I am in Beijing at yet another food safety conference. It is odd really that at each of these conferences - regardless the continent - all tend to talk about the victims of food safety failures in the abstract. Mari's story is jarringly real. Click on the below and read the three part story of a food poisoning victim - a raw milk Campylobacter outbreak.
I am heading to a food safety conference here in Beijing sponsored by the Chinese Government. However, we still had time to keep on top the food safety situation in the United States.
The parents of Andrea Munro, 12, of Marshfield, say their daughter became infected with E. coli after eating Fairbank Farm’s beef on September 24.
On October 31, 2009, FSIS issued a notice about a recall of 545,699 pounds of beef products from Fairbank Farms that may be contaminated with E. coli O157:H7. Health officials in several states who were investigating a cluster of E. coli O157:H7 illnesses, with isolates that match by “DNA fingerprinting” analyses, found that most ill persons had consumed ground beef, with several purchasing the same or similar product from a common retail chain. At least some of the illnesses appear to be associated with products subject to these recalls. A sample from an opened package of ground beef recovered from a patient's home was tested by the Massachusetts Department of Health and yielded an E. coli O157:H7 isolate that matched the patient isolates by DNA analysis.
The cluster includes twenty-eight persons from 12 states infected with matching strains of E. coli O157:H7. Of these, the genetic association of 7 human isolates and the product isolate have been confirmed by an advanced secondary DNA test; secondary tests are pending on others. The number of ill persons identified in each state is as follows: California (1), Connecticut (4), Massachusetts (8), Maryland (1), Maine (2), Minnesota (1), New Hampshire (4), New Jersey (1), New York (1), Pennsylvania (2), South Dakota (2), and Vermont (1).
In the second case, the mother of Austin Richmond, 11, of Lincoln, R.I., says her son was infected with E. coli after eating a hamburger on a school trip to Camp Bournedale in Plymouth. Richmond’s burger was reportedly produced using meat from South Shore Meats, Inc., a subsidiary of Crocetti’s Oakdale Packing. Crocetti's Oakdale Packing Co., doing business as, South Shore Meats, Inc., a Brockton, Mass., establishment, is recalling approximately 1,039 pounds of fresh ground beef patties derived from bench trim as well as mechanically tenderized beef cuts that may be contaminated with E. coli O157:H7.
ABC News Reports the growing E. coli O157:H7 Outbreak is spreading West after killing two and sickening dozens in the Northeast. Now - Maine, Maryland, Massachusetts, Minnesota, New York, New Hampshire, Pennsylvania, Connecticut, Rhode Island, South Dakota, Vermont according to the CDC.
The CDC now says that two deaths and 26 other illnesses may be linked to contaminated ground beef recalled by Fairbank Farms. Lola Scott Russell, a spokeswoman for the Centers for Disease Control and Prevention, says one of the deaths involved a New York adult with several underlying health conditions. The other is a death previously reported by New Hampshire officials.
She says all but three of the suspected E. coli infections are in the northeastern U.S. and 18 are in New England. The CDC is investigating all the cases. Ashville, N.Y.-based Fairbank Farms recalled almost 546,000 pounds of fresh ground beef that may be tainted with E. coli bacteria. The meat was distributed in September to stores from Virginia to Maine.
On October 26, South Shore Meats in Brockton recalled more than 1,000 pounds of hamburger and steak after 20 Rhode Island students and adults became sick after eating E. coli O157:H7 contaminated meat at Camp Bournedale in Plymouth. A sixth-grade class from Lincoln, Rhode Island and adult chaperones spent several days at an environmental education program at Camp Bournedale in mid-October. Two of the students were hospitalized but were released on October 23.
Then on October 31, Fairbank Farms recalled almost 546,000 pounds of ground beef because E. coli O157:H7 contaminated meat has caused illness and one death. USDA has said that Fairbank Farms is linked to cases of E. coli-related illness in New Hampshire, Connecticut, Maine and Massachusetts. At least on child remains hospitalized in Massachusetts. The USDA says the ground beef was sold at numerous retail stores, including B.J.’s Wholesale, Giant, Lancaster, Price Chopper, Shaw’s, Trader Joe’s and Wild Harvest. In addition, ground beef packaged under the Fairbank Farms name was distributed to stores in Maryland, Massachusetts, North Carolina, New Jersey, New York, Pennsylvania and Virginia, and was likely repackaged for sale.
