July 2015

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Pattegris-Paa-grillThe outbreak of Salmonella infections that may be linked to pork products has grown to 90 cases in several counties around the state. The ongoing outbreak is under investigation by state, local, and federal public health agencies.

With the increase in cases, state health officials have asked the federal Centers for Disease Control and Prevention (CDC) to send a special team to help with the investigation. This team of “disease detectives” will arrive in Washington next week.

ceeb8cb2-37e7-11e5-99e9-6315a5a2a013-1020x1051Disease investigators are searching for possible exposure sources from farm to table. An apparent link to pork consumption or contamination from raw pork is the strongest lead, though no specific source has yet been found. The likely source of exposure for some of the ill people appears to have been whole roasted pigs, cooked and served at private events.

The cases, many of which are in King County, appear to have been caused by the same rare strain of Salmonella bacteria, health officials said. The outbreak is linked to Salmonella I, 4, 5, 12:i:-, a germ that has been emerging nationally but has never before been seen in Washington state.

635699704564741722-Boise-Co-Op-signThe Central District Health Department (CDHD) investigated a Salmonella outbreak associated with the Boise Co-op deli – specifically food purchased from the deli after June 1, 2015.

As of the end of July, approximately 300 cases of Salmonella were associated with the outbreak. Test results showed Salmonella growth in raw turkey, tomatoes and onion.

Salmonella is a bacteria that can cause diarrheal illness in humans. They are microscopic living creatures that pass from the feces of people or animals to other people or other animals. There are many different kinds of Salmonella bacteria.

Salmonella serotype Typhimurium and Salmonella serotype Enteritidis are the most common in the United States.

Besides the confirmed case at the prison about 100 miles northeast of Reno, there are two suspected cases of E. coli being examined, the department said in a news release.

Corrections officials contacted the state’s Division of Public and Behavioral Health to investigate the cause and sent samples to the Centers for Disease Control and Prevention for testing, the release said.

“No other inmates or anyone in the general public have been reported as showing symptoms of or have been suspected of having E. coli in Nevada,” the release said.

donantonios_406x250This is a single outbreak that occurred among patrons who dined at Restaurant A (Don Antonio’s) between March 18, 2015 and March 20, 2015. The agent S. Enteritidis was confirmed by laboratory results. An ill food handler is the likely source of illness.

BACKGROUND

On Tuesday, March 24, 2015, the Los Angeles County Department of Public Health (LAC-DPH) received a foodborne illness report via the web (FBIR #23973). The initial complainant, Group A, reported 5 out of 5 ill after eating on Friday, March 20, 2015. Approximately 3 hours later, a second complainant, Group B (FBIR 23974), reported 2 out of 2 ill, and 4 hours later, a third complainant, Group C (FBIR 23978), reported 3 out of 7 ill. The following evening, March 25, 2015, a fourth complainant, Group D (FBIR 23987), reported 1 out of 4 ill. All four groups had eaten on the same date. Initial food items reported were enchiladas, tacos, chile relleno, beans, rice, chips, and salsa. Symptoms included diarrhea, abdominal cramps, fevers, body aches, and headaches. The Acute Communicable Disease Control Program (ACDC) initiated an outbreak investigation to determine the extent of the outbreak, risk factors for the disease, and steps needed to prevent further spread.

METHODS

An outbreak-associated case was defined as a person eating at the restaurant between March 18, 2015 and March 20, 2015 who 1) had a stool, urine, or blood sample taken which grew Salmonella, or 2) had diarrhea and fever, or 3) had diarrhea and two other symptoms. An outbreak-associated control was defined as a person who ate at the restaurant during the same period of time but did not become ill with any gastrointestinal symptoms.

