Yesterday I suggested that the FDA’s Dr. Scott Gottlieb should be a bit more transparent on who produced, processed, transported and sold the E. coli tainted romaine.  Today, the FDA notes that retailers are still selling Salmonella tainted Kellogg’s Honey Smacks cereal (See below)

The FDA has become aware that recalled Kellogg’s Honey Smacks cereal are still being offered for sale. All Honey Smacks cereal was recalled in June 2018. Retailers cannot legally offer the cereal for sale and consumers should not purchase Kellogg’s Honey Smacks cereal. The FDA has learned that some retailers are still selling this product. The FDA will continue to monitor this situation closely and follow up with retailers as we become aware of recalled products being offered for sale.

As of July 12, 2018, 100 people infected with the outbreak strain of Salmonella Mbandaka have been reported from 33 states.

Illnesses started on dates from March 3, 2018, to July 2, 2018. Ill people range in age from less than one year to 95, with a median age of 57. Of ill people, 68% are female. Out of 77 people with information available, 30 (39%) have been hospitalized. No deaths have been reported.

Illnesses that occurred after June 19, 2018, might not yet be reported due to the time it takes between when a person becomes ill and when their illness is reported. This takes an average of 2 to 4 weeks.

State and local health officials continue to interview ill people and ask questions about the foods they ate and other exposures in the week before they became ill. Fifty-five (85%) of 65 people interviewed reported eating cold cereal. In interviews, 43 people specifically reported eating Kellogg’s Honey Smacks cereal. Ill people in this outbreak reported this cereal more often than any other cereals or food items.

Health officials in several states collected Kellogg’s Honey Smacks cereal from retail locations and ill people’s homes for testing. Laboratory testing identified the outbreak strain of Salmonella Mbandaka in a sample of unopened Kellogg’s Honey Smacks cereal collected from a retail location in California. Laboratory testing also identified the outbreak strain in samples of leftover Kellogg’s Honey Smacks cereal collected from the homes of ill people in Montana, New York, and Utah.

The Kellogg Company recalled all Honey Smacks products that were on the market within the cereal’s one-year shelf-life. However, Honey Smacks products with earlier dates could also potentially be contaminated. Do not eat Kellogg’s Honey Smacks cereal of any size package or with any “best if used by” date.

Dr. Gottlieb it is past time for the FDA – especially during an outbreak and recall situation – to make the supply chain transparent.

The Centers for Disease Control and Prevention (CDC) is reporting 60 cases from five states – Illinois, Indiana, Michigan, Missouri, and Ohio. The CDC investigation indicates pre-cut melons, including fruit salads, are a likely source of this multistate outbreak.  SpartanNash appears to be the supplier and processor, but may be named under Renaissance or Caito Foods.

“The Illinois Department of Public Health is urging people not to eat pre-cut melon purchased from any Walmart store in Illinois, or any of the other affected states, at this time,” said IDPH Director Nirav D. Shah, M.D., J.D. “If you have recently purchased pre-cut melon from Walmart, throw it out. If you have recently eaten pre-cut melon from a Walmart store and experience diarrhea, fever, and cramps, contact your health care provider.”

Illinois cases range in age from 23 to 87 years and have been reported in all regions of the state. Therefore, it is recommended that people not eat pre-cut melon from Walmart stores anywhere in Illinois. As the investigation continues, additional grocery stores may be added.

Most people affected by Salmonella develop diarrhea, fever, and abdominal cramps 12 to 72 hours after eating food contaminated by the bacteria. The illness usually lasts 4 to 7 days, and most people recover without treatment. However, diarrhea for some people may be so severe that they need to be hospitalized. The CDC has indicated there have been more hospitalizations with this outbreak than what is typically seen. The elderly, infants, and those with compromised immune systems are more likely to have a severe illness.

The U.S. Food and Drug Administration is working to identify the source of Salmonella and there may be recalls as more information is learned. Walmart stores in Illinois have removed pre-cut melons linked to this outbreak from their shelves.

King 5 News reports that Seattle and King County public health officials are investigating an E.coli outbreak at several Homegrown restaurants in the Seattle area.

Officials say four people have tested positive for Shiga-producing E. coli (STEC) after eating food at three different Homegrown restaurants in King County: Redmond, Kirkland, and Seattle at the Westlake Avenue location.

All four people – three adults and one child – ate the chicken pesto chicken sandwich during April 24-26, 2018. Victims suffered abdominal cramps and diarrhea, with one person reporting they had bloody diarrhea.

Health investigators inspected the three Homegrown locations and identified potential risk factors, such as handwashing facilities violations at two of three locations and a cold holding temperature violation at one of them. All three restaurants were required to complete a thorough cleaning and disinfection.

Investigators were also looking into the various ingredients of the chicken pesto sandwich. Since then, all Homegrown locations in King County have stopped selling the chicken pesto sandwich during the investigation.

Do these ladies look like they might have hepatitis A?

According to Live Science, Kentucky Derby fans may need to take some extra precautions before heading off to the races.

The Indiana State Department of Health is recommending that its residents get vaccinated against hepatitis A and take other steps to protect themselves from the illness before traveling to Kentucky or Michigan, both of which are experiencing large outbreaks of the viral infection.

Kentucky has reported more than 300 cases of hepatitis A since November 2017, with 39 new cases reported in the first week of April, according to the Kentucky Department for Public Health. Most cases in the state have occurred around Louisville — the city where the Kentucky Derby is held. The famous horse race, which draws more than 150,000 people each year, takes place on the first Saturday in May.

I remember the first time I traveled outside the US, I got a series of vaccine – including a Hepatitis A vaccine.  I do not recall ever seeing a warning about travel within the US – go figure.

Indiana health officials are advising residents to get vaccinated for hepatitis A if their summer plans include visits to Kentucky or Michigan.

The Department of Health says significant outbreaks of the liver-damaging hepatitis A virus have been reported in Kentucky and Michigan.

The agency says Kentucky has seen more than 300 cases of the highly contagious viral infection, including three deaths, most of those in the Louisville area. Michigan has had more than 800 cases, including 25 deaths.

Indiana typically sees less than 20 hepatitis cases each year, but 77 have been confirmed since January.

State Epidemiologist Pam Pontones says getting vaccinated for hepatitis A and thoroughly washing hands when preparing food are “simple, safe and effective ways” to prevent the spread of hepatitis A.

Likely not so good for tourism?

Rose Acre Farms – FDA 483 Investigation Report

Observation 1:
When your monitoring indicated unacceptable rodent activity within a poultry house, appropriate methods were not used to achieve satisfactory rodent control.

Specifically, a review of your pest control records from September 2017 to present indicate an ongoing rodent infestation. The corrective actions taken by your firm have not been effective at reducing the rodent levels within your poultry houses to an acceptable level that is below the threshold established in your SE Prevention Plan.

Observation 2:
There were insanitary conditions and poor employee practices observed in the egg processing facility that create an environment that allows for the harborage, proliferation and spread of filth and pathogens throughout the facility that could cause the contamination of egg processing equipment and eggs.

On 03/28118, during a review of the firm’s cleaning procedures and a walkthrough of the cleaning procedures we observed that the firm did not have in their procedures or use a sanitizing step following the wash step.

Throughout the inspection we observed condensation dripping from the ceiling, pipes, and down walls, onto production equipment (i.e. crack detector, egg grader) and pooling on floors in foot traffic and forklift pathways.

On 03/28/18, we observed maintenance and sanitation employees placing buffers (food contact) and metal covers to the egg packer with buffers (non-food contact) onto floor, pa11ets, and equipment that was visibly dirty with accumulated grime and food debris, before placing the equipment into service. Additionally, throughout the inspection several production and maintenance employees were observed touching non-food contact surfaces (i.e. face, hair, intergluteal cleft, production equipment with accumulated grime and food debris, floor, boxes, trash cans, inedible transport cans) and then touch shell eggs and food contact surfaces (i.e. buffers, rollers, etc.) without changing gloves or washing hands. We also observed maintenance employees dragging non-food contact equipment (i.e. black electrical conduit with accumulated grime and dried food debris) on top of food contact surfaces (i.e. conveyors and rollers).

Throughout the inspection we observed equipment (i.e. conveyor belts, chains, rail guards, buffers, egg transport arms, egg clappers, production computers and exterior of production equipment surfaces) with accumulated food debris (i.e. dried egg and shells) and grime, post sanitation. The same areas of accumulated food debris were observed uncleaned on multiple days during the inspection pre-and post-sanitation.

Rose Acre Farms of Seymour, Indiana is voluntarily recalling 206,749,248 eggs because they have the potential to be contaminated with Salmonella Braenderup, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy individuals infected with Salmonella Braenderup can experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella Braenderup can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

The eggs were distributed from the farm in Hyde County, North Carolina and reached consumers in the following states: Colorado, Florida, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia through retail stores and restaurants via direct delivery.

22 illnesses have been reported to date.

The affected eggs, from plant number P-1065 with the Julian date range of 011 through date of 102 printed on either the side portion or the principal side of the carton or package, as follows:

Lot Codes 011 – 102

Item Description Carton UPC
COUNTRY DAYBREAK A LARGE X 30 DOZEN 077236000302
COUNTRY DAYBREAK A LARGE X15 DOZEN 077236000302
COUNTRY DAYBREAK A JUMBO X24 DOZEN 077236000500
COUNTRY DAYBREAK A MEDIUM X30 DOZEN 077236000203
COUNTRY DAYBREAK A XLARGE X30 DOZEN 077236000401
COUNTRY DAYBREAK A JUMBO X12 DOZEN 077236000500
FOOD LION A JUMBO X 12 DOZEN 035826089618
FOOD LION A MEDIUM X15 DOZEN 035826089649
FOOD LION A XLARGE X 15 DOZEN 035826089625
FOOD LION A 18PK LARGE X15 DOZEN 035826089601
FOOD LION A LARGE X15 DOZEN 035826089588
FOOD LION A 6PK LARGE X 15 DOZEN 035826089632
LOOSE A USDA SMALL X 30 DOZEN N/A
LOOSE A USDA MEDIUM X 30 DOZEN N/A
LOOSE A XLARGE X15 DOZEN N/A
LOOSE A XLARGE X30 DOZEN N/A
LOOSE A MEDIUM X 15 DOZEN N/A
LOOSE A MEDIUM X30 DOZEN N/A
LOOSE USDA AA XLARGE X30 DOZEN N/A
LOOSE USDA AA XLARGE X15 DOZEN N/A
LOOSE USDA AA LARGE X30 DOZEN N/A
LOOSE USDA AA LARGE X15 DOZEN N/A
LOOSE USDA AA MEDIUM X30 DOZEN N/A
LOOSE AA XLARGE X30 DOZEN N/A
LOOSE USDA AA LARGE PFG X 30 DOZEN N/A
LOOSE USDA AA LARGE PFG X 15 DOZEN N/A
LOOSE USDA A XLARGE X30 DOZEN N/A
NELMS A JUMBO X24 634181000018
WAFFLE HOUSE LOOSE USDA A LARGE X 30 DOZEN N/A
CRYSTAL FARMS A MEDIUM X30 077236000203
CRYSTAL FARMS A 18PK MEDIUM X 30 077236000258
CRYSTAL FARMS A 2.5 DOZ MEDIUM X 25 077236000124
COUNTRY DAYBREAK A XLARGE X15 DOZEN 077236000401
COUNTRY DAYBREAK USDA GRADE A XLARGE X 240 DOZEN PULP 077236700400
COUNTRY DAYBREAK USDA GRADE A LARGE RACK X 240 DOZEN PULP 077236700301
COBURN FARMS A MEDIUM MP X 30 DOZEN 051933182608
COBURN FARMS A LARGE X 30 DOZEN 051933190801
COBURN FARMS A 18PK LARGE X 30 DOZEN 051933182509
SUNSHINE FARMS A JUMBO X 12 DOZEN 804879457336
GLENVIEW USDA AA LOOSE LARGE (6-2.5 FLATS) X 15 DOZEN N/A
GLENVIEW USDA AA LOOSE LARGE (12-2.5 FLATS) X 30 DOZEN N/A
GLENVIEW USDA AA LOOSE MEDIUM (6-2.5 FLATS) X 15 DOZEN N/A
GLENVIEW USDA AA LOOSE XLARGE (6-2.5 FLATS) X 15 DOZEN N/A
GLENVIEW USDA AA LOOSE MEDIUM (12-2.5 FLATS) X 30 DOZEN N/A
GLENVIEW USDA AA LOOSE XLARGE (12-2.5 FLATS) X 30 DOZEN N/A
GREAT VALUE GRADE A USDA 18PK XLARGE X 24 DOZEN RPC 078742127132
GREAT VALUE GRADE A USDA 12PK XLARGE X 24 DOZEN RPC 078742127128
GREAT VALUE GRADE A USDA TWIN 18PK LARGE X 24 DOZEN RPC 078742127101
GREAT VALUE GRADE A USDA 6PK LARGE X 15 DOZEN 078742127095
GREAT VALUE GRADE A USDA 12PK MEDIUM X 15 DOZEN 078742127224
GREAT VALUE GRADE A USDA 12PK LARGE X 24 DOZEN RPC 078742127071
GREAT VALUE GRADE A USDA 18PK LARGE X 24 DOZEN RPC 078742127088
GREAT VALUE GRADE A 12PK JUMBO X 22 DOZEN RPC 078742127149
GREAT VALUE GRADE A USDA 5DZ LARGE X 5 DOZEN 078742127118

The voluntary recall was a result of some illnesses reported on the U.S. East Coast, which led to extensive interviews and eventually a thorough FDA inspection of the Hyde County farm, which produces 2.3 million eggs a day. The facility includes 3 million laying hens with a USDA inspector on-site daily.

As of  April 13, 2018, Marler Clark represents E. coli victims in Idaho, Missouri, New Jersey and Pennsylvania.

As of April 12, 2018, 35 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states. Connecticut 2, Idaho 8, Illinois 1, Michigan 1, Missouri 1, New Jersey 7, New York 2, Ohio 2, Pennsylvania 9, Virginia 1 and Washington 1.  (CDC Report)

Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 29. Sixty-nine percent of ill people are female. Twenty-two ill people have been hospitalized, including three people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to leafy greens. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.

Epidemiologic evidence collected to date indicates that chopped romaine lettuce is the likely source of this outbreak. Most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. The restaurants reported using bagged, chopped romaine lettuce to make salads.

Traceback investigations are ongoing to determine the source of chopped romaine lettuce supplied to restaurant locations where ill people ate. At this time, no common grower, supplier, distributor, or brand has been identified. However, preliminary information indicates that the chopped romaine lettuce was from the Yuma, Arizona growing region. Information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.