine testing by FDA revealed the presence of Salmonella in one lot of Organic Basil. Subsequent testing conducted at the request of Infinite Herbs and the retailer on other lots of Organic Basil located at the retail locations, as well as at the grower, resulted in no findings of contamination of any additional lots.

Consumers who have purchased this lot of Infinite Herbs Organic Basil are urged not to eat the product and to dispose of it or return it to the place of purchase for a full refund.