  • LAC-DPH Environmental Health Services (EHS) contacted the parties on the FBIR complaints to obtain contact information and preliminary information for all members.
  • EHS conducted three inspections of the restaurant (3/25/2015, 3/27/2015, 4/1/2015).
  • EHS requested contact information for any other complaints of illness to the restaurant and all reservations made between March 16, 2015 and March 20, 2015.
  • ACDC contacted individuals on YELP who complained about foodborne illnesses after eating at the restaurant and requested that they report to the public health department.
  • ACDC created a food history and illness questionnaire for all the complainants from the FBIR’s and the one reservation group, called all patrons with contact information, and interviewed them via telephone.
  • ACDC collected data in MS Access and calculated frequency and distribution of symptoms among cases. Analyses of food items and combination of food items were also performed. All analyses were conducted using SAS 9.3 analysis software and MS Excel.
  • ACDC sent out a health advisory to hospitals requesting to be notified of salmonellosis patients who could potentially be cases of the outbreak.
  • ACDC created a separate questionnaire to interview employees on job duties, food history, and possible illnesses prior to the outbreak.
  • ACDC, in conjunction with the District Public Health Nurses (PHNs), conducted a site visit on March 27, 2015 to the restaurant to observe food preparation, interview employees, initiate the process of stool collection, and provide education.
  • ACDC and PHNs returned to the restaurant on March 30, 2015 and April 1, 2015 to collect stool samples and provide additional education to the managers and workers.
  • PHNs questioned all routinely reported Salmonella cases to determine if they had any connection to Restaurant A. Any new cases identified by the PHNs were additionally interviewed over the phone by ACDC with the food and illness history questionnaire.
  • PHNs collected any additional stool samples from the employees at their District Health Centers.
  • The Public Health Laboratory (PHL) tested all the employee stool specimens and provided results.
  • PHL serotyped and determined the pulsed-field gel electrophoresis (PFGE) patterns for all the employee and case isolates.

RESULTS

Setting

On Friday, March 20, 2015, multiple small groups gathered separately for meals at an LAC Restaurant. This restaurant is a dine-in Mexican restaurant offering a variety of traditional Mexican dishes, a full bar, and an outdoor seating option. Some food items include burritos, enchiladas, tacos, tamales, taquitos and tostadas. Margaritas and other alcoholic beverages are additionally available upon order. Patrons typically consume their food at the establishment. However, the restaurant also offers a take-out option. Among the four groups, 11 out of 18 people eating at the restaurant reported becoming ill. EHS obtained line lists of the diners and ACDC interviewed patrons via telephone. For Group A, interviews were obtained for 5 individuals (100%). For Group B, two interviews were completed (100%) and for Group C, 2 out of 7 (29%). For Group D, we made contact with 2 out of 5 (40%) members. ACDC emailed electronic copies of the survey to Group D’s controls because only email addresses had been provided. Approximately 3 weeks later (on 4/14/2015), a FBIR was received for Group E reporting 3 ill individuals who ate on 3/19/15. Three out of 3 (100%) case interviews were completed. Collectively, food and illness history questionnaires were completed for 14 out of 22 (64%) individuals.

The PHNs were notified of the outbreak and 9 additional cases connected to the restaurant were discovered. These cases had eaten at the restaurant between 3/18/15 and 3/20/15. ACDC made contact with 8 out of the 9 cases (89%). One case did not want to return the phone calls from ACDC. However, the District Nurse was able to gather some preliminary food and illness history during her standard Salmonella surveillance interview.

From these 9 confirmed cases, 5 controls were identified. One eating partner of a confirmed case reported illness but did not meet the case definition. Many controls were non-responsive and could not be included in the analysis. In total, 23 cases and 6 controls were identified. Stool and blood samples were collected by the private medical facilities the cases visited. Isolates from these cases are routinely forwarded to the PHL for PFGE testing. Therefore, ACDC did not need cases to submit stools to the PHL for confirmation.

Cases – Restaurant Patrons

The median age of cases was 37 years, ranging from 3-83 years (Table 1). Cases were both male (40%) and female (60%). The controls also included males (33%) and females (67%) with a median age of 30 years (range: 17-47 years) (Table 2). Main symptoms of cases included diarrhea (100%), abdominal cramps (95%), nausea (77%), fever (68%), and chills (64%) (Table 3). Illness onsets occurred between March 20, 2015 and March 25, 2015 (Figure 1). The median incubation period was 26.5 hours (range: 2 to 122 hours). The duration for cases was approximated due to several cases still experiencing major symptoms at the time of the interview. The median duration was at least 5 days (range: at least 3 days to at least 11 days). Thirteen restaurant patrons had confirmed positive Salmonella Enteritidis laboratory cultures with the PFGE pattern JEGX01.0002. This includes the party of the fifth complainant, FBIR 24085, who reported on 4/14/2015. Two case isolates were submitted to CDC for whole genome sequencing.

