Food Poisoning Lawyer & Attorney : Marler Clark : Marler Blog

KTRE 9 reports that Ashlyn Johnson was one of more than three dozen people who came down with salmonella last week.  They all attended a Relay For Life event at Roughrider Stadium in Center last Friday evening. Ashlyn's kidneys were failing so she was lifeflighted to a Shreveport hospital Tuesday night. She came home Friday, exactly one week after eating one scoop of some homemade ice cream that was sold at the event. Her mother said her daughter ate only the homemade ice cream that was made and served by a Center church. Ashlyn spent a week in the intensive care unit. She's now well enough to return to school on Monday. The Texas Department of State Health Services said the investigation is continuing and that no organism or specific sources for the illness have been confirmed yet, though some kind of food or drink served at the event is suspected.

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Newsday reports that the number of confirmed cases of salmonella at Princeton University continues to grow.  The university said today that there are now 22 confirmed cases -- 20 students and two staff.  Health officials have been investigating more than 70 other cases of stomach problems at the school that may be related to the bacteria.  The number of confirmed cases is four times what it was a week ago.  No source has been determined. But a salad bar and a Mexican food station at the campus center's dining facility remain closed as a precaution.

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You usually think of Hawaii for it's great weather and beaches (below).  But late last night it was announced that Palama Holdings LLC, a Kapolei Hawaii firm is voluntarily recalling more than 68,000 pounds of ground beef products because they may be contaminated with E. coli contamination.  Click in QuickTime Player Icon for Hawaiian News.  The following products are subject to recall:

• Six- and ten-pound boxes containing 1/4-pound and 1/3-pound "May's Teriyaki Beef Patties."

• 24-pound bulk boxes of "May's Beef Picnic Patties."

• Ten-pound boxes of "May's Beef Pattie, 3:1 Layer Pack."

• Three-pound trays of "May's Ground Beef Family Pack."

• Five- and ten-pound chubs of May's brand coarse ground and fine ground beef products.

See FSIS Recall Notice.

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Princeton health authorities have confirmed at least 17 cases of salmonella at Princeton University and are investigating 70 other cases of stomach problems at the school that may be related to the bacteria.  Princeton spokeswoman Cass Cliatt says the most recent patient diagnosed got sick last week. Lab tests for salmonella take at least three days.  On Friday, the university stopped serving some produce as a precaution. It also closed a salad bar and a Mexican food station at the campus center's dining facility.  Officials have interviewed 135 sick and healthy subjects at the school to try to track a common food source.

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Jack Ackerman of the Daily Princetonian reported that the number of confirmed Salmonella infections on campus has risen to 16, including 15 students and one staff member. Despite not knowing the source, the Princeton Regional Health Department (PRHD) has been working with New Jersey state officials to conduct preliminary food history surveys with both infected and healthy students. The data collected so far points to the Frist Gallery as being a possible source of infection.

Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis (the disease caused by Salmonella) is the second most common foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95% of those cases are foodborne-related. Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 or 31% of all food-related deaths are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

Salmonella infection occurs when the bacteria are ingested, typically from food derived from infected food-animals, but it can also occur by ingesting the feces of an infected animal or person. Food sources include raw or undercooked eggs/egg products, raw milk or raw milk products, contaminated water, meat and meat products, and poultry. Raw fruits and vegetables contaminated during slicing have been implicated in several foodborne outbreaks. We are involved in representing families of children who have suffered from this bacterium.  For more information on past outbreaks, visit Marler Clark.

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I was reading Bill Lambrecht’s article from the St. Louis Post-Dispatch this morning, “Seafood imports: worries growing,” and was struck by these quotes:

"As our system becomes more antiquated and more ineffective, the world is sending us their junk."

"When you look at less than 1 percent of shipments, and sample and test maybe one-fifth of those, there's no way you can protect the American food supply"

The quotes coming from Former FDA and FSIS officials commenting on the findings of inspectors checking Chinese seafood arriving at U.S. ports who found some unsettling discoveries: fish infected with salmonella in Seattle and Baltimore, and shrimp with banned veterinary drugs in Florida. According to Food and Drug Administration records examined by the Post-Dispatch, inspectors turned away nearly 400 shipments of tainted seafood in a year's time from China. The records told a troubling tale, but even more troubling was what they didn't tell. Only a tiny fraction of imports are inspected at all, and even fewer are tested.

In 15 years of litigating most of the foodborne illness cases in the United States, I have seen very few illnesses tied to fish products – imported or home raised. I wonder if some of the concerns raised over imports are simply being raised to protect home grown fish companies or if we are really seeing a fishy tale of increased imports or another opportunity for growth here at Marler Clark.

The problems with imports, home produced products and illness were also outlined in a recent report, Fixing Food Safety: Protecting America's Food from Farm-to-Fork, include:

The U.S. food safety system has not been fundamentally modernized in over 100 years;

Inadequate resources are spent on fighting modern bacteria threats, such as trying to reduce Salmonella or dangerous strains of E. coli;

An estimated 85 percent of known foodborne illness outbreaks are associated with foods regulated by the U.S. Food and Drug Administration (FDA), but the agency receives less than half of the federal funding for food safety;

In the past 3 years, the main food safety function at FDA has lost 20 percent of its science staff and 600 inspectors;

Gaps in current inspection practices mean acts of agroterrorism -- such as contamination of wheat gluten or botulism -- could go undetected until they are widespread;

While 15 federal agencies are involved in food safety, the efforts are fragmented and no one agency has ultimate authority or responsibility for food safety;

Only one percent of imported foods are inspected. Approximately 60 percent of fresh fruits and vegetables and 75 percent of seafood consumed in the U.S. is imported; and

States and localities are not required to meet uniform national standards for food safety.