In nearly 17 years doing E. coli cases, I do not recall two separate outbreaks and recalls occurring in the same geographical area in the same time frame. It will be interesting to see during litigation (we represent children linked to the Camp and to illnesses in Massachusetts) and discovery, if Fairbanks supplied meat to South Shore. It will also be interesting to see if any of all of these cases are linked genetically via PFGE. Bottom line is that people getting sick and dying are still how we do outbreak investigations and issue recalls. It will be certain that we will be looking hard at finished hamburger testing for E. coli from both plants.
New Hampshire health officials are advising residents to take part in a beef recall after one person has died and two others became ill after eating contaminated ground beef.
"E. coli is a bacteria that produces a toxin that is potentially deadly to people," said Dr. Jose Montero, Director of Public Health at DHHS, a press release.
Montero urges residents to check their freezers for any affected products.
Health officials said Saturday the products were packaged between Sept. 15-16 and may have been labeled with sell-by dates from Sept. 19-28, and were sold at various stores throughout the state.
Health officials say the three became sick because of possible E. coli contamination.
They say the contaminated meat may be related to the recall of almost 546,000 pounds of ground beef in Connecticut, Maine and Massachusetts. That meat was sold by Fairbank Farms in Ashville, N.Y.
Each package carried the number "EST. 492" inside the USDA inspection mark or on the nutrition label.
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NY Firm Recalls 546,000 pounds tied to E. coli Illnesses - 45,000,000 pounds recalled in last two years.
The first lawsuit stemming from the E. coli outbreak in Massachusetts and likely Rhode Island will be filed Monday in the Trial Court of the Commonwealth of Massachusetts, Superior Court, against Crocetti-Oakdale Packing, doing business as South Shore Meats, Inc., which had recalled 1.039 pounds of E. coli tainted beef linked to illnesses.
The E. coli lawsuit was filed on behalf of a Marshfield, Massachusetts family, whose grandmother and children were infected with the pathogenic E. coli strain O157:H7 after eating ground beef purchased from the Star Market in Marshfield. The plaintiff is represented by Marler Clark, a Seattle law firm dedicated to representing victims of foodborne illness.
In addition, on Saturday (10/31/09), Ashville NY firm Fairbank Farms recalled 546,000 pounds of beef products due to E. coli contamination. According to the USDA release, the meat has been linked to illnesses in Maine, Massachusetts, and Connecticut, and distributed via retail outlets including Trader Joe's, Price Chopper, Lancaster, Wild Harvest, Shaw's, BJ's, Ford Brothers, and Giant.
Ground beef packaged under the Fairbank Farms name was also distributed to stores in Maryland, Massachusetts, North Carolina, New Jersey, New York, Pennsylvania, and Virginia.
It appears that this recall is an expansion of the Crocetti-Oakdale Packing, doing business as South Shore Meats, Inc., recall of 1.039 pounds of E. coli tainted beef linked to illnesses in Massachusetts and likely Rhode Island. “This expansion is a massive recall, and the danger cannot be overstated,” said foodborne illness expert and attorney Bill Marler, who represents several families in the outbreak. “The last recall of this size—Nebraska Beef in August of 2008—sickened dozens. It means that tainted meat is in homes across the country, and we have to do our best to get the word out to consumers so that they don’t suffer the illnesses that these families have.”
In addition, a cluster of at least 20 E. coli illnesses were reported by middle schoolers and chaperones who visited Camp Bournedale in Plymouth, MA in mid-October. “At this time it is unclear if these illnesses are linked to either recall, however, the timing is quite suspicious,” added Marler.
Recall Release CLASS I RECALL
FSIS-RC-059-2009 HEALTH RISK: HIGH
Fairbank Farms, an Ashville, NY, establishment, is recalling approximately 545,699 pounds of fresh ground beef products that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.
FSIS became aware of the problem during the course of an investigation of a cluster of E. coli O157:H7 illnesses. Working with the Centers for Disease Control and Prevention (CDC) and state health and agriculture departments, FSIS determined that there is an association between the fresh ground beef products subject to recall and illnesses in Connecticut, Maine and Massachusetts. FSIS is continuing to work with the Massachusetts Department of Public Health, the Connecticut Department of Public Health, other state health and agriculture departments and the CDC on the investigation. Anyone with signs or symptoms of foodborne illness should consult a physician.
The products subject to recall include: [View Labels, PDF Only]
Trader Joes
* 1-pound packages of "TRADER JOE'S BUTCHER SHOP FINE QUALITY MEATS GROUND BEEF 85/15."
* 1-pound packages of "TRADER JOE'S BUTCHER SHOP FINE QUALITY MEATS GROUND BEEF 80/20."
NOTE: The sell-by dates for the above two products may be October 6 or 7, 2009.
* 1-pound trays of "TRADER JOE'S BUTCHER SHOP FINE QUALITY MEATS GROUND BEEF PATTIES 96/4 EXTRA LEAN."