Food Analysis

The results of the analysis of food items eaten by the patrons are shown in Table 4. All groups were combined for food analysis because many food items were shared across parties. Each party also had a limited number of individuals or respondents. Since only a few groups ate with people who did not report illness, these controls could also be compared to cases from other groups. No food items were found to be significantly associated with illness. The most common food items eaten by cases were rice (78%), chips (78%) and beans (67%). For controls, it was chips (78%), rice (78%), beans (67%) and salsa (67%). These foods are commonly served to all patrons as an appetizer or sides to the main dish. Also, because they were eaten by both ill and non-ill individuals, they are unlikely to be the source of illness.

Restaurant A

Inspection

Restaurant A is a casual dining restaurant open 7 days a week for lunch and dinner. It is frequented by families and friends who gather to share a meal or to celebrate special events. Employees are responsible for all the preparation and service of the food. Some patrons reported consuming items at the establishment and others had consumed the food elsewhere. The inspection by EHS on March 25, 2015 revealed violations such as improper holding temperatures, unapproved equipment usage, and the need for sanitization of utensils. During the inspection on March 27, 2015, EHS noticed failure to clean a cutting board after pounding raw chicken and an unapproved immersion blender paddle in use. The possibility for cross contamination during preparation of chile rellenos from raw shell eggs was also observed. The restaurant voluntarily closed that weekend (March 27-March 28, 2015) for terminal cleaning.

On April 1, 2015, EHS conducted a third inspection of the restaurant. All violations that were noted on the prior two inspections had been abated. The District Inspector followed up within two weeks with a standard graded inspection.

Employees

There were 36 employees reported to ACDC. Contact was made with all 36 employees (100%). One food server admitted to gastrointestinal symptoms which began on 3/23/2015 and lasted for 5 days. This individual took time off while sick and tested negative for Salmonella/Shigella. Like the rest of the restaurant staff, this employee frequently eats at the restaurant and did not admit to any ill contacts. All other employees denied symptoms of gastrointestinal illnesses in themselves and members of their household during the month preceding the outbreak. Stool samples were collected from the entire staff, 36 out of 36 employees (100%). The PHL performed the test for results. Nine employees had positive culture for S. Enteritidis, with PFGE pattern JEGX01.0002. These are identical to the serotypes and PFGE patterns of the patrons. One employee isolate was submitted to CDC for whole genome sequencing.

ACDC worked with the restaurant owner to ensure that these nine employees were either removed from the restaurant until they were cleared by standard procedures or were placed in duties that did not involve food handling. No employee tested positive for Shigella. All other workers yielded negative test results for both Salmonella and Shigella.

DISCUSSION

This is a laboratory confirmed S. Enteritidis outbreak. The PHL, in conjunction with private labs, yielded a total of 22 positive Salmonella tests. The nine positive employees included managers, cooks, waiters, bartenders and cleaning staff. Patrons who tested positive were from separate groups and had eaten at different times or dates. Several cases were identified from routine Salmonella surveillance rather than foodborne illness reporting. Presumptive cases also reported severe symptoms such as ongoing diarrhea, fever, headaches and body aches. No food item was found to be significantly associated with illness.

According to the Centers for Disease Control and Prevention, Salmonella results in symptoms of diarrhea, fever and abdominal cramps. Individuals generally become symptomatic 12 to 72 hours after being infected and remain so for approximately 4-7 days. Children, the elderly, those immunocompromised, and individuals with severe symptoms may require hospitalization. Salmonella infections are more commonly seen in the summer. Certain food items and meats are known to cause Salmonellosis when not properly heated. Such products served at this restaurant include eggs, pork, beef and chicken. When undercooked, these foods can be the source of bacterial infections. Raw fruits and vegetables such as lettuce, tomatoes and radishes could also be contaminated by the drippings of these products, while in the field, or during packaging and shipping1.

The spread of Salmonella in this restaurant could have been through employees, cross contamination or an undercooked or raw ingredient that infected both patrons and the employees. Infected individuals can excrete the bacteria in their feces for a few days or several weeks, depending on how quickly their bodies are able to get rid of the illness2 (Heymann). Salmonella can remain in a person’s system even after symptoms have resolved. Food handlers are possible sources of Salmonella due to the nature of their work2,3,4. Appropriate measures were taken to prevent additional spread. No cases occurred after Salmonella positive employees were removed and thorough cleaning and sanitizing of the kitchen.

LIMITATIONS

The food analysis is limited by the small number of controls available for the analysis. Having few cases and even fewer controls reduces statistical power and decreases the likelihood of calculated p-values being statistically significant. A small number of groups had controls. Due to a low response rate, attempts to get controls through reservations, take-out orders, and online solicitation were not successful.

Cases that are found through routine Salmonella surveillance occasionally have difficulties recalling when and what they ate at the restaurant. Persons may eat out frequently and the restaurant is one of many exposures. More time has also passed for these cases compared to the individuals who report foodborne illness. As a result, it is also harder to remember the date and time their symptoms first began. These are individuals who have already been diagnosed and may be several days out from their symptoms.

PREVENTION

EHS educated restaurant owners and managers about sanitization and ways to prevent future Salmonella infections. Some recommendations included using separate preparation surfaces for raw foods and produce, methods to properly rid surfaces of contamination and buying pasteurized products to eliminate risk. Additional recommendations include proper hand washing after using the restroom and monitoring employees for signs of illnesses3. The PHNs and ACDC educated all the restaurant workers and individual salmonellosis cases on the spread of Salmonella and the importance of staying home when ill to prevent spreading sickness.

CONCLUSION

This is a single outbreak that occurred among patrons who dined at Restaurant A between March 18, 2015 and March 20, 2015. The agent S. Enteritidis was confirmed by laboratory results. An ill food handler is the likely source of illness. No additional complaints or illnesses have been reported for Restaurant A since the restaurant has taken appropriate measures to remove all potential causes of this outbreak. ACDC in conjunction with EHS will monitor for future reports of foodborne illness from Restaurant A.

Full Report is Linked Here – includes all attachments, charts and references.  I am not sure why the report says “Restaurant A.”

tarheelThe Salmonella outbreak connected with the Tarheel Q restaurant in Lexington, NC, has been deemed over with at least 280 people sickened, according to a July 28 case count. One person died.

The designation was announced after two incubation periods (six days for most Salmonella cases) had passed without new illnesses since the restaurant reopened. Local health departments will no longer accept additional reports of illness.

The 280 cases were distributed across 21 North Carolina counties and 6 states. Of the North Carolina cases, 77 percent were residents of Davidson County and Davie County.

Laboratory testing indicated that the BBQ sample and a sample from a patient who became ill during the beginning of the outbreak were both positive for Salmonella species. The serogroup was Typhimurium, and both samples had the same PFGE pattern (DNA fingerprint). Three additional patients had a different PFGE pattern.

Fifty-eight percent of those sickened were male, 42 percent were between the ages of 20 and 49, and 9 percent had been hospitalized. Most cases had illness onset dates between June 16 and June 21.

thI just got this email – can I have your support?

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The nomination deadline for The Expert Institute’s Best Legal Blog Contest has been set for August 21st. That means there’s only three weeks left to nominate your favorite legal blog for a chance to win one of our three cash prizes, as well as a permanent position on The Expert Institute’s best legal blogs page.

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7b301fea4b134c79ac975fca9969cd9bThe North Dakota Department of Health is investigating a possible cluster of Shiga toxin-producing E. coli (STEC) infections in eastern North Dakota.

Five cases have been reported, all are less than 18 years of age and all reported attending the Red River Valley Fair in West Fargo, which was held July 7 through 12.

At least one of the cases has been diagnosed with hemolytic uremic syndrome (HUS), a severe complication of STEC infections, in which red blood cells are damaged and can cause kidney damage and kidney failure. Four of the five have been hospitalized.

“We are in the early stages of this investigation and are asking people who became sick with diarrhea or bloody diarrhea for more than 24 hours within ten days of attending the fair to let us know,” said Michelle Feist, a health department epidemiologist. “Although the cases reported having contact with animals while at the fair, we are looking into other possible exposures as well.”

STEC is a bacterial infection that can cause abdominal cramping, nausea, vomiting, diarrhea and bloody diarrhea. Symptoms can be severe resulting in dehydration and electrolyte imbalances. People usually get sick within 3 to 4 days from the time of infection, but it can take as long as 10 days for symptoms to appear.

People who have symptoms of STEC should consult with their health care provider.

STEC is shed in the stool of infected animals and people. STEC infections can result from eating contaminated food, drinking contaminated water, coming into contact with animals that are carrying STEC and can be spread from person to person through inadequate hygiene. Undercooked meats, especially ground beef, contaminated produce or sprouts and attending petting zoos have all been implicated in STEC outbreaks in the U.S. Animals may be infected and not have symptoms but can shed the bacteria.

First, see www.fair-safety.com – this is nothing new.

cilantro$100 says Trump puts out a press release.

FDA Investigators found:

  • Human feces and toilet paper found in growing fields and around facilities; Inadequately maintained and supplied toilet and hand washing facilities (no soap, no toilet paper, no running water, no paper towels) or a complete lack of toilet and hand washing facilities;
  • Food-contact surfaces (such as plastic crates used to transport cilantro or tables where cilantro was cut and bundled) visibly dirty and not washed;
  • Water used for purposes such as washing cilantro vulnerable to contamination from sewage/septic systems;
  • In addition, at one such firm, water in a holding tank used to provide water to employees to wash their hands at the bathrooms was found to be positive for Cyclospora cayetanensis.

The Centers for Disease Control and Prevention (CDC) and state public health officials have identified annually recurring outbreaks (in 2012, 2013, and 2014) of cyclosporiasis in the United States, which have been associated with fresh cilantro from the state of Puebla, Mexico. There is currently (in July 2015) another ongoing outbreak of cyclosporiasis in the United States in which both the Texas Department of State Health Services and the Wisconsin Department of Health Services and the Wisconsin Department of Agriculture, Trade and Consumer Protection have identified cilantro from the Mexican state of Puebla as a suspect vehicle with respect to separate illness clusters.

Texas DSHS has received reports of 205 Cyclosporiasis cases from around Texas this year, prompting an investigation into the infections in hopes of determining a common source. People who have a diarrheal illness lasting more than a few days or diarrhea accompanied by a severe loss of appetite or severe fatigue should contact their health care provider.

Past outbreaks have been associated with cilantro from the Puebla area of Mexico. While the investigation into the current outbreak is ongoing, imported cilantro has been identified as a possible source of some infections. The U.S. Food and Drug Administration recently issued an import alert detaining cilantro from that area coming into the U.S.

DSHS recommends thoroughly washing fresh produce, but that may not entirely eliminate the risk because Cyclospora can be difficult to wash off. Cooking will kill the parasite.

Cyclospora cayetanensis is a human-specific protozoan parasite that causes a prolonged and severe diarrheal illness known as cyclosporiasis. In order to become infectious, the organism requires a period outside of its host. Illnesses are known to be seasonal and the parasite is not known to be endemic to the United States. Cyclosporiasis occurs in many countries, but it seems to be most common in tropical and subtropical regions. People become infected with C. cayetanensis by ingesting sporulated oocysts, which are the infective form of the parasite. This most commonly occurs when food or water contaminated with feces is consumed. An infected person sheds unsporulated (immature, non-infective) C. cayetanenis oocysts in the feces.

As I said to ABC News:

Bill Marler, a Seattle-based food safety lawyer, said the number of cyclospora outbreaks in recent years is worrying.

“Banning the product is probably a bit past due given the numbers of outbreaks that have occurred, “said Marler. “The fact is that cyclospora is called an emerging pathogen. It’s relatively new bug making people sick in the U.S.”

Lucky Peach asked me to give a differing perspective on “Hamburger Month.”  Now you know why I am seldom asked to dinner.

Attorney Bill Marler has won more than $600 million for clients since he and his partners formed Marler Clark in 1998. Marler rose to fame—or notoriety, if you’re a food producer—in 1993, when he successfully litigated a series of suits against Jack in the Box on behalf of children who contracted E. coli from eating the fast food joint’s tainted beef. We asked him to explain the ten worst E. Coli outbreaks that he’s seen.

meat-_v2E. coli O157:H7 did not burst onto the scene in the early 1990s, as many in the big food business like to think. It slowly crept into our food supply, spreading in the enormous feedlots that began to dot the U.S. landscape during the last century. The bacteria is now endemic and can be found in cows, sheep, and wild animals such as boar, elk, and deer. As few as fifty E. coli O157:H7 bacteria are enough to cause human illness—and as many as 100,000 can fit on the head of a pin.

Once this strain of E. coli makes it into our small intestine, it can damage the intestinal wall, causing severe cramping and bloody diarrhea. In some instances, the toxin that the bacteria releases gets into the human bloodstream, damaging red blood cells and causing severe complications like kidney failure, stroke, brain damage, and death.

I wrote an op-ed for the Denver Post in 2002 entitled: “Put me out of business. Please.” In it, I discussed how between 1993 and 2002, at least 95 percent of my law firm Marler Clark’s revenue was from E. coli cases linked to hamburger meat. Now, it is almost zero—which is not to say that there are no cases, but that big beef processors have gotten serious about keeping E. coli O157:H7 out of the food supply. Still, I find that knowing your history is a great motivator to maintain and champion continuing diligence—because one person sickened by careless meat processing is too many. Here, then, is a rundown of the most significant E. coli outbreaks in America.

FEBRURARY 1982: 47 ill

The first time E. coli O157:H7 was linked to an outbreak was in 1982, when contaminated hamburgers were sold at McDonald’s outlets in Oregon and Michigan. The source was suspected to be a meat plant in Michigan, which had distributed the beef patties to the restaurants. At the time, the serotype O157 was thought of as a rare occurrence; the only known previous isolation of E. coli O157:H7 was from a case of hemorrhagic colitis (a disease that causes inflammation and ulcers in the colon and rectum) in 1975. This outbreak got barely a mention in the media.

NOVEMBER 1986: 37 ill

Cases of E. coli O157:H7 were detected throughout Washington state in November 1986, after a physician in eastern Washington hospitalized three patients with hemorrhagic colitis that progressed to thrombotic thrombocytopenic purpura, a condition where small clots form within the body’s small blood vessels. The beef was traced back to the farms, where cattle were shown to be carrying the disease. This was not a big outbreak, but it was an important one: it prompted Washington state to be one of the first states to make E. coli O157:H7 a reportable event, and state health officials changed the food code to increase the internal temperature for hamburger from 140 to 155 degrees—the only state in the country to do so.

NOVEMBER 1992/JANUARY 1993: 501 ill; 151 hospitalized; 4 deaths

In January 1993, a physician from Children’s Hospital and Medical Center in Seattle reported that there had been an increase in emergency room visits for bloody diarrhea and hemolytic uremic syndrome, when red blood cells break down and start blocking the kidneys’ filtering system. A study implicated Jack in the Box’s hamburgers, resulting in a multi-state recall of the remaining product. Only 20 percent of the product was still around by the time of the recall; this amounted to 272,672 hamburger patties. No specific slaughter plant or farm was ever identified as the source of the contaminated meat. This was the first event to illustrate the disastrous potential of outbreaks tied to restaurant chains.

At the time of the outbreak, culturing for E. coli in clinical laboratories was being done incorrectly, and many health departments were not actively tracking and investigating the illness.

NOVEMBER 2000: 46 ill; 24 hospitalized

In November of 2000, Minnesota health officials detected a group of people who were infected with the same strain of E. coli O157:H7—most of whom had consumed ground beef from SuperValu’s Cub Food stores. The American Foods Group (AFG) had supplied beef to the SuperValu/Cub Food stores and to 178 independent retailers, and E. coli O157:H7 was isolated from at least twenty-three different meat samples during the investigation. A total of forty-two cases were reported in Minnesota, one case was discovered in Wisconsin, and three cases in Ohio.

On December 4, the American Foods Group recalled the ground beef. USDA records showed that the company had been cited by federal inspectors for a variety of problems, including nine instances where fecal matter had been spotted on the meat and the presence of Salmonella.

JUNE 2002: 28 ill; 7 hospitalized; 1 death

After the Colorado Department of Health identified an outbreak of E. coli O157:H7 among its residents, the same strain started popping up in cases around the country. The initial investigation pointed to ground beef purchased at Kroger’s grocery stores, which was produced by ConAgra Beef Company. On June 30, independent of the outbreak, the ConAgra Beef Company issued a nationwide recall of 354,200 pounds of ground beef produced on May 31—a recall that had resulted from routine microbiological testing that had been conducted by the USDA. After the outbreak was detected and the plant was inspected, the ground-beef recall was expanded, and an additional 18.6 million pounds of fresh and frozen ground beef and beef trimmings were recalled. Turns out that evidence of E. coli O157:H7 contamination had been ignored since January 2001—more than a year before this outbreak was detected.

I think it was at this point that the industry truly began paying more attention to E. coli O157:H7 through intervention, testing, and safer handling practices—and when I first started to see a drop in the number of recalls and outbreaks.

AUGUST 2007: 47 ill

In early October 2007, Minnesota health department officials noticed a cluster of three E. coli O157:H7 cases with the same genetic pattern. Interviews with the patients—and, later, with patients in Wisconsin, North Carolina, and Tennessee—found a common exposure of Cargill hamburger. Sam’s Club was a major purchaser of the Cargill frozen hamburgers, and eventually recalled 845,000 pounds of Cargill ground beef. The outbreak became the focus of the New York Times story “The Burger That Shattered Her Life,” which won the author a Pulitzer Prize.

OCTOBER 2007: 40 ill; 21 hospitalized

Frozen Topp’s brand ground-beef patties gathered from patients’ homes and from unopened packages around the country yielded E. coli O157:H7 with several different genetic patterns—and forty of those cases were matched with the same genetic fingerprint pattern that was found in the ground beef. Confusingly—and maddeningly—the USDA’s Food Safety and Inspection Service refused to recall hamburger that was linked to an illness unless the package was unopened—somewhat of a difficult feat given that it must be opened before someone can consume it.

MAY 2008: 79 ill; 32 hospitalized

Kroger was put back in the spotlight in May of 2008, when an investigation linked ground beef purchased at one of several Kroger stores in Michigan and Ohio to an outbreak of E. coli O157:H7. The ground beef was traced to Nebraska Beef, Ltd., a beef processor. On June 30, Nebraska Beef Ltd. announced a recall of 531,707 pounds of ground beef—and four days later, they expanded the recall to include all beef manufacturing trimmings and other products intended for use in raw ground beef produced between May 16 and June 26, totaling approximately 5.3 million pounds. Nebraska Beef would later be implicated in July in another, separate outbreak of E. coli O157:H7. This was a company simply more interested in production than safety.

MARCH 2009: 23 ill; 6 hospitalized

In June 2009, a multi-state outbreak was discovered involving ground beef produced by the JBS USA beef company. Samples from unopened packages of ground beef recovered from a patient’s home were tested by the Michigan Public Health Laboratory, which yielded E. coli O157:H7 that matched the DNA fingerprint of the outbreak strain. The beef was sold in the United States and Mexico, and Mexican health officials banned further importation of the meat. (I always find it a bit amusing when other countries ban our food products; U.S. companies tend to be so gleeful when they can point the finger at some food manufacturer from somewhere outside the U.S., with the underlying implication that they must be dirty. The truth is that contamination can happen anywhere.

JUNE 2014: 3 ill; 3 hospitalized; 1 death

The Massachusetts Department of Public Health, the Centers for Disease Control and Prevention, and the USDA FSIS identified three patients diagnosed with E. coli O157:H7 who became ill after consuming ground beef sold at Whole Foods stores in Massachusetts. Although there were few victims, the results were vicious; all three were hospitalized, and one child died. This outbreak was linked to grass-fed, organic beef: a product that many consider to be safe, but clearly is not, or not more so than other beef. The danger comes from improper or careless handling, not from how the cows live.