The bottom line is that approximately 76 million Americans -- one in 4 -- are sickened by foodborne diseases each year. Of these, an estimated 325,000 are hospitalized and 5,000 die. Medical costs and lost productivity due to foodborne illnesses in the U.S. are estimated to cost $44 billion annually.

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Salad Recall

Gourmet Boutique of Jamaica, N.Y., is recalling 35 types of fresh and frozen products, which were distributed nationwide. It includes various salads and other products. It is voluntarily recalling 286,320 pounds of meat products that may be contaminated with Listeria monocytogenes, according to the U.S. Department of Agriculture’s Food and Safety Inspection Service.

More information about the specific products included in this recall can be found on the USDA Web site.

Raw Milk Recall - Again

Consumers are also advised to discard tainted Raw Milk. Consumers who purchased raw milk from Green Acres Jersey Farm in Lebanon County, Pennsylvania, any time should discard it immediately due to the risk of Listeria monocytogenes contamination, Pennsylvania Agriculture officials said. Officials said during routine inspection of the dairy, a preliminary test showed the presence of Listeria bacteria in some raw milk samples.

Listeria Symptoms

Symptoms of Listeriosis include fever, muscle aches and sometimes, gastrointestinal symptoms such as nausea or diarrhea. If infection spreads to the nervous system, symptoms such as headache, stiff neck, confusion, loss of balance or convulsions can occur. Infected pregnant women may experience only a mild, flu-like illness, but infections during pregnancy can lead to miscarriage or stillbirth. Symptoms of Listeriosis can appear in four days to three weeks.

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Ohio Health officials are working to identify the source of a salmonella scare that sent 10 people to the hospital last week in Norwalk. However, The common thread linking the 10 victims together is that they all ate at Casa Fiesta, 196 Milan Avenue in Norwalk on April 24. That restaurant voluntarily closed its doors Thursday while food samples from the restaurant are tested at the Ohio Department of Health to find the source of the bacteria.

Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis (the disease caused by Salmonella) is the second most common foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95% of those cases are foodborne-related. Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 or 31% of all food-related deaths are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

Salmonella infections occurs when the bacteria are ingested, typically from food derived from infected food-animals, but it can also occur by ingesting the feces of an infected animal or person. Food sources include raw or undercooked eggs/egg products, raw milk or raw milk products, contaminated water, meat and meat products, and poultry. Raw fruits and vegetables contaminated during slicing have been implicated in several foodborne outbreaks. We are involved in representing families of children who have suffered from this bacterium.

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There are now eight confirmed cases of salmonella at Princeton University and health officials are investigating whether they are related to 80 other cases of stomach problems at the school.  A Princeton spokeswoman said those who tested positive for the salmonella bacteria had more severe symptoms than the others, who may have caught an unrelated virus.  The bacteria is most commonly transmitted through food. Local authorities have inspected the school's largest dining hall and the university has sent food samples to a lab.  For more updates, see the student paper:

Campus sees gastroenteritis spike - McCosh Health Center observes symptoms in 50 to 60 students

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CDC is collaborating with public health officials in multiple states across the United States and with the U.S. Food and Drug Administration (FDA) to investigate a multi-state outbreak of Salmonella Agona infections. An investigation that includes interviews of persons with Salmonella Agona infections and comparison of the DNA fingerprints suggests that cereal from Malt-O-Meal unsweetened Puffed Rice Cereals and unsweetened Puffed Wheat Cereals is likely related to these illnesses.

As of April 22, 2008, state and city health departments from 12 states have identified 21 ill persons infected with same genetic fingerprint of Salmonella Agona. Ill persons with the outbreak strain have been identified from Colorado (1), Delaware (1), Maine (3), Massachusetts (2), Minnesota (1), North Dakota (1), New Hampshire (2), New Jersey (4), New York (3), Pennsylvania (1), Rhode Island (1), and Vermont (1). Onset dates, which are known for 13 patients, ranged from January 22 to March 8, 2008. Patients’ ages ranged from 4 months to 95 years with a median age of 66 years. Five hospitalizations and no deaths have been reported.

This might sound a bit familiar:

Multistate Outbreak of Salmonella Serotype Agona Infections Linked to Toasted Oats Cereal -- United States, April-May, 1998

During April-May 1998, a total of 11 states reported an increase in cases of Salmonella serotype Agona infections; as of June 8, a total of 209 cases have been reported and at least 47 persons have been hospitalized, representing an eightfold increase over the median number of cases reported in those states during 1993-1997. The states reporting increases were Illinois (49 cases), Indiana (30), Ohio (29), New York (24), Missouri (22), Pennsylvania (20), Michigan (15), Iowa (8), Wisconsin (6), Kansas (4), and West Virginia (2). This report summarizes the outbreak investigation by local, state, and federal public health officials, which implicated Millville brand plain Toasted Oats cereal manufactured by Malt-O-Meal, Inc. as the cause of illness. Among 162 patients in this outbreak for whom information was available, 85 (52%) were female. Most cases occurred in children and the elderly (47% in persons aged less than 10 years and 21% in persons aged greater than 70 years).

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A day after I listened to Bill Richardson, Governor of New Mexico, give a great speech in Seattle, restaurant workers in New Mexico are diagnosed with hepatitis A.  Two Albuquerque I-HOP restaurants are under the microscope after two of its workers were diagnosed with hepatitis A.
According to the New Mexico Department of Health, the employees work at the I-HOP on Wyoming and Paseo and at the one near Interstate-25 and Montano.

