January 2016

epi-big-12-21-15Will the numbers go above 58?

Fifty-three people infected with the outbreak strain of STEC O26 have been reported from 9 states. The majority of illnesses have been reported from Washington and Oregon during October 2015. The number of ill people reported from each state is as follows: California (3), Illinois (1), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (13), Pennsylvania (2), and Washington (27).

Among people for whom information is available, illnesses started on dates ranging from October 19, 2015 to November 14, 2015. Ill people range in age from 1 year to 94, with a median age of 21. Fifty-nine percent of ill people are female. Twenty (38%) people reported being hospitalized. There have been no reports of hemolytic uremic syndrome and no deaths.

The most recent person reporting Chipotle exposure became ill on November 10, 2015. Reports to PulseNet of new illnesses in this outbreak have slowed substantially since the peak of the outbreak in October 2015. CDC and state and local public health partners are continuing laboratory surveillance through PulseNet to identify additional ill people and to interview them.

State and local public health officials continue to interview ill people to obtain information about foods they might have eaten and other exposures in the week before their illness started. To date, 46 (88%) of 52 people interviewed reported eating at a Chipotle Mexican Grill restaurant. The investigation is still ongoing to identify common meal items or ingredients causing illness.

Investigators are also using whole genome sequencing (WGS) to get more information about the DNA fingerprint of the STEC O26 bacteria causing illness. WGS has been performed on STEC O26 isolates from 29 ill people in Washington (16), California (2), Maryland (1), Minnesota (2), New York (1), Ohio (3), Oregon (3), and Pennsylvania (1). All 29 isolates were highly related genetically to one another. This provides additional evidence that illnesses outside the Pacific Northwest are related to the illnesses in Oregon and Washington.

Additionally, 5 people infected with a different, rare DNA fingerprint of STEC O26 have been identified in Kansas (1), North Dakota (1), and Oklahoma (3) and appear to be linked to Chipotle Mexican Grill. The infections started on dates ranging from November 18, 2015 to November 26, 2015. All five (100%) reported eating at a Chipotle Mexican Grill in the week before illness started. All 3 Oklahoma ill people ate at a single Chipotle location in Oklahoma, and the North Dakota ill person traveled to Kansas during their exposure period and ate at the same Chipotle location as the Kansas ill person. It is not known if these infections are related to the larger outbreak of STEC O26 infections; this investigation is ongoing. WGS is being used to determine if this strain is genetically related to the STEC O26 causing the larger outbreak.

And, let’s not forget:

Seattle

When: July 2015

Sickened: 5 people

Culprit: E. coli O157:H7

Source: Unknown

Simi Valley, CA

When: August 2015

Sickened: At least 234

Culprit: Norovirus

Source: Ill worker

Minnesota

When: August and September 2015

Sickened: 64 people

Culprit: Salmonella Newport

Source: Tomatoes

Boston

When: December 2015

Sickened: At least 136 people

Culprit: Norovirus

Source: Ill worker

151208103509-chipotle-boston-college-students-sick-pkg-00000000-exlarge-169More than 120 Boston College students were taken ill after eating at the same Chipotle at 1924 Beacon Street in Brighton in December 2015.

After receiving reports of multiple cases of gastrointestinal illness among patrons who ate at the Chipotle Mexican Grill in Cleveland Circle, the Boston Public Health Commission, the City of Boston Inspectional Services Department, and the Massachusetts Department of Public Health launched an investigation to determine the cause and the nature of the illness. Laboratory testing confirmed the presence of norovirus.

There were 136 known cases of norovirus from people who ate at Chipotle; others who were contacts to these cases have also become ill.

City inspectors closed the Chipotle, located in Brighton near BC’s campus, “until further notice” after reporting three critical health violations following a visit Monday.

According to the Inspection Services Department, an employee came to work sick last Thursday and chicken and steak on the service line were being held at 128 degrees F and 124 degrees F, respectively—below the required temperature range of at least 140 degrees F. The third violation was of multiple reports of foodborne illness from the location. All three citations were given the department’s most serious grade of violation. A spokeswoman for the Boston Public Health Commission said the illnesses were likely caused by norovirus, but final test results are not expected to for a couple of days.

dailymeal-logo-FINALWell, I made the Daily Meal’s “50 Most Powerful People in Food” again. I’m up a few spots from last year – now wedged between the Dole CEO (didn’t they just have a Listeria outbreak) and Rachael Ray. Here is the full list:

#50 Vani Hari, “Food Babe”

#49 Andrew Zimmern, Host, ‘Bizarre Foods’

#48 Ingrid Newkirk, President and Co-Founder, People for the Ethical Treatment of Animals

#47 Rodney McMullen, Chairman and CEO, The Kroger Co.

#46 Todd J. Vasos, CEO, Dollar General

#45 Julie Packard, Executive Director and Vice-Chairman, Monterey Bay Aquarium

#44 Steven Spinner, CEO, President, and Director, United Natural Foods, Inc.

#43 Anthony Bourdain, Chef and Television Personality

#42 David Murdock, CEO, Dole Food Company

#41 Bill Marler, Foodborne Illness Lawyer and Attorney

#40 Rachael Ray, Television Personality

#39 Jim McGovern, Co-Chair, House Hunger Caucus

#38 Bill Shore, Founder and CEO, Share Our Strength

#37 Paul Grimwood, CEO and Chairman, Nestlé USA

#36 Pete Wells, Restaurant Critic, The New York Times

#35 Michel Landel, CEO, Sodexo

#34 Irene Rosenfeld, CEO, Mondelez International

#33 Craig Jelinek, CEO, Costco

#32 Mario Batali and Joe Bastianich, Chef/ Restaurateurs

#31 Dan Bane, Chairman and CEO, Trader Joe’s

#30 Danny Meyer, Restaurateur

#29 Oprah Winfrey, Media Mogul

#28 José Andrés, Chef-Restaurateur

#27 Eric J Foss, CEO, Aramark

#26 Tim Ryan, President, Culinary Institute of America

#25  Travis Kalanick, Founder, Uber

#24 David Chang, Chef and Restaurateur

#23 Dawn Sweeney, President and CEO, National Restaurant Association

#22 Jeff Bezos, Founder and CEO, Amazon

#21 Kevin Systrom, Co-Founder and CEO, Instagram

#20 David C Novak, Executive Chairman, Yum! Brands

#19 Steve Easterbrook, CEO, McDonalds

#18 Paul Polman, CEO, Univeler

#17 Kathleen Finch, Chief Programming, Content & Brand Officer, Scripps Networks Interactive

#16 Patricia Woertz, Chairman, President, and CEO, Archer Daniels Midland

#15 Donnie Smith, President and CEO, Tyson Foods

#14 Pamela Bailey, President and CEO, Grocery Manufacturers Association

#13 George Zoghbi, Chief Operating Officer, U.S. Commercial Business, Kraft Foods

#12 Susan Neely, President & CEO, American Beverage Association

#11 David MacLennan, Chairman and CEO, Cargill

#10 William J. Delaney III, CEO, Sysco

#9 Jeremy Stoppelman, Co-Founder and CEO, Yelp

#8 James P. Hoffa, General President, International Brotherhood of Teamsters

#7 Indra Nooyi, Chairman and CEO, Pepsi

#6 Howard Schultz, CEO, Starbucks

#5 John Mackey, Founder and Co-CEO, Whole Foods Market

#4 Michael R. Taylor, Deputy Commissioner for Food, Federal Drug Administration

#3 Hugh Grant, Chairman, President, and CEO, The Monsanto Company

#2 Judith McKenna, Executive Vice President and Chief Operating Officer, Walmart U.S.

#1 Thomas Vilsack, Secretary, USDA

norovirusThe Kansas Department of Health and Environment (KDHE) is working with the Kansas Department of Agriculture and the Johnson County Department of Health and Environment to investigate an outbreak of norovirus infection among individuals who became ill after attending the New Theatre Restaurant in Overland Park, Kan. Based on reports of illness from attendees, KDHE is now expanding the investigation. KDHE would like all persons, those that became ill and those that did NOT become ill, who attended performances since Friday, Jan. 15 to fill out our secure, confidential online survey available at http://tinyurl.com/newtheatre2016. KDHE is still investigating the source of the illness.

So far during KDHE’s investigation, more than 390 individuals have reported illness and attended the New Theatre Restaurant from Friday, Jan. 15 to present. Four people who became ill have laboratory specimens that confirmed norovirus.

Norovirus is different from influenza and is very contagious. Norovirus symptoms include diarrhea, vomiting, nausea and stomach pain. A person develops symptoms 12 to 48 hours after being exposed and most people get better within one to three days. Norovirus is spread person to person (having contact with someone who is infected with norovirus), through contaminated food or water, or by touching contaminated surfaces. Norovirus is not spread through the air through coughing, sneezing or talking. The best way to prevent norovirus is proper handwashing. Norovirus causes an estimated 19 to 21 million persons to become ill each year, and is more common in the winter months.

big-map-1-27-2016Since September 2015, CDC has been collaborating with public health officials in several states, the U.S. Food and Drug Administration (FDA), and the Public Health Agency of Canada to investigate a multistate outbreak of Listeria monocytogenes infections (listeriosis).

Listeria can cause a serious, life-threatening illness.

Fifteen people infected with the outbreak strain of Listeria have been reported from eight states since July 5, 2015, an increase of three cases since the last update on January 22. All 15 people were hospitalized, including one person from Michigan who died as a result of listeriosis. One illness was reported in a pregnant woman.

Laboratory tests performed on clinical isolates from all 15 ill people showed that the isolates are highly related genetically.

According to the Public Health Agency of Canada, there are seven people in five Canadian provinces infected with the same outbreak strain of Listeria. Laboratory tests performed on clinical isolates from ill people in Canada showed that the isolates are highly related genetically to Listeria isolates from ill people in the United States.

Epidemiologic and laboratory evidence indicate that packaged salads produced at the Dole processing facility in Springfield, Ohio and sold under various brand names are the likely source of this outbreak.

maggianosFB.0.0Public Health is currently investigating an outbreak of norovirus-like illness associated with Maggiano’s Little Italy restaurant in Bellevue. We are in the early stages of our investigation so information could change. Preliminary information indicates that as many as 50 who attended a private event at the restaurant on 1/18/16 may have come down with norovirus following the event. One or more of the attendees may have already been ill at the time of the event. Several restaurant workers were also believed to be ill with symptoms consistent with norovirus dating back to 1/9/16 and over the subsequent two weeks. We currently do not have laboratory confirmation that this is definitively norovirus, but often in norovirus outbreaks no laboratory testing is done. If and when we get confirmation we will update this information on this website.

Public Health learned of the outbreak late on Friday, 1/21. The restaurant is working cooperatively with Public Health, and we have suspended their food business permit in order to allow time for thorough cleaning and sanitizing. Public Health staff will be conducting interviews of ill persons. People who are ill with vomiting or diarrhea for more than 3 days, or who have signs of serious illness like bloody diarrhea should see a health care provider.

epi-big-1-26-2016The CDC, multiple states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of Salmonella Poona infections.

Epidemiologic, laboratory, and traceback investigations identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as a likely source of the infections in this outbreak.

Two recalls of cucumbers that may be contaminated with Salmonella were announced in September 2015 as a result of this investigation: Andrew & Williamson Fresh Produce and Custom Produce Sales.

888 people infected with the outbreak strains of Salmonella Poona have been reported from 39 states, an increase of 50 cases since the last update on November 19, 2015. 191 ill people have been hospitalized, and six deaths have been reported from Arizona (1), California (3), Oklahoma (1), and Texas (1). Salmonella infection was not considered to be a contributing factor in two of the three deaths in California.

As of January 21, 2016, 888 people infected with the outbreak strains of Salmonella Poona have been reported from 39 states. The number of ill people reported from each state is as follows: Alabama (1), Alaska (19), Arizona (134), Arkansas (13), California (241), Colorado (21), Connecticut (1), Florida (1), Hawaii (1), Idaho (26), Illinois (11), Indiana (5), Iowa (7), Kansas (2), Kentucky (1), Louisiana (5), Maryland (1), Minnesota (43), Missouri (15), Montana (16), Nebraska (8), Nevada (17), New Hampshire (1), New Mexico (35), New York (6), North Dakota (8), Ohio (3), Oklahoma (13), Oregon (23), Pennsylvania (2), South Carolina (10), South Dakota (3), Tennessee (1), Texas (52), Utah (62), Virginia (1), Washington (26), Wisconsin (46), and Wyoming (7).

The source of contamination for the cucumbers distributed by Andrew & Williamson Fresh Produce has not been identified.

Screen Shot 2016-01-25 at 4.44.29 PMImpacting as many as 25,000 who received Hepatitis A vaccines to prevent becoming ill with the Hepatitis A Virus.

Although it has been a long time coming, with much work done to get here, but today we finally received the court’s ruling on class certification, and the ruling was in our favor. The court granted our motion that asked it to certify what is called a “liability only” class action. This means that, for purpose of determining whether Townsend Farms and Costco are liable for damages caused by consumption of the contaminated berries, that question will be determined on behalf of the both the named plaintiffs and all class members.  Technically, the court certified a sub-class for each of the nine states with a class representative, and it could be that there is a trial for each subclass.  More likely, there will be a single trial with the jury answering separate verdict questions for each state.  The question of damages would then be decided in a second phase of trial.  Certification Order

THE COSTCO HEPATITIS A OUTBREAK

Epidemiologic Investigation

According to the CDC, as of September 15, 2014, 165 people had been confirmed to have become ill from hepatitis A after eating ‘Townsend Farms Organic Antioxidant Blend’ in 10 states: Arizona (24), California (80), Colorado (29), Hawaii (8), New Hampshire (1), New Jersey (1), New Mexico (11), Nevada (6), Utah (3), and Wisconsin (2). Six of the confirmed cases were household contacts of confirmed cases (secondary cases). The Townsend Farms Berries were sold at Costco.

  • 91 (55%) ill people were women
  • Ages range from 1 – 84 years
  • 95 (57%) of those ill were between 40 – 64 years of age.
  • 11 children age 18 or under were also ill.
  • Illness onset dates range from 3/31/2013 – 8/12/2013
  • 69 (42%) ill people have been hospitalized, but no deaths have been reported
  • All ill people who reported eating this product purchased it from Costco markets

Laboratory Investigation

The major outbreak strain of hepatitis A virus, belonging to genotype 1B, was found in clinical specimens of 107 people in eight states: AZ, CA, CO, HI, NH, NM, NV, and WI. This genotype is rarely seen in the Americas but circulates in North Africa and the Middle East.

Regulatory Investigation

By combining information gained from FDA’s traceback and traceforward investigations and the CDC’s epidemiological investigation, FDA and CDC have determined that the most likely vehicle for the hepatitis A virus appears to be a common shipment of pomegranate seeds from a company in Turkey, Goknur Foodstuffs Import Export Trading. Purely Pomegranate, Fallon Trading and United Juice imported the seeds into the United Sates.

These pomegranate seeds were used by Townsend Farms to make the Townsend Farms Organic Antioxidant Blends. On June 4, 2013, Townsend Farms voluntarily recalled certain lots of its frozen Organic Antioxidant Blend because of potential hepatitis A virus contamination. On June 28, 2013, Townsend Farms expanded the recall because of potential hepatitis A virus contamination.

Technology-Research-laboratory-engineerAt the end of 2012 the Microbiological Data Program (MDP) formerly run by the U.S. Department of Agriculture ended. Because of produce industry pressure Obama killed a food safety program started by Bush.

Here is how the MDP worked. Public health officials pulled samples of Tomatoes (cherry, round, roma), Cantaloupe, Lettuce (leaf, romaine, cut, and pre-washed), Celery, Parsley, Cilantro, Spinach (bunched and bagged and pre-washed), Hot Peppers, Sprouts (alfalfa and clover), Onions (bulb and green) to test for pathogens that can kill your kids and mine. And, in fact sickened and killed people in both the US and Canada after they consumed Listeria-tainted lettuce.

The samples were collected from distribution centers in 11 states that represented about 50 percent of the United States population. Any isolated pathogens were sent for pulsed field gel electrophoresis (PFGE) testing and the resulting genetic pattern was uploaded to the Centers for Disease Control PulseNet database so that it could be matched against human isolates or outbreak patterns. MDP also tested all isolates for antimicrobial resistance and contributed data to the National Antimicrobial Resistance Monitoring (NARMS) database.

From 2009 to 2012, MDP found Salmonella 100 times, E. coli O157:H7 twice, and Listeria monocytogenes 8 times. Over the same time period, the program sparked 23 Salmonella recalls, two E. coli O157:H7 recalls, and five Listeria recalls. Of the pathogens the program identified during that time, 39 Salmonella isolates were matched to human illnesses – as were the two E. coli O157:H7 and all eight Listeria isolates.

In Obama’s budget request for FY 2013, the administration justified cutting MDP, calling it a “lower-priority program because it is has a low impact and is not central to the core mission of USDA, which is to facilitate the competitive and efficient marketing of agricultural products.”

Here were just a few reasons to fully fund the MDP and not kill it:

  • MDP was the only robust sampling program we had. That surveillance data was irreplaceable and would have been important for moving forward with the FSMA produce safety rule. Having commodity-specific surveillance data can be used by growers to tailor preventative practices.
  • MDP did sometimes spark recalls before their sell by or use by dates, which allowed retailers to pull potentially contaminated product from shelves before consumers ate it. The $4.5 million program would have been more than worth it even if it only prevented one case of E. coli O157:H7 caused acute kidney failure – hemolytic uremic syndrome – in a child.
  • MDP had a sampling, testing, and reporting infrastructure in place that could rapidly be deployed and begin sampling and testing for outbreak related commodities within a week. It gave health officials rapid response capability. Rapid was good for consumers and good for the industry. The faster we knew what was causing an outbreak, the faster we could alert consumers and the faster the impact could be minimized to industry.
  • As many states cut their public health budgets, MDP lost resources to help build better microbiological labs. When the program was first launched in 2001, many labs were using antiquated methods. MDP introduced the labs to polymerase chain reaction (PCR) and currently real time PCR. With the help of USDA funding, MDP labs were state of the art and each was ISO 17025 accredited. By continually sampling throughout the year, MDP staffs became proficient at testing and isolation of pathogens. This was more art than science and was a skill that was developed not acquired.

I guess we will never know for sure if the outcome for Dole and its consumers would have been different.  For a good overview of how the MDP died, read:  Letter From The Editor at Food Safety News: “Blood” http://www.foodsafetynews.com/2012/05/letter-from-the-editor-blood/#.VqVsj8Cnu2Q.twitter

norovirusIn late August 2015 Ventura County Environmental Health and Ventura County Public Health investigated an outbreak of norovirus occurring among customers of the Chipotle Restaurant located at Simi Valley Towne Center. Ill customers ate at the restaurant on August 18 or August 19. Symptoms began between 3 and 30 hours after patrons ate at the restaurant. Commonly reported symptoms were nausea, vomiting, diarrhea, fatigue, fever, body aches, stomach cramps and chills. At least two customers submitted stool specimens that were positive for norovirus.

The restaurant was closed on August 21 for a thorough cleaning. All food was discarded and surfaces were cleaned. Ill food handlers were told they could not return to work until five days after symptoms resolved. Food handlers who tested positive for norovirus could not return to work until laboratory tests were negative for norovirus.

The outbreak was summarized in an inspection report written by Ventura County Environmental Health inspector, Ramesh Bassiri. Mr. Bassiri documented a report of two complaints encompassing three individuals who had eaten at Chipotle between August 16 and August 20. He noted that the Chipotle area manager had been alerted to illnesses via a computer complaint hotline. By August 24, as many as 46 customers and 17 employees were ill. The number of ill customers would grow and as many as 100 Chipotle customers reported symptoms.

Mr. Bassiri conducted an inspection at the restaurant on August 24. Numerous violations were noted. Employees did not have valid food handler cards, a requirement for employment. Inspector Bassiri observed an accumulation of mildew on the inside of the ice machine and on the backsplash of the ware washing sink as well as an accumulation of grease and food debris in the deep fryer. Restrooms were in disrepair and ceiling tiles were missing. Employees were instructed to keep floors clean and maintained. These violations needed to be corrected and a follow up inspection would be conducted within several days.

On August 27 Mr. Bassiri returned to the restaurant. This time he observed a serious food safety practice. A container of beef was held at 118oF on the steam table, considerably below the 135oF required by California food code regulations. The food item was discarded. Most of the violations noted on August 24 had been corrected. The item not corrected was a repair of a damaged gasket to a “merchandiser” located at the front of the service counter. Mr. Bassiri emphasized the importance of handwashing and provided restaurant employees with handouts and stickers.

The report reveals that the Simi Valley outbreak was larger than any of the other four outbreaks Chipotle has suffered since July, including the ongoing norovirus outbreak mostly involving Boston College students, the two E. coli outbreaks, and the Salmonella Newport outbreak in Minnesota in August. Together, these events have sickened more than 490 people.

The Simi Valley chronology was prepared by the Environmental Health Division of Ventura County’s Resource Management Agency. The first report of illness at the Chipotle Mexican Grill at 1263 Simi Town Center Way came to the agency’s executive officer by email at 9:36 p.m. on Thursday, Aug. 20, 2015. A man said that his daughter, one of 16 students, had dined at that Chipotle restaurant and was ill. And, the students were all sick, and one was in the hospital.

The county’s chronology includes detailed tracking of the complaints as they came in and as the illnesses were confirmed as norovirus. From that first report through Sept. 25, 2015, the chronology comes to this conclusion: “the total number of reportedly ill customers and employees at this Chipotle outbreak investigation is 234.”

Here are the public records of the California norovirus outbreak:

CHIPOTLE NOROVIRUS – CDPH records

CHIPOTLE NOROVIRUS – Ventura County EH inspection records

CHIPOTLE NOROVIRUS – Ventura County Epidemiology records