* 1-pound trays of "TRADER JOE'S BUTCHER SHOP FINE QUALITY MEATS GROUND BEEF PATTIES 85/15."
Price Chopper
* 1- and 2.5-pound trays of "PRICE CHOPPER MEATLOAF & MEATBALL MIX."
* 1-pound trays of "PRICE CHOPPER EXTRA LEAN GROUND BEEF 96/4."
* 1-pound trays of "PRICE CHOPPER FRESH GROUND BEEF CHUCK FOR CHILI 80% LEAN 20% FAT."
Lancaster and Wild Harvest
* 1-pound trays of "LANCASTER BRAND 96/4 EXTRA LEAN GROUND BEEF."
* 1- and 2-pound trays of "LANCASTER BRAND 90/10 GROUND BEEF."
* 1-pound trays of "WILD HARVEST NATURAL 85/15 ANGUS GROUND BEEF."
Shaw's
* 1- and 2-pound trays of "SHAW'S FRESH GROUND BEEF 93/7."
* 1-, 2- and 3-pound trays of "SHAW'S FRESH GROUND BEEF 80/20."
* 1- and 3-pound trays of "SHAW'S FRESH GROUND BEEF 75/25."
* 1.3-pound trays of "SHAW'S FRESH GROUND SIRLOIN BEEF PATTIES 90/10."
* 1.3-pound trays of "SHAW'S FRESH GROUND ROUND BEEF PATTIES 85/15."
* 1.3-pound trays of "SHAW'S FRESH GROUND BEEF PATTIES 80/20."
* 3-pound trays of "SHAW'S FRESH GROUND BEEF PATTIES FAMILY PACK 80/20."
* 1-pound trays of "SHAW'S ANGUS GROUND BEEF 85/15."
* 1-, 2- and 3-pound trays of "SHAW'S FRESH GROUND ROUND BEEF 85/15."
* 1-pound trays of "SHAW'S 90% NATURAL GROUND BEEF."
* 1-pound trays of "SHAW'S 85% NATURAL GROUND BEEF."
* 1-, 2- and 3-pound trays of "SHAW'S FRESH GROUND SIRLOIN 90/10."
* 1-pound trays of "MEATLOAF & MEATBALL MIX."
BJ's
* 5-pound trays of "FRESH GROUND BEEF, CONTAINS 15 % FAT" patties.
* 3- and 5-pound trays of "LEAN GROUND BEEF, CONTAINS 7% FAT."
* 2.5-pound trays of "MEATLOAF & MEATBALL MIX."
Ford Brothers
* 3-pound trays of "FRESH GROUND BEEF, CONTAINS 20% FAT" patties.
Giant
* 1-pound trays of "GIANT EXTRA LEAN GROUND BEEF 96/4."
* 1-pound trays of "GIANT MEATLOAF & MEATBALL MIX."
* 1-pound trays of "GIANT NATURE'S PROMISE GROUND BEEF."
* 1-pound trays of "GIANT NATURE'S PROMISE GROUND BEEF PATTIES."
Each package bears the establishment number "EST. 492" inside the USDA mark of inspection or on the nutrition label. These products were packaged on September 15 and 16, 2009, and may have been labeled at the retail stores with a sell-by date from September 19 through 28, 2009, unless otherwise noted above. Consumers should ask at their point of purchase if the products they have are subject to recall. The products were sent to distribution centers, intended for further distribution to retail establishments in Northeast and Mid-Atlantic regions. When available, the retail distribution list(s) will be posted on FSIS' Web site at http://www.fsis.usda.gov/FSIS_Recalls/ Open_Federal_Cases/index.asp.
Products for further processing:
* Cases of 10-pound "FAIRBANK FARMS FRESH GROUND BEEF CHUBS."
Each case bears the establishment number "EST. 492" inside the USDA mark of inspection; has package dates of "09.14.09," "09.15.09," or "09.16.09;" and sell-by dates of "10.3.09," "10.4.09," or "10.5.09. These products were distributed to retail establishments in Maryland, Massachusetts, North Carolina, New Jersey, New York, Pennsylvania, and Virginia for further processing. However, these products at retail will likely not bear the package dates and sell-by dates listed above. Customers with concerns should contact their point of purchase.
At midnight Crocetti's Oakdale Packing Co., doing business as, South Shore Meats, Inc., a Brockton, Massachusetts establishment, "voluntarily" recalled approximately 1,039 pounds of fresh ground beef patties derived from bench trim as well as mechanically tenderized beef cuts that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today. Hamburger recalls since 2007 have now reached 41,412,504 pounds.