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Four more hepatitis A cases have been linked to a Chipotle restaurant in La Mesa, California, bringing the total number of confirmed cases to 18.  Local Health and Human Services officials said no employees at the Chipotle restaurant tested positive for hepatitis A.   Health officials are recommending that anyone who ate at the restaurant between March 1 and April 22 get checked by a doctor.  Hepatitis A is commonly transmitted when an object contaminated with the stool of someone with hepatitis A comes in contact with another person’s mouth.  Exposure also can occur when an individual consumes food or water contaminated with the Hepatitis A virus, according to the health department.  Symptoms of hepatitis A include fever, fatigue, nausea and jaundice.

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Illnesses as of a few moments ago are holding at 14. However, San Diego Health officials have advised people who ate at the restaurant, at 8005 Fletcher Parkway, between March 1 and April 22 to see a doctor if they are experiencing symptoms of the viral infection.

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most viruses are present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults. We have been involved in representing families who have suffered from this virus.

* Carl’s Jr. Hepatitis A Outbreak - Washington
* Chi-Chi’s Hepatitis A Outbreak - Pennsylvania
* D’Angelo’s Deli Hepatitis A Outbreak - Massachusetts
* Friendly’s Hepatitis A Exposure - Massachusetts
* Houlihan’s Hepatitis A Exposure - Illinois
* Maple Lawn Dairy Hepatitis A Outbreak - New York
* McDonald’s Hepatitis A Outbreak - Washington
* Quizno’s Hepatitis A Exposure - Massachusetts
* Soleil Produce Hepatitis A Outbreak - California
* Subway Hepatitis A Outbreak - Washington
* Taco Bell Hepatitis A Outbreak - Florida

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Outbreak supports the rationale for expanding E. coli O157:H7 as an adulterant on all meats, including those formerly considered “intact.”

According to Nebraska State health officials, an E. coli outbreak in Sarpy County has sickened 14 people -- including a 7-year-old -- and sent four people to the hospital. The E. coli outbreak was caused by roast beef served at a reception hall in Sarpy County for a private gathering on March 26. The people affected ranged in age from 7 to 73.  It appears that the “mystery ingredient,” in addition to E. coli O157:H7 were cloves that broke the surface of the roast beef prior to cooking, probably inserting the E. coli bacterium into the meat where cooking was not sufficient to kill the bacteria.

Two weeks ago I attended an FSIS conference where FSIS officials explained the E. coli adulterant rationale on intact meat.  Currently, intact product distributed for consumption as intact product - designated primal and sub-primal cuts such as roasts and steaks - is not considered adulterated if it is contaminated with E. coli.

The USDA's proposal to consider E coli O157:H7 an adulterant in primal cuts of beef - those that are intact and thought to have a sterile interior - officials said they were concerned about cross-contamination during meat preparation. Daniel Engeljohn, deputy assistant in the FSIS Office of Policy and Program development, said some primal cuts are being made into ground beef, and some of them may not have received an antimicrobial treatment that is typically applied to boneless trim.

The Centers for Disease Control and Prevention (CDC) estimated in 1999 that 73,000 cases of E. coli O157:H7 occur each year in the United States. Approximately 2,000 people are hospitalized, and 60 people die as a direct result of E. coli O157:H7 infections and complications. The majority of infections are thought to be foodborne-related, although E. coli O157:H7 accounts for less than 1% of all foodborne illness. We have been involved in representing families who have suffered from this bacterium.

* AFG / Supervalu E. coli Outbreak - Minnesota
* AgVenture Farms Petting Zoo E. coli O157:H7 Outbreak Litigation - Florida
* Bauer Meat E. coli Litigation - Georgia
* BJ’s Wholesale Club E. coli Litigation - New York and New Jersey
* Captain’s Galley Seafood Restaurant E. coli Outbreak - North Carolina
* Cargill E. coli Outbreak - Nationwide
* Carneco / Sam’s Club E. coli Outbreak - Wisconsin & Michigan
* CCC Alternative Learning Daycare E. coli Outbreak - Texas
* China Buffet E. coli Outbreak - Minnesota
* ConAgra Ground Beef E. coli Outbreak - Nationwide
* Crossroads Farm Petting Zoo E. coli Outbreak - North Carolina
* Dee Creek Farm E. coli Outbreak - Washington & Oregon
* Dole Lettuce E. coli Outbreak - Minnesota, Wisconsin, and Oregon
* Dole Spinach E. coli Outbreak - Nationwide
* Emmpak E. coli Outbreak - Wisconsin
* Excel E. coli Outbreak - Georgia
* Finley Elementary School E. coli Outbreak - Washington
* Fresno Meat Market E. coli Outbreak - California
* Gold Coast Produce E. coli Outbreak - California
* Golden Corral E. coli Outbreak - Nebraska
* Habaneros E. coli Outbreak - Missouri
* Jack in the Box E. coli Outbreak - Western States
* Karl Ehmer Meats E. coli Outbreak – New Jersey
* KFC E. coli Outbreak - Ohio
* Kid’s Korner Daycare E. coli Outbreak - Missouri
* Kindercare E. coli Outbreak - California
* King Garden Restaurant E. coli Outbreak - Ohio
* Lane County Fair E. coli Outbreak - Oregon
* Nebraska Beef E. coli Litigation - Minnesota
* Olive Garden E. coli Outbreak - Oregon
* Organic Pastures E. coli Outbreak - California
* Parsley E. coli Outbreak - Washington & Oregon
* Peninsula Village E. coli Outbreak - Tennessee
* PM Beef Holdings, Lunds & Byerly’s E. coli Outbreak
* Robeson Schools E. coli Outbreak - North Carolina
* Rochester Meat Company E. coli Outbreak - Wisconsin, California
* Sizzler E. coli Outbreak - Wisconsin
* Sodexho Spinach E. coli Outbreak - California
* Spokane Produce E. coli Outbreak - Washington, Oregon, Idaho
* Stop & Shop E. coli Case - New Hampshire
* Taco Bell E. coli Outbreak - Northeast
* Taco John’s E. coli Outbreak – Iowa and Minnesota
* Topps and Price Chopper E. coli Case - New York
* Topps Meats E. coli Outbreak - Nationwide
* Totino’s and Jeno’s Pizza E. coli Outbreak - Nationwide
* United Food Group E. coli Outbreak - Western States
* Washington County Fair E. coli Outbreak - New York
* Wendy’s E. coli Outbreak - Oregon
* Wendy’s E. coli Outbreak - Utah
* White Water Water Park E. coli Outbreak - Georgia

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Those sickened include six women and eight men, ranging in age from 23 to 55.  The concern is over anyone who dined at the restaurant located at 8005 Fletcher Parkway between March 1 and April 22.

Anyone who is symptomatic for Hepatitis A should immediately see his or her doctor to be screened for the illness.  Symptoms include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and jaundice.

Although it appears at this point, food service workers may not be the cause of this outbreak, Phyllis Entis at efoodalert correctly notes that “only St. Louis County in Missouri and Clark County, Nevada mandate this [Hepatitis A vaccines for food service workers].” Phyllis goes on the point out:
The CDC Advisory Committee on Immunization Practices (ACIP) has this to say about hepatitis A and food handlers:

"Foodborne hepatitis A outbreaks are recognized relatively infrequently in the United States. Outbreaks typically are associated with contamination of food during preparation by an HAV-infected food handler; a single infected food handler can transmit HAV to dozens or even hundreds of persons (34,36,37,78--81). However, the majority of food handlers with hepatitis A do not transmit HAV. Food handlers are not at increased risk for hepatitis A because of their occupation. However, among the approximately 40,000 adults with hepatitis A reported during 1992--2000 for whom an occupation was known, 8% were identified as food handlers, reflecting the large number of persons employed in the food service industry (34). Evaluating HAV-infected food handlers is a common and labor-intensive task for public health departments. In a 1992 common-source outbreak involving 43 persons, the estimated total medical and disease control cost was approximately $800,000 (82)."

Nevertheless, ACIP does not recommend routine vaccination of food handlers, on the grounds that this is not an occupation that presents increased risk of becoming infected with the virus. They don't appear to consider the potential benefits or cost-savings to the general public that food handler vaccination would bring.

Current CDC recommendations for hepatitis A vaccination include:

* all children under one year of age;
* adults who live in a community with a high rate of hepatitis A infection;
* males who have sex with other men;
* users of street drugs;
* those who work in or travel to countries with a high rate of hepatitis A infection;
* people with long-term liver disease;
* people who receive agents to help their blood clot; and
* people who work with hepatitis A virus-infected animals or who work with the virus in a research setting.

Roughly one-third (31% in 2006) of US residents already have long-term immunity to hepatitis A, either through prior infection or as a result of having been vaccinated. This proportion should continue to rise, if parents follow CDC recommendations and have their children immunized.

Meanwhile, the two-thirds of the public without immunity to hepatitis A are at risk of infection from the occasional asymptomatic – and symptomatic – carrier working as a food handler. Perhaps it's time for one of the major restaurant food chains to take the lead and require that its employees be tested for hepatitis A immunity and, if necessary, be vaccinated. Are you listening, Chipotle?

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E. coli illnesses seem to be a part of nearly every news cycle. This week stories of illnesses have come from Colorado and Nebraska.

The Omaha World-Herald reports – “Sarpy County E. coli outbreak investigated”

State health officials are continuing to investigate an E. coli outbreak in Sarpy County that sickened 14 people — including a 7-year-old — and sent four people to the hospital. Dr. Tom Safranek, state epidemiologist, said the outbreak was caused by roast beef served at a reception hall in Sarpy County for a private gathering on March 26. The meat was prepared at a person's home and brought to the event, he said. The people affected ranged in age from 7 to 73. The four people who were hospitalized were released several weeks ago, he said.

The Rocky Mountain News reports – “Illness hits tornado-stricken family-Daughter hospitalized in latest crisis to hit Holly household”

A little more than a year after a tornado took his wife and turned his life upside down, Gus Puga finds himself in the throes of another family crisis — this time at the bedside of his seriously ill daughter. Little Noelia Puga, a 4-year-old bundle of energy, is in the pediatric intensive care unit at Children's Hospital, battling an E. coli infection. She was on dialysis and oxygen Thursday, but physicians expect her to make a full recovery, her father said.

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San Diego County health officials say they have identified six more cases of hepatitis A that may be linked to a restaurant in La Mesa, bringing to 12 the total number of people sickened. Those who became ill ate at the Chipotle Mexican Grill between March 1 and April 22.

Hepatitis A is one of five human hepatitis viruses (hepatitis A, B, C, D, and E) that primarily infect the liver and cause illness. An estimated 80,000 cases occur each year in the U.S., although much higher estimates have been proposed based on mathematical modeling of the past incidence of infection. Each year, an estimated 100 persons die as a result of acute liver failure in the U.S. due to hepatitis A, but the rate of infection has dramatically decreased since the hepatitis A vaccine was licensed and became available in the U.S. in 1995.

Hepatitis A is a communicable (or contagious) disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Food contaminated with the virus is the most common vehicle transmitting hepatitis A. The food preparer or cook is the individual most often contaminating the food, although he or she is generally not ill at the time of food preparation. The peak time of infectivity, when the most viruses are present in the stool of an infectious individual, is during the two weeks before illness begins. Although only a small percentage of hepatitis A infections are associated with foodborne transmission, foodborne outbreaks have been increasingly implicated as a significant source of hepatitis A infection.

Hepatitis A may also be spread by household contact among families or roommates, sexual contact, ingestion of contaminated water, ingestion of raw or undercooked fruits and vegetables or shellfish (like oysters), and from persons sharing illicit drugs. Children often have asymptomatic or unrecognized infections and can pass the virus through ordinary play to family members and other children and adults. We have been involved in representing families who have suffered from this virus:

* Carl’s Jr. Hepatitis A Outbreak - Washington
* Chi-Chi’s Hepatitis A Outbreak - Pennsylvania
* D’Angelo’s Deli Hepatitis A Outbreak - Massachusetts
* Friendly’s Hepatitis A Exposure - Massachusetts
* Houlihan’s Hepatitis A Exposure - Illinois
* Maple Lawn Dairy Hepatitis A Outbreak - New York
* McDonald’s Hepatitis A Outbreak - Washington
* Quizno’s Hepatitis A Exposure - Massachusetts
* Soleil Produce Hepatitis A Outbreak - California
* Subway Hepatitis A Outbreak - Washington
* Taco Bell Hepatitis A Outbreak - Florida

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San Diego is the latest in a series out outbreaks and exposure to hepatitis A via restaurant food and/or infected workers. County health officials there say they are investigating six cases of hepatitis A linked to a Chipotle Mexican Grill in La Mesa.

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States. Yet according to foodborne illness litigation specialist William Marler, not a month goes by without a warning from a health department somewhere in the US that an infected food handler is the source of a potential hepatitis A outbreak. Vaccinations of food handlers combined with an effective and rigorous hand washing policy is the only sure road to preventing more hepatitis A outbreaks. It is time for health departments across the country to require vaccinations of foodservice workers, especially those that serve the very young and the elderly.

Hepatitis A virus a result of fecal-oral contamination, and can be spread person to person or through food handling, particularly cold or uncooked foods. These include salads and salad items, rolls, breads, buns, fruit or vegetable garnishes, sandwich condiments such as pickles and onions, chips, and ice or beverages containing ice, according to the state Department of Public Health.

The Centers for Disease Control (CDC) estimates that 83,000 cases of hepatitis A occur in the United States every year, and that many of these cases are related to food-borne transmission. In 1999, over 10,000 people were hospitalized due to hepatitis A infections and 83 people died. In 2003, 650 people became sickened, 4 died and nearly 10,000 people got Ig shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but businesses lose customers or some simply go out of business.

Marler Clark has represented thousands of victims of food borne illness outbreaks since 1993. The firm’s attorneys have litigated hepatitis A cases against such companies as Quiznos, Houlihan’s, Carl’s Jr., McDonald’s, Subway, Taco Bell, Friendly’s, D’Angelo’s and Chi Chi’s restaurants, the latter resulting in a $6.25 million award on behalf of one man. Marler Clark has represented tens of thousands of restaurant customers who received Ig shots.

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The number of people who reported that they became sick with norovirus after eating at the Chipotle Mexican Grill in Kent has grown to about 435.  The restaurant at 429 E. Main St. reopened Saturday, after a voluntary shutdown Friday. Workers replaced the food and sanitized equipment with a bleach solution. Chipotle’s spokesperson was quoted in the Akron Beacon-Journal:

''Food safety is, and always has been, our highest priority.''

However, a Hepatitis A outbreak was brewing on the California Coast, San Diego TV reports “6 Cases of Hepatitis A Linked to La Mesa Chipotle.” Yet another spokesperson was quoted as saying:

“The health and safety of our customers and employees is our highest priority,… We have done and will continue to do everything we can to assist the health department in identifying the cause of this illness.”

One would think they were having a bad week. Perhaps, but today Chipotle Mexican Grill Inc. reported a 38.9 percent jump in quarterly profits and a 29.3 percent rise in revenue over the same period a year earlier, largely fueled by the burrito chain's rapid expansion.

Well, I guess the good news is that they have the money to pay the victims and to upgrade their food safety program?  What is interesting about both of these viruses is that they seem to have been transmitted via ill employees.  One must wonder about both the company's hand washing policy and sick leave policy.

Noroviruses are estimated to cause 23 million cases of acute gastroenteritis (commonly called the "stomach flu") in the U.S. each year, and are the leading cause of gastroenteritis. Of viruses, only the common cold is reported more often than viral gastroenteritis (norovirus). Noroviruses may cause more outbreaks of foodborne illness than all bacteria and parasites. They can cause extended outbreaks because of their high infectivity, persistence in the environment, resistance to common disinfectants, and difficulty in controlling their transmission through routine sanitary measures.

The norovirus is transmitted primarily through the fecal-oral route and fewer than 100 norovirus particles are said to be needed to cause infection.  Transmission occurs either person-to-person or through contamination of food or water. Transmission can occur by touching surfaces or objects contaminated with norovirus and then placing that hand in your mouth; having direct contact with another person who is infected and showing symptoms; sharing foods or eating utensils with someone who is ill; exposure to aerosolized vomit; and consuming food contaminated by an infected food handler.

Hepatitis A is the only common vaccine-preventable foodborne disease in the United States (Fiore, 2004). It is one of five human hepatitis viruses that primarily infect the human liver and cause human illness. Unlike hepatitis B and C, hepatitis A doesn’t develop into chronic hepatitis or cirrhosis which are both potentially fatal conditions (Mayo Clinic, 2006); however, hepatitis A infection can still lead to acute liver failure and death. Viral hepatitis is a major public health concern in the United States, and a source of significant morbidity and mortality. Each year, approximately 30 - 50,000 cases of hepatitis A occur in the United States. Direct and indirect costs of these illnesses exceed $300 million, including wage loss and medical expenses. Adults who become ill miss an average of 27 work days per illness. Eleven to 12 percent of persons infected are hospitalized, and 100 people die as a result of acute liver failure annually in the United States due to hepatitis A (CDC, 2007). The unfortunate aspect of these statistics is that with 21st Century medicine, hepatitis A is totally preventable and cases—especially outbreaks relegated to food consumption—need not occur.

Hepatitis A is a communicable (or contagious) disease that spreads from person to person. It is transmitted by the “fecal – oral route,” generally from person-to-person, or via contaminated food or water. Outbreaks associated with food have been increasingly implicated as a significant source of hepatitis A infection. Such “outbreaks are usually associated with contamination of food during preparation by an HAV-infected food handler.” (CDC, 2007; Francis & Maynard, 1983).

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According to wikipedia, the popular saying "[it will happen] when pigs fly" (or when pigs have wings) is traditionally used to mean that the specified event will never occur.  Well, pigs do have wings.

Today, the American Meat Institute, the National Meat Association and the National Milk Producers Federation announced that they have petitioned the Agriculture Department to enact a total ban on the slaughter of downer cattle.  The American Meat Institute and the National Meat Association said they would encourage companies to enact a voluntary moratorium until the Agriculture Department changes the rule.

Downer cows also might have contracted such infections as  mad cow disease.  The animals are also more prone to infections such as Salmonella and E. coli partly because they wallow in feces before slaughter.

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From 1993 to 2002 nearly all the revenue to my firm came to E. coli-contaminated hamburger.  Then it was E. coli-contaminated spinach and lettuce.  Although spinach and lettuce were down in 2007, hamburger is back up.  With the increase in sales of raw milk in states, I am expecting a brisk growth in this sector of the Marler Clark firm.

A new study from the National Associations of State Departments of Agriculture (NASDA) finds raw milk is now available to consumers in 29 of the 50 states. The Federal Government  prohibits the interstate commerce of raw milk to consumers across state lines. Other than that, it is up to the states.   A questionnaire was sent to state regulatory milk program directors and/or managers in all fifty states in January 2008 and responses came in from all 50.

The survey found 29 states authorize the legal sale of raw milk, in some specified manner, for direct human consumption while the remaining 21 states prohibit the sale of raw milk to consumers.  Of the 29 that allow the sale, 17 regulate that it can only be sold on the farm where the milk is produced.   Two of the states, Minnesota and Wisconsin restrict sales to only incidental occurrences, not as a regular course of business and no advertising is allowed.  Arkansas, Kentucky, Mississippi and Rhode Island allow only for the sale of raw goats milk and Kentucky and Rhode Island require a physician’s prescription.  South Dakota allows farmers to deliver the milk to customers but not to stores. Oregon sales are limited to farms with no more than three cows and only two milking at any one time.  Three states, Texas, Massachusetts and South Carolina have coliform standards.  The remaining 13 states allow the retail sale of raw milk away from the farm, although in Utah the store must be owned by the producer even if it is off the farm.  11 of these states have coliform standards; Oregon and New Hampshire do not.  However, Oregon only allows raw goats milk to be sold at a store.

Not mentioned in the survey is also the growing issue of the sales of raw milk products that are sold as pet food with the knowledge that it is actually being consumed by humans.  The Chicago Tribune ran a story on Raw Milk this morning - "Milk issue not black and white."

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Or, at least it's lawyers do.  I'm always a bit shocked that people other than my mom and dad read my blog.  I was pleased that the lawyers for Malt-O-Meal corrected me on one of my earlier posts (I posted a picture of the wrong product):

Dear Mr. Marler:

James A. O'Neal
Amy R. Freestone
Faegre & Benson LLP
2200 Wells Fargo Center
90 S. Seventh St.
Minneapolis, MN 55402
(612) 766-7000

Here are the correct photos:

According to the CDC's most recent count, as of April 14 the outbreak had sickened 23 patients in 14 states, including two cases each were reported in New Hampshire and Massachusetts with California, Colorado, Delaware, Indiana, North Dakota, Pennsylvania, Minnesota, Rhode Island and Vermont each reported one case.  Maine, New Jersey and New York each reported three cases.  Illness onset dates were known for nine patients and ranged from January 22 to March 2.  Patients' ages range from 1 to 95 years and 62% are female.  Three hospitalizations have been reported, but no deaths.  The CDC said the PulseNet system notified its outbreak team on April 7 about a cluster of human Salmonella Agona isolates from several states that had the same genetic fingerprint.

In 1998, Malt-O-Meal  recalled as much as 3 million pounds of its plain toasted oat cereal after the U.S. Centers for Disease Control and Prevention found that it was the likely source of Salmonella Agona food poisoning.  At least 17 Washington state children became ill with Salmonella infections, and litigation resulted.

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There have been 411 reported cases of salmonella linked to the outbreak, with 112 of those cases confirmed through laboratory testing. Eighteen people had to be hospitalized.  It now appears that there may be a death related to the consumption of Salmonella-tainted water.  See story in the Pueblo Chieftain.

The CDC estimates that 1.4 million cases occur annually (CDC, 2005, October 13). Approximately 600 deaths are caused by Salmonella infections in the U.S. every year, accounting for 31 percent of all food-related deaths (CDC, 2005, October 13; MMWR Weekly, 2001). The reported incidence of Salmonella illnesses is about 14 cases per each 100,000 persons (MMWR Weekly, 2006), amounting to approximately 30,000 confirmed cases of salmonellosis yearly in the U.S. (CDC, 2005, October 13). In 2005, just over 36,000 cases were reported from public health laboratories across the nation, representing a 12 percent decrease compared with the previous decade, but a 1.5 percent increase over 2004 (CDC, 2007). As only about 3 percent of Salmonella cases are officially reported nationwide, and many milder cases are never diagnosed, the true incidence is undoubtedly much higher (Mead, 1999).

We have been retained by nearly 50 residents who became ill.  We are continuing our investigation as to the cause of the outbreak.

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The Food and Drug Administration (FDA) today announced that at least 23 people in 14 states have been diagnosed with salmonellosis that was caused by the same strain of Salmonella that was found in the recently recalled unsweetened Puffed Rice and unsweetened Puffed Wheat Cereals produced by Malt-O-Meal.  The recalled products were distributed nationally under the Malt-O-Meal brand name as well as under private label brands including Acme, America's Choice, Food Club, Giant, Hannaford, Jewel, Laura Lynn, Pathmark, Shaw's, ShopRite, Tops and Weis Quality. The cereals have "Best If Used By" dates from April 8, 2008 (coded as "APR0808") through March 18, 2009 (coded as "MAR1809").

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Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis (the disease caused by Salmonella) is the second most common foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95% of those cases are foodborne-related. Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 or 31% of all food-related deaths are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

Salmonella litigation makes up quite a bit of what we do at Marler Clark. Here are a few of current cases:  ConAgra Pot Pie Salmonella Outbreak, Pars Cove/Taste of Chicago Salmonella Outbreak, Veggie Booty Salmonella Outbreak, Peanut Butter Salmonella Outbreak, Wal-Mart Salmonella Outbreak, Sushi King Salmonella Outbreak

Here are some of our resolved cases:  Black Forrest Bakery, Brook-Lea Country Club, Cafe Santa Fe, Chili's, ConAgra, Corky & Lenny's, Golden Corral, Harmony Farms, KFC, Linh's Bakery, Malt-O-Meal, Old South Restaurant, Orchid Island, Paramount Farms, Pars Cove, Quality Inn, Robert's American Gourmet, San Antonio Taco, Seasons at the Pond, Sheetz, Sun Orchard, Sunset House, Sushi King, Susie Cantaloupe, Viva Cantaloupe, Wal-Mart, Western Sizzlin', Wyndham Anatole Hotel

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Well into the second day of "Who's Minding the Store" food safety conference here in Seattle.  The only competition seems to be our first sunny day with temperatures reaching 70 and the visit from the Dali Lama.  The hot item at the conference is the Marler Clark hat:

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Maine and Minnesota have identified cases of infection with Salmonella Agona.  At least 11 other states report as many as 20 other illnesses.  The onset of illness dates range from January 22 to March 19. Two of the individuals were hospitalized.  All three reported consumption of unsweetened puffed rice or wheat cereals, but at present it is unknown if the products consumed were part of the current recall. Additional cases of illness in other states are being investigated by the federal Centers for Disease Control and Prevention.

On April 5, 2008 the Malt-O-Meal Company of Minnesota announced a recall of unsweetened puffed rice and unsweetened puffed wheat cereal. In addition to Malt-O-Meal’s own brand, these cereals are sold under multiple labels, including the store brands for Hannaford and Shaw’s Supermarkets. The other brands being recalled are Acme, America’s Choice, Food Club, Giant, Jewel, Laura Lynn, Pathmark, ShopRite, Tops, and Weis Quality. The products recalled include “Best if used by” codes between April 8, 2008 (APR0808) and March 18, 2009 (MAR1809).

1998 Malt-O-Meal Salmonella Agona Litigation - Multistate

In 1998, Malt-O-Meal on recalled as much as 3 million pounds of its plain toasted oat cereal after the U.S. Centers for Disease Control and Prevention found that it was the likely source of Salmonella food poisoning. At least 17 Washington state children became ill with Salmonella Agona infections, and litigation resulted.

We learned this morning at the Seattle University School of Law Food Safety Seminar that not only is this 2008 outbreak caused by Salmonella Agona - the same serotype in the 1998 outbreak, but also the same PFGE pattern.

Salmonella is one of the most common enteric (intestinal) infections in the United States. Salmonellosis (the disease caused by Salmonella) is the second most common form of bacterial foodborne illness after Campylobacter infection. It is estimated that 1.4 million cases of salmonellosis occur each year in the U.S.; 95% of those cases are foodborne-related. Approximately 220 of each 1000 cases result in hospitalization and eight of every 1000 cases result in death. About 500 to 1,000 or 31% of all food-related deaths are caused by Salmonella infections each year. Salmonellosis is more common in the warmer months of the year.

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Today, the CDC will conduct a Media Briefing on new FoodNet Data

Dr. Robert Tauxe, Deputy Director, CDC Division of Foodborne, Bacterial and Mycotic Diseases

Faye Feldstein, Acting director, Food and Drug Administration’s Office of Food Defense, Communication and Emergency Response

Dr. Morris Potter, Lead Scientist for Epidemiology in the FDA’s Office of Food Defense, Communication and Emergency Response

Dr. Elisabeth Hagen, Executive Associate for Public Health, United States Department of Agriculture’s Food Safety Inspection Service, Office of Public Health Science

“Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food – 10 States, United States, 2007” being published in this week's Morbidity and Mortality Weekly Report.   The new report highlights foodborne illness disease trends and growing foodborne illness challenges.

Foodborne illnesses are a substantial health burden in the United States. The Foodborne Diseases Active Surveillance Network  collects data from 10 U.S. states regarding diseases caused by enteric pathogens transmitted commonly through food. FoodNet quantifies and monitors the incidence of these infections by conducting active, population-based surveillance for laboratory-confirmed illnesses. This report describes preliminary surveillance data for 2007 and compares them with baseline data from the period 1996–1998.

Reuters reports that:

U.S. efforts to contain foodborne illness have made no dent in reducing the number of infections, which were flat last year after a period of decline, according to a government report released on Thursday.

In the past two years, high-profile food safety scares involving peanut butter, spinach and other products have intensified pressure on lawmakers to protect the nation's food supply.

Yet the 10-state report issued by government researchers found no change in the rate of infections caused by Listeria, Salmonella, Shigella, E. coli O157 and several other nasty bugs in 2007 compared with the previous three years.

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In 1998, the CDC reported a Multistate Outbreak of Salmonella Serotype Agona Infections Linked to Toasted Oats Cereal -- United States, April-May.  During April-May 1998, a total of 11 states reported an increase in cases of Salmonella serotype Agona infections; as of June 8, a total of 209 cases have been reported and at least 47 persons have been hospitalized, representing an eightfold increase over the median number of cases reported in those states during 1993-1997. The states reporting increases were Illinois (49 cases), Indiana (30), Ohio (29), New York (24), Missouri (22), Pennsylvania (20), Michigan (15), Iowa (eight), Wisconsin (six), Kansas (four), and West Virginia (two). This report summarizes the outbreak investigation by local, state, and federal public health officials, which implicated Millville brand plain Toasted Oats cereal manufactured by Malt-O-Meal, Inc. as the cause of illness.

  Now, once again Malt-O-Meal cereals are recalled.  Malt-O-Meal voluntarily recalled its unsweetened Puffed Rice and unsweetened Puffed Wheat Cereals produced with ‘Best if Used By’ dates ranging from April 8, 2008, to March 18, 2009, because of the potential salmonella contamination.  Consumers should check their pantries for Malt-O-Meal, Acme, America’s Choice, Food Club, Giant, Hannaford, Jewel, Laura Lynn, Pathmark, Shaw’s, ShopRite, Tops and Weise Quality Unsweetened Puffed Rice and Wheat Cereals in 6, 12 and 16-ounce bags.  A comprehensive listing of affected products is available online at www.malt-o-meal.com/recallinfo.

According to Malt-O-Meal, "there have been no illnesses or injuries reported to date."  However, without the release by Malt-to-Meal of the Salmonella serotype, how are we to know that the claim of no illnesses is actually the case?

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According to a company press release, Malt-O-Meal announced today that it is voluntarily recalling its unsweetened Puffed Rice and unsweetened Puffed Wheat Cereals produced with “Best If Used By” codes between April 8, 2008 (coded as “APR0808”) and March 18, 2009 (coded as “MAR1809”) because they may have the potential to be contaminated with Salmonella.  The recalled product was distributed nationally, marketed under the Malt-O-Meal brand and as some private label brands including Acme, America’s Choice, Food Club, Giant, Hannaford, Jewel, Laura Lynn, Pathmark, Shaw’s, ShopRite, Tops and Weis Quality.

In 1998, Malt-O-Meal  recalled as much as 3 million pounds of its plain toasted oat cereal after the U.S. Centers for Disease Control and Prevention found that it was the likely source of Salmonella food poisoning.  At least 17 Washington state children became ill with Salmonella infections, and litigation resulted.

Founded in 1919, the Malt-O-Meal Company is privately held and headquartered in the IDS Center in Minneapolis, Minnesota.  Malt-O-Meal, the Nation’s fourth largest ready-to-eat cereal manufacturer, supplies a full line of branded cereals and private label cereals to the grocery industry.  The company currently produces 30 different branded ready-to-eat cereals, three varieties of Malt-O-Meal Hot Wheat cereal, and a full line of oatmeal products.  The company currently operates five production facilities and four distribution centers around the U.S.

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In what might be the most bizarre headline I have seen in 15 years of following food cases:

Cattle heads recalled by USDA

The U.S. Department of Agriculture is warning consumers that 406,000 pounds of frozen cattle heads are being recalled by a Kansas meat packer.

  The cattle heads are being recalled because tonsils were not removed properly, according to the USDA’s Food Safety and Inspection Service.

  The recall is being made to prevent human exposure to bovine spongiform encephalopathy, or BSE.

  BSE is popularly known as mad cow disease.

  The heads packed before March 28 and sent to wholesalers and retailers were produced by Elkhorn Valley Packing of Harper, Kansas.  The Food Safety and Inspection Service rated the health risk as low, with no reports of illness.

Ok, someone know what people do with frozen cattle heads?

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David Mitchell of The Packer reported “FDA confirms presence of salmonella in melons”
Cantaloupe from Agropecuaria Montelibano tested positive for salmonella freetown during the Food and Drug Administration’s traceback investigation of an outbreak of salmonella litchfield. The FDA issued an import alert March 22 after traceback evidence linked product from Honduran grower-shipper Agropecuaria Montelibano with a salmonella litchfield outbreak that caused 50 reported illnesses in 16 states.

FDA spokesman Sebastian Cianci, however, said the agency started to escalate its melon sampling as reports of illnesses increased. The positive test for salmonella freetown was taken from an import sample of Agropecuaria Montelibano’s product on March 12, he said.

The FDA has identified 10 U.S. importers who received cantaloupe from Agropecuaria Montelibano during the outbreak:

* Bounty Fresh LLC, Miami, Fla.
* C.H. Robinson Worldwide Inc., Eden Prairie, Minn.
* Central American Produce Inc., Pompano Beach, Fla.
* Chiquita Brands International Inc., Cincinnati, Oh.
* Dole Fresh Fruit International, Westlake Village, Calif.
* Legend Produce LLC, Firebaugh, Calif.
* Pero Vegetable Co. LLC, Delray Beach, Fla.
* T.M. Kovacevich International Inc., Philadelphia, Pa.
* Tropifresh Inc., Los Angeles, Calif.
* Wuhl Shafman Lieberman Corp., Newark, N.J.

In addition to Chiquita and Dole, brands affected are:

* Chestnut Hill Farms
* Perfect Melon
* Mike’s Melons
* Mayan Pride

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