Employees at two local Louisville, Kentucky businesses have been diagnosed with Hepatitis A.

That has been a similar and common headline in newspapers across the country over the last several months.

One worker at Sarino (1030 Goss Avenue) was diagnosed. Customers who dined at the establishment from February 24 through March 15 may have been exposed to the virus. One worker from Kroger (520 N 35th Street) was diagnosed. Customers who shopped at the store from March 2 through March 19 may have been exposed to the virus.

Kentucky

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 198 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

Counts as of Mar. 17, 2018

  • Total Outbreak: 198
  • Hospitalizations: 142
  • Deaths: 1

Utah

Since January 1, 2017, Utah public health has identified 226 confirmed cases of hepatitis A virus (HAV) infection; many among persons who are homeless and/or using illicit drugs. Several cases have been linked by investigation and/or viral sequencing to a national outbreak of hepatitis A involving cases in California and Arizona. Hospitalization rates of less than 40% have been described in previous hepatitis A outbreaks; however, other jurisdictions associated with this outbreak are reporting case hospitalization rates approaching 70%.

California

On Jan. 23, 2018, the San Diego County ended the local health emergency, declared on September 1, 2017, in response to the local hepatitis A outbreak. The action does not mean the outbreak is over, and the County will continue efforts it has taken to control the spread of the disease.  There has been a total of 586 illnesses, 401 hospitalizations and 20 deaths.

Arizona

Arizona officials believe the local outbreak was mainly confined to homeless people in Maricopa County. The county recorded only 15 known cases and no deaths, and officials have detected no new Arizona cases since the end of May 2017.  The illnesses in Arizona were linked to a person who traveled from San Diego.

Michigan

Since the beginning of the outbreak in August 2016, the Michigan public health response has included increased healthcare awareness efforts, public notification and education, and outreach with vaccination clinics for high-risk populations. No common sources of food, beverages, or drugs have been identified as a potential source of infection. Transmission appears to be through direct person-to-person spread and illicit drug use. Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate.  There has been a total of 789 illnesses, 635 hospitalizations and 25 deaths.

What about all the rest of the states?  What is the cause?  What is the source?  What can we do – in addition to vaccinations – to stop this?

According to the CDC, as of March 20, 2018, 13 people infected with the outbreak strain of Salmonella Typhimurium have been reported from 8 states. WGS performed on bacteria isolated from ill people showed that they were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from September 22, 2017 to February 26, 2018. Ill people range in age from 1 to 73 years, with a median age of 40. Sixty-seven percent are female. Three hospitalizations have been reported. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicates that dried coconut is the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Seven (88%) of eight people interviewed reported eating dried coconut from grocery stores. Of the seven people who reported eating dried coconut, four people purchased the product at different Natural Grocers store locations. Public health officials continue to interview ill people to learn more about what they ate in the week before becoming sick.

FDA and state health and regulatory officials collected leftover dried coconut from ill people’s homes, as well as dried coconut from Natural Grocers store locations where ill people shopped and from the Natural Grocers’ Distribution Center. FDA testing identified the outbreak strain of Salmonella Typhimurium in an unopened sample of Natural Grocers Coconut Smiles Organic collected from Natural Grocers. The outbreak strain was also identified in an opened, leftover sample of Natural Grocers Coconut Smiles Organic collected from an ill person’s home.

FDA also collected dried coconut from International Harvest, Inc. The outbreak strain of Salmonella Typhimurium was identified in samples of International Harvest Brand Organic Go Smile! Dried Coconut Raw and Go Smiles Dried Coconut Raw.

On March 16, 2018, International Harvest, Inc. recalled bags of Organic Go Smile! Raw Coconut and bulk packages of Go Smiles Dried Coconut Raw. The recalled Organic Go Smile! Raw Coconut was sold online and in stores in 9-ounce bags with sell-by dates from January 1, 2018 through March 1, 2019. Recalled bulk Go Smiles Dried Coconut Raw was sold in a 25-pound case labeled with batch/lot numbers OCSM-0010, OCSM-0011, and OCSM-0014. These products were sold in various grocery stores. Regulatory officials are working to determine where else Organic Go Smile! Raw Coconut and Go Smiles Dried Coconut Raw were sold.

On March 19, 2018, Vitamin Cottage Natural Food Markets, Inc. recalled packages of Natural Grocers Coconut Smiles Organic labeled with barcode 8034810 and packed-on numbers lower than 18-075. Recalled Natural Grocers Coconut Smiles Organic were sold in 10-ounce clear plastic bags with the Natural Grocers label. The packed-on number can be found in the bottom left-hand corner of the label.

Ill employee prompts Kroger to vaccinate employees but not customers.

According to Kentucky press reports, an employee in the produce department of the Kroger store at 4915 Dixie Highway has been diagnosed with Hepatitis A.

Kroger said the man worked at the store in Pleasure Ridge Park in February, and customers who bought produce between Feb. 4 to Feb. 28 may have been exposed to the virus. Any produce purchased during that time frame should be thrown away, Kroger said.

The employee worked third shift in the produce section and was diagnosed with Hepatitis A on Feb. 28 at a visit to the doctor. He immediately notified his supervisor, and Kroger notified the Health Department later that day, the company said.

Kroger said officials are cooperating with local and state health officials. Other employees threw away all the produce that the man is believed to have come in contact with and cleaned the store.

Additionally, Kroger is offering all associates and their families Hepatitis A vaccines. About 300 people work at the Pleasure Ridge Park store.

Hepatitis A can be transmitted through eating or drinking contaminated food or water. Symptoms include fatigue, loss of appetite, stomach pain, nausea and jaundice.

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 125 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

Counts as of Feb. 24, 2018

  • Total Outbreak: 125
  • Hospitalizations: 91
  • Deaths: 0

According to the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), and National Institute for Communicable Diseases (NICD)/ National Health Laboratory Service (NHLS), as of February 27, 2018, a total of 945 cases have been reported since 1 January 2017, with 30 additional cases recorded since the last update , February 20, 2018.  To date, 743 cases were reported in 2017, and 202 cases in 2018. Females account for 55% (516/943) cases where gender is reported. Where age was reported (n=909), ages range from birth to 92 years (median 19 years) and 41% (377/902) are neonates aged ≤28 days (Figure 2). Of neonatal cases, 94% (355/377) had early-onset disease (birth to ≤6 days). Most cases have been reported from Gauteng Province (59%, 555/945) followed by Western Cape (12%, 116/945) and KwaZulu-Natal (7%, 66/945) provinces. Outcome at the end of hospitalization is known for an additional 18 cases, bringing the total with known outcome to 635/945 (67%) patients. 176 (19%) patients are known to have died.

At present, the source of the outbreak is not known. The public are advised that processed, ready-to-eat meat products, soft cheeses, and unpasteurised milk and dairy products should be avoided by persons who are at risk of listeriosis. In addition, processed, ready-to-eat meat products include viennas, polonies, russians, ham, other ‘cold’ meats, sausages, various corned meats, salami, pepperoni and similar products typically found in the processed meat sections of food retailers and butcheries should be avoided, or thoroughly cooked in boiling water or heated at high temperatures of 70°C or higher before eating.

According to Australian press reports, two of the six who became ill in NSW subsequently died.

All states and territories are working together to investigate the outbreak and to date they have identified ten cases in elderly patients in NSW (six), Victoria (one) and Queensland (three) with onset of illness notification dates between 17 January and 9 February 2018. All 10 cases consumed rockmelon prior to their illness.

The outbreak has been linked to a grower (yet unnamed) in Nericon NSW. The company voluntarily ceased production on Friday 23 February 2018, shortly after being notified of a potential link to illness and is working proactively with the Authority to further investigate how any contamination could have occurred in order to get back into production as soon as possible.

The NSW Food Authority is advising consumers who are most vulnerable to Listeria infection such as older persons, and people who have weakened immune systems due to illness or pregnancy, to avoid eating rockmelon after a recent spike in listeriosis cases in elderly people has been linked to the fruit.

As a precaution, consumers particularly those who are elderly, pregnant or immune compromised who may have rockmelon already in their home are advised to discard it.

Listeria is found widely in the environment and rarely causes serious illness in the general population but for vulnerable people, such as those who are over 70, pregnant, or have diabetes, cancer or suppressed immune systems, it can be extremely serious or even life threatening.

Listeriosis starts with flu-like symptoms such as fever, chills, muscle aches, nausea, and sometimes diarrhea. The symptoms can take a few days or even up to six weeks to appear after eating contaminated produce.

People at risk should consult their local doctor as early as possible should symptoms appear.

Sounds much like the beginning of the US 2011 Multistate Outbreak of Listeria Linked to Whole Cantaloupes from Jensen Farms, Colorado. A total of 146 persons infected with any of the four outbreak-associated strains of Listeria monocytogenes were reported to CDC from 28 states. Thirty deaths were reported. In addition, one woman pregnant at the time of illness had a miscarriage.

In its continued efforts to protect consumers and ensure food safety, the U.S. Food and Drug Administration has begun testing fresh cilantro, parsley and basil, as well as processed avocado and guacamole, for certain microbial contaminants. These two large-scale sampling assignments will help the FDA assess the rates of bacterial contamination in these commodities, as well as help to identify possible common factors among the positive samples.

The FDA plans to collect 1,600 samples for each assignment. As of January 1, 2018, the agency had collected 35 domestic samples (4.6 percent) and 104 import samples (12.4 percent) of the total for fresh herbs. None of the domestic samples tested positive. Of the 104 import samples tested, 4 tested positive for Salmonella, 3 tested positive for Shiga toxin-producing E. coli, and none tested positive for E. coli 0157:H7.

As of January 1, 2018, the agency had collected 58 domestic samples (7.3 percent) and 49 import samples (6.1 percent) of the totals for processed avocado/guacamole. Of the 58 domestic samples tested, 3 tested positive for Listeria monocytogenes. Of the 49 imported samples, 1 tested positive for Listeria monocytogenes. It is important to note that no conclusions about overall contamination rates can be made until all of the data are collected, validated and analyzed.

If samples are found to be positive for microbial hazards, the FDA will pursue an appropriate regulatory and enforcement option, which may include encouraging a voluntary recall, ordering a mandatory recall, ordering administrative detention to prevent food from being distributed, issuing public warnings to alert consumers to the potential danger, or, in the case of imported products, refusing their entry into the United States and subjecting future shipments to an import alert. In the case of the positive samples identified in the first quarter of data collection, imported products capable of causing disease were prevented from entry into the United States and domestic products were voluntarily recalled.

The agency chose to sample fresh herbs because they are typically eaten without having undergone a ‘kill step,’ such as cooking, to reduce or eliminate bacteria. These herbs are also often eaten as part of multi-ingredient foods, and thus people may not report having eaten them when they become ill.

From 1996 to 2015, the FDA reported nine foodborne outbreaks linked to basil, parsley and cilantro, which resulted in 2,699 illnesses and 84 hospitalizations. Of the nine outbreaks, seven were attributed to Cyclospora cayetanensis; one was attributed to E. coli O157:H7; and one was attributed to Shigella sonnei. The FDA is seeking to obtain baseline estimates of the prevalence of Salmonella and Shiga toxin-producing E. coli (STEC) in cilantro, basil and parsley. The agency also intends to test for Cyclospora cayetanensis during the summer months, when  Cyclospora-related illnesses typically occur.

The agency chose to sample processed avocado because avocados have a high moisture content and a non-acidic pH level, conditions that can support the growth of harmful bacteria. Processed avocado products, including avocado that is fresh cut, refrigerated and frozen, may be packaged and eaten without having undergone a ‘kill step’ prior to consumption. According to the Centers for Disease Control and Prevention, there were 12 outbreaks of foodborne illness related to avocado, avocado products or guacamole products from 2005 to 2015. Of those 12 outbreaks, nine involved Salmonella and three involved E. coli, resulting in 525 illnesses and 23 hospitalizations. Though no Listeria outbreaks were reported in connection with avocados from 2005 to 2015, a recent sampling assignment by the FDA detected Listeria monocytogenes in samples collected from the fruit’s pulp and skin. The agency is seeking data on the prevalence of Salmonella and Listeria monocytogenes in processed avocado and processed avocado products.

The  assignments are anticipated to last 18 months. The agency will post results on a quarterly basis and also post a comprehensive report once sampling and analysis is complete.

 

The Weld County Department of Public Health and Environment (WCDPHE) is investigating an outbreak of Salmonella illness at Aims Community College. This illness may be associated with catered events held at Aims on February 9 and February 13, 2018. The February 9 event has 1confirmed Salmonella case that had about 70 people attend. The February 13 event has 2 confirmed cases that was attended by 400 people. Of the 10 confirmed Salmonella cases, 6 adults reside in Weld County, 1 in Larimer, and 1 in Boulder county. The events were catered by an outside restaurant, the Burrito Delight, located in Fort Lupton. The public is not at risk and the restaurant is now closed for the duration of the investigation.

Health officials said Thursday that they have confirmed all 10 illnesses are linked to food served by Burrito Delight at catered events, or at the restaurant between Feb. 9 and 12.

The restaurant failed the health inspection in the following areas: Temperature control, appropriate storage, proper storage of employee drinks, one instance of improper hand washing, and the presence of a rodent. The restaurant has received 12 critical violations in the past year.

“Salmonella is a bacteria that causes symptoms like diarrhea, upset stomach, fever, and occasionally vomiting,” said Mark E. Wallace, MD, MPH, Executive Director of the Weld County Health Department. “Symptoms typically last 4 to 7 days, and most people recover on their own. Anyone who suspects they became ill should contact their health care provider.” For some people, the diarrhea may become so severe that they require hospitalization. Symptoms typically appear 6-72 hours after eating contaminated food and will typically last for 4 to 7 days without treatment. However, in severe cases, the symptoms may last longer.

915 Sick with 172 Deaths.

According to the National Institute For Communicable Diseases:

As of 20 February 2018, 915 laboratory-confirmed listeriosis cases have been reported to NICD since 01 January 2017 (Figure 1). Most cases have been reported from Gauteng Province (59%, 541/915) followed by Western Cape (12%, 112/915) and KwaZulu-Natal (7%, 66/915) provinces. Cases have been diagnosed in both public (64%, 587/915) and private (36%, 328/915) healthcare sectors. Diagnosis was based most commonly on the isolation of Listeria monocytogenes in blood culture (73%, 669/915), followed by CSF (22%, 198/915). Where age was reported (n=886), ages range from birth to 92 years (median 20 years) and 41% (361/886) are neonates aged ≤28 days (Figure 2). Of neonatal cases, 97% (351/361) had early-onset disease (birth to ≤6 days). Females account for 56% (499/886) of cases where gender is reported. Final outcome data is available for 67% (617/915) of cases, of which 28% (172/617) died.

94 Sick in Iowa, Chicken Salad sold at Fareway grocery stores in Iowa, as well as Illinois, Minnesota, Nebraska and South Dakota.

28 – Confirmed Case Definition:

Persons with Salmonella Typhimurium (confirmed or visual match to Pattern JPXX01.0275) with illness onset since January 1, 2018 reporting consumption of chicken salad from Fareway (any store) in the 7 days prior to illness onset.

66 – Probable Case Definition:

Persons that are epi linked to a confirmed case (all confirmed cases are laboratory confirmed), OR Persons who test positive by CIDT or culture (with serotype and PFGE pending) with illness onset since January 1, 2018 reporting consumption of chicken salad from Fareway (any store) in the 7 days prior to illness onset.

Minnesota has one case associated with this outbreak so far, in a Martin County resident.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert out of an abundance of caution due to concerns about illnesses reported in the state of Iowa that may be caused by Salmonella associated with a chicken salad product. This product was sold at all Fareway grocery stores in Iowa, as well as Illinois, Minnesota, Nebraska and South Dakota.

The chicken salad item for this public health alert was produced between Dec. 15, 2017 and Feb. 13, 2018. The following product is subject to the public health alert:

  • Varying weights of “Fareway Chicken Salad” sold in plastic deli containers with a Fareway store deli label.

This product was shipped to all Fareway grocery stores in Iowa, Illinois, Minnesota, Nebraska and South Dakota and sold directly to consumers who shopped at Fareway.  The problem was discovered following reports of illness in Iowa.

On Feb. 9, 2018, the Iowa Department of Public Health notified FSIS of an investigation of Salmonella related illnesses, within the state of Iowa.  FSIS continues to work with public health partners at the Iowa Department of Public Health and Department of Inspections and Appeals on this investigation. Updated information will be provided as it becomes available.

FSIS is concerned that some product may be in consumers’ refrigerators or freezers.

Consumers who have purchased these products are urged not to consume them.

The Iowa Department of Public Health (IDPH) and the Iowa Department of Inspections and Appeals (DIA) today jointly issued a consumer advisory for chicken salad sold at Fareway stores. The chicken salad, which is produced and packaged by a third party for Fareway, is implicated in multiple cases of salmonella illness across Iowa. Preliminary test results from the State Hygienic Laboratory (SHL) at the University of Iowa indicate the presence of salmonella in this product.

Fareway voluntarily stopped the sale of the product and pulled the chicken salad from its shelves after being contacted by DIA. “The company has been very cooperative and is working with IDPH and DIA in the investigation of the reported illnesses,” said DIA Food and Consumer Safety Bureau Chief Steven Mandernach, who noted that no chicken salad has been sold to the consuming public since last Friday evening (2/9/18).

IDPH is investigating multiple cases of possible illness associated with the chicken 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.”