And, this is not counting another recall from 2008. Then, Hallmark/Westland Meat Packing Co., a Chino, California establishment, voluntarily recalled approximately 143,383,823 pounds of raw and frozen beef products that FSIS has determined to be unfit for human food because the cattle did not receive complete and proper inspection. Through evidence obtained by FSIS, the establishment did not consistently contact the FSIS public health veterinarian in situations in which cattle became non-ambulatory after passing ante-mortem inspection, which is not compliant with FSIS regulations.
This recall was initiated after the Massachusetts Department of Public Health confirmed a positive sample for E. coli O157:H7 in hamburger which it collected during an epidemiological investigation at the home of our client. She and family members are now ill.
FSIS is continuing to work with the Massachusetts Department of Public Health, the Rhode Island Department of Health and the Centers for Disease Control and Prevention on the investigation. CDC had determined that the product sampled is associated with the illnesses being investigated related to illnesses in Massachusetts and in illnesses linked to Camp Bournedale in Plymouth, Massachusetts of 20 children from Rhode Island. Total number of illnesses are now near 30.
Crocetti's Oakdale Packing Co., doing business as, South Shore Meats, Inc., a Brockton, Mass., establishment, is voluntarily recalling approximately 1,039 pounds of fresh ground beef patties derived from bench trim as well as mechanically tenderized beef cuts that may be contaminated with E. coli O157:H7, the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) announced today.
This recall was initiated after the Massachusetts Department of Public Health (DPH) confirmed a positive sample for E. coli O157:H7 which it collected during an epidemiological investigation. FSIS is continuing to work with the Massachusetts DPH, the Rhode Island Department of Health and the Centers for Disease Control and Prevention on the investigation. CDC had determined that the product sampled is associated with the illnesses being investigated. Anyone with signs or symptoms of foodborne illness should consult a physician.
The products subject to recall include:
* 10-pound boxes containing 40, 4-ounce packages of "Beef Sirloin Patties, Manufactured by South Shore Meats."
* 7.5-pound boxes containing 12, 10-ounce packages of "Beef Teres Major Steaks Seasoned."
* Boxes of 24, 5-ounce packages of "BEEF BUTT STEAKS, (Filet Style)."
* 9-pound boxes containing 12, 12-ounce packages of "BEEF BUTT STEAKS, Center Cut, (sirloin style)."
* 9-pound boxes containing 12, 12-ounce packages of "BEEF BUTT STEAK, Center Cut, (filet style)."
* 6.75-pound boxes containing 12, 9-ounce packages of "BEEF BUTT STEAK, Center Cut, (sirloin style)."
* Boxes of 16, 10-ounce packages of "Beef Top Butt Steaks Sirloin Style."
* Boxes of 20, 8-ounce packages of "Beef Butt Steaks Club Style."
* Boxes of 26, 6-ounce packages of "Beef Top Butt Steaks Sirloin Style."
* Boxes of 12, 10-ounce packages of "BEEF BUTT STEAKS, (Filet Style)."
* 6-pound boxes containing 16, 6-ounce packages of "Beef Filet Of Sirloin, Executive Cut."
* Boxes of 12, 8-ounce packages of "BEEF BUTT STEAKS, (Filet Style)."
Each box bears the establishment number "EST. 6336" inside the USDA mark of inspection and may also bear a date code of "281." The beef products were produced on October 8, 2009, and were distributed to wholesale distributors and institutions in Massachusetts. If available, the retail distribution list(s) will be posted on FSIS' Web site at http://www.fsis.usda.gov/FSIS_Recalls/ Open_Federal_Cases/index.asp
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The Rhode Island Department of Health (HEALTH) advises Rhode Islanders that the South Shore Meat packing plant in Brockton has initiated a voluntary recall on certain ground beef products based on confirmed laboratory evidence of the presence of E. coli O157:H7 in leftover ground beef samples obtained from Camp Bournedale in Plymouth, Massachusetts. The ground beef was tested by the Massachusetts Department of Public Health (MDPH) after more than 20 students and chaperones from Lincoln Middle School became ill. Other Massachusetts residents are also sickened from meat purchased at Star Market in Marshfield.
USDA is investigating what lot codes are involved at this time and will be updating their website with detailed information on a regular basis. HEALTH continues to work with MDPH and federal partners to determine if any other products are involved with this recall and where the product(s) were distributed.
The New York Times story on my client, Stephanie Smith, has been an old and new media sensation. More blogs and twitters have reprinted her struggle with E. coli O157:H7 than any recent story. All that said, when FOX covers the story with the same level of concern, I think the meat industry and FSIS need to pay attention. Hmmm, perhaps Obama needs to reconsