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July 2016

blue-bellTexas health officials today finalized with Blue Bell Creameries a penalty and agreement that the company will continue to test and monitor its ice cream following last year’s outbreak of Listeria monocytogenes linked to Blue Bell products made in Brenham.

The total penalty amount is $850,000. Of that, $175,000 must be paid within 30 days. The remaining balance will not have to be paid if the company follows the terms outlined in the agreement for 18 months. The penalty was issued against the company because it allowed adulterated product to enter the marketplace and cause illness.

The enforcement agreement between Blue Bell and the Texas Department of State Health Services extends several requirements from a previous agreement for the next 18 months. Blue Bell must continue to notify DSHS of any presumptive positive test results for Listeria monocytogenes in ice cream, ingredients, food surfaces, machinery and other equipment in its Brenham plant. The company must maintain its “test and hold” procedures for all finished product, meaning ice cream must be found to be free of pathogens before it can be sold to the public. As a licensed frozen dessert manufacturer, the company also must continue to provide state inspectors with full access to the plant to take samples.

Last year the company temporarily shut down its Brenham operation following the discovery of Listeria monocytogenes in certain ice cream products that were linked to several cases of Listeriosis. At the time, Texas health officials outlined requirements and milestones the company had to reach before releasing ice cream into the marketplace. State health inspectors periodically were on site at the Brenham plant to evaluate test results and records, review cleaning procedures and assess training activities.

The company is currently producing, testing and selling ice cream made at the plant.

The enforcement agreement is posted here.

I assume Oklahoma and Alabama are not far behind

iwilei_costcoPerhaps vaccinating food service workers would be good?

From the Hawaii Department of Health Website:

An employee of the following food service businesses has been diagnosed with hepatitis A. This list does not indicate these businesses are sources of this outbreak; at this time, no infections have been linked to exposure to these businesses. The likelihood that patrons of these businesses will become infected is very low. However, persons who have consumed food or drink products from these businesses during the identified dates of service should contact their healthcare provider for advice and possible preventive care.

Establishment Island Location Dates of Service
Baskin-Robbins Oahu Waikele Center June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3, 2016
Costco Bakery Oahu Hawaii Kai June 16-20, 2016
Sushi Shiono Hawaii Waikoloa Beach Resort, Queen’s MarketPlace (69-201 Waikoloa Beach Drive) July 5-8, 11-15, and 18-21, 2016
Taco Bell Oahu Waipio (94-790 Ukee Street) June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11, 2016

As of today, 93 people have been reported with hepatitis A on Oahu or people on Hawaii, Kauai, and Maui that had visited Oahu.  No none source has been announced.

Screen-Shot-2016-07-28-at-4.54.20-PM-300x297The Iowa Department of Inspections and Appeals (DIA) and the Iowa Department of Public Health (IDPH) today jointly issued a consumer advisory for potato salads made in and sold by Big G Food Store in Marengo, Iowa.  Big G’s “Zesty Potato Salad” and “Traditional Potato Salad” have been implicated in several cases of foodborne illness reported in Iowa County.  Presumptive test results from the State Hygienic Laboratory at the University of Iowa indicate the presence of salmonella in these products.

Big G Food Store has voluntarily pulled the potato salads from its shelves, and is working with the state departments in the investigation of the reported illnesses.  The suspect salads were prepared in the store during the month of July.  Neither potato salad has been sold to the consuming public since last Friday evening, DIA Food & Consumer Safety Bureau Chief Steven Mandernach said.

IDPH is investigating several cases of possible illness associated with the potato salad. “The bottom line is that no one should eat this product,” said IDPH Medical Director, Dr. Patricia Quinlisk. “If you have it in your refrigerator, you should throw it away.”

Salmonella infection is a common bacterial disease that can cause illness and rarely, it can be severe.  Usually, people who get salmonella infection develop symptoms within 12 to 36 hours after ingesting the bacteria, but symptoms can appear as early as six hours and as late as three days after ingestion.

Symptoms of salmonella infection generally last four to seven days and include:

  • Diarrhea
  • Headache
  • Fever
  • Nausea
  • Abdominal pain
  • Dehydration
  • Vomiting
  • Muscle pains
  • Bloody stools

Most people get better without treatment, but in some cases, the diarrhea associated with a salmonella infection can cause dehydration, which can sometimes result in hospitalization. It is important whenever you have diarrhea to make sure you drink plenty of fluids. If you are ill, you should contact your health care provider.

Chapel-Hill-Creamery-cheeseFood Safety News reports that the Chapel Hill Creamery in Chapel Hill, NC, is recalling all of its cheese products because they have been linked to a growing Salmonella outbreak in North Carolina and elsewhere.

A local county health officer said Thursday that the outbreak has sickened at least 50 people in North Carolina and about the same number in other states, and that it’s the same strain found in samples of raw milk from the Chapel Hill Creamery. Nine of those sickened in North Carolina have been hospitalized so far, she said.

“This is way more than usual, which is why we started doing the investigation. We hit clusters of Salmonella, especially in the summertime, but we started seeing dozens and that’s when we started doing questionnaires to identify a common source,” said Colleen Bridger, director of the Orange County Health Department in Chapel Hill.

Bridger said not all of the 50-plus in-state cases have been interviewed, but the “vast majority” of those who have recalled eating cheese from the Chapel Hill Creamery.

“We’ve been monitoring the Salmonella cases for about three weeks and started doing questionnaires about a week ago, and it was just yesterday that we felt we had enough information to say this is probably the Chapel Hill Creamery. We didn’t want to make the declaration until we were sure,” she added.

The products being recalled include all codes, packages and sizes of 14 varieties of cheese manufactured by the Chapel Hill Creamery and distributed through retail locations, farmers markets and restaurants throughout North Carolina, Tennessee, South Carolina, Virginia and Georgia.

The cheese varieties are: Quark, Danziger, Swiss, Paneer, Calvander, Hot Farmers Cheese, Dairyland Farmers Cheese, Smoked Mozzarella, Fresh Mozzarella, Burrata, Hickory Grove, Carolina Moon, Smoked Farmers Cheese, New Moon, and Pheta.

IMG_3079It only looks like paradise

I flew to Oahu Hawaii over the weekend to meet with two people impacted by what is now at least a 93 person hepatitis A outbreak that has left 29 hospitalized as of July 26, 2016.

Ill people have also been located on the islands of Hawaii, Kauai and Maui, but the had been visiting Oahu in the weeks before the onset of their illnesses.

The onset of ill has ranged from June 12, 2016 to July 19, 2016.  Therefore in essence this outbreak is growing and ongoing.

The Health Department has suggested that unvaccinated contacts of cases should talk to their healthcare providers about the possibility of receiving hepatitis A vaccine or immune globulin, which may provide some protection against the disease if administered within the first two weeks after exposure.

A contact is defined as:

  • All unvaccinated household members
  • All unvaccinated sexual contacts
  • Anyone sharing illicit drugs with a case
  • Anyone sharing food or eating or drinking utensils with a case
  • Anyone consuming ready-to-eat foods prepared by an infectious food handler with diarrhea or poor hygiene 

Unvaccinated food handlers who are contacts of cases must have a negative hepatitis A IgM test before they return to work. An employee of the following food service business(es) has been diagnosed with hepatitis A. This list does not indicate these businesses are sources of this outbreak; at this time, no infections have been linked to exposure to these businesses. The likelihood that patrons of these businesses will become infected is very low. However, persons who have consumed food or drink products from these businesses during the identified dates of service should contact their healthcare provider for advice and possible preventive care.


Sushi Shiono

Taco Bell

What can the 74 do to help health officials?  Being your own Jr. Epidemiologist.

baad9453-477d-4dd2-8863-4396a6691157Sitting in my hotel room on the shores of Waikiki in the remnants of tropical storm Darby, has given me time – perhaps too much – to think about this outbreak – especially after meeting with a few of the families.

The Hawaii Department of Health (HDOH) is investigating a cluster of 74 hepatitis A infections on Oahu.  Onset of illness has ranged between 6/12/16 – 7/14/16.  Sick individuals were likely exposed to the fecal human virus through food, drink or personal exposure 2 – 6 weeks prior to onset of symptoms – so the likely exposure period in 5/1/16 – 7/1/16.

HDOH staff are conducting interviews with the cases in an effort to identify the source of infection.  HDOH reports that identifying the source of infection continues to be a challenge because of the long incubation period of the disease and the difficulty patients have in accurately recalling the foods consumed and locations visited during the period when infection could have taken place.

All of the cases are residents of Oahu with the exception of two individuals who now live on the islands of Hawaii and Maui, respectively, but were on Oahu during their exposure period.

On the 74 sickened, 1 was an employee of Taco Bell and 1 was an employee of Baskin-Robbins on Oahu who worked prior to the onset of illness but during the peak exposure period.  This has caused additional community concern that the outbreak may spread to Taco Bell and Baskin-Robbins patrons.

So, what can the 74 do to help health officials find the common link?  Here are some suggestions that I am sure HDOH officials are already using:

  • Be cooperative – hepatitis A illnesses can last 2 – 6 months and victims are certainly not feeling their best, but their cooperation is vital.
  • Thinking about what you ate or drank and where may well not be that productive – trying to recall what you ate or drank several weeks ago is difficult – I can hardly recall what I ate or drank a few days ago – however, try.
  • Focus on where you have been eating and drinking in the 2 – 6 weeks prior to becoming ill – at home or out. Check your calendar, phone records and social media like Facebook and Twitter.
  • Pull your credit and debit card purchases as well as any accounts you have at grocery stores or restaurants.
  • As friends, co-workers or family what they might recall that you did over that same time.
  • Keep in contact with HDOH. Its resources are stretched and it needs your support and assistance.

With the help of the 74 (hopefully, not more), HDOH will solve this mystery and stop the spread of this potentially deadly virus.

Disease Outbreak Control Division
1250 Punchbowl Street, Room 443
Honolulu, HI 96813
Tel: (808) 587-6845
Fax: (808) 586-8347

Disease Investigation Branch
Tel: (808) 586-8362
Toll free: 1-800-360-2575
Fax: (808) 586-4595

UnknowneThe New Hampshire Department of Health and Human Services (DHHS), Division of Public Health Services (DPHS) is investigating an outbreak of Escherichia coli O157:H7 (E. coli) associated with ground beef. Since June, 12 people have been infected with the same strain of E. coli after eating ground beef. Investigations are underway to determine the source of the ground beef. The safety of ground beef in the United States is regulated by the United States Department of Agriculture (USDA), which is assisting DPHS with the investigation.

“The Division of Public Health Services is working with our federal partners to investigate the source of the ground beef that is causing people in New Hampshire to become ill,” said Marcella Bobinsky, Acting Director of DPHS. “Ground beef is a known source of E. coli and it is important for people to avoid eating under-cooked ground beef whether at home or at a restaurant. Young children and the elderly are especially vulnerable to severe illness with this infection.”

The people who became ill ate ground beef at a number of different locations.

lightning_strikeSeattle/King County Department of Public Health is investigating an outbreak of salmonellosis (caused by Salmonella bacteria) associated with a Good Vibe Tribe Luau held on 7/3/16 from 6:00-11:00 PM at Golden Gardens Park in Seattle. A number of different foods were eaten, and the cause has not been determined.

A total of 11 people that appear to have gotten sick at the luau event. Six cases have been confirmed with Salmonella, and five additional people who responded to the survey report eating at the event and later developing an illness consistent with salmonellosis, but did not get tested. None of them were hospitalized.

The pork served at the luau was supplied by Kapowsin Meats, and everyone who got sick after the luau had eaten the pork that was served there.  The genetic fingerprints of cases in this outbreak match the fingerprint of the Salmonella outbreak cases from last year when 192 people (30 hospitalized) in 5 states were sickened according to the CDC. However, there were many other foods served at the event. The Department of Public Health is still investigating food source and preparation procedures for all items to confirm which item might have made people ill.

Salmonellosis is a bacterial infection that is often spread through the fecal-oral route, through contaminated food and water, or through contact with animals and their environments. Symptoms of salmonellosis include nausea, vomiting, diarrhea, headache, fever, chills, and abdominal cramping. Illness typically lasts several days and people can spread infection to others even after symptoms resolve. To prevent Salmonella infection:

– Wash hands with soap and water after going to the bathroom, changing diapers, touching animals, and before eating or preparing food.

– Cook all meats thoroughly, especially poultry.

– Wash cutting boards and counters used for meat or poultry preparation immediately after use to avoid cross contaminating other foods.

Barf_BagPerhaps not the tag line the intended?  You could also use Make American Vomit, Puke, Gag, Retch, Spew, Hurl, Shit, Poop, Dump, Defecate, Crap Again.

The LA Times, Seema Mehta reports:

At least a dozen California GOP staff members at the Republican National Convention have been quarantined in their hotel rooms after becoming ill with what appears to be a highly contagious norovirus, also known as the cruise-ship virus, according to officials from both the California GOP and local health agencies.

“It looks like norovirus,” said Pete Schade, the Erie County health commissioner. His department collected fecal samples from the afflicted staffers Tuesday morning and planned to take them to a state lab in the afternoon.

“As soon as we know a little bit more about what we’re dealing with for sure, we’ll have a better way of dealing with future precautions.”

The 550-member delegation was warned of the outbreak by state GOP officials in an email at 2:40 a.m. Tuesday. They were advised to avoid shaking hands with others, to wash hands frequently, to avoid sharing food and to not use the delegation buses to the convention if they have any symptoms — all difficult rules to follow at a political convention.

Trump, however, is likely safe.  According to Kevin Drum at Mother Jones:

I assume everyone knows this about Donald Trump, right?

A self-confessed germaphobe, Trump doesn’t even like to push a ground floor elevator button because it’s been tapped by so many people….This does not sit well with the masses, let alone the PTA crowd. Trump especially avoids shaking hands with teachers, since they are likely to be have been “in touch” with too many germy kids.

For more on Norovirus, see

hepatitisa11On Wednesday the Hawaii State Department of Health (DOH) reported a confirmed case of Hepatitis A in a food service employee at the ice cream specialty store, Baskin-Robbins, located at the Waikele Center in Waipahu. The department is advising persons who consumed any food or drink products from this store between June 17 and July 3, 2016 (actual dates: June 17, 18, 19, 21, 22, 25, 27, 30, and July 1 and 3) they may have been exposed to the disease.

Today DOH has confirmed a new case of hepatitis A infection in a food service employee. The employee worked at the fast food restaurant, Taco Bell, located in Waipio at 94-790 Ukee Street. The department is advising persons who consumed any food or drink products from this store from June 16 through July 11, 2016 (actual dates: June 16, 17, 20, 21, 24, 25, 28, 29, 30, and July 1, 3, 4, 6, 7, and 11) that they may have been exposed to the disease.

These individuals appear to be two in a growing number of ill reported to DOH. Since the outbreak began, there have been 53 cases of hepatitis A reported to and now confirmed by DOH. All cases have been in adults on Oahu, 16 have required hospitalization.  One man is reported to need a liver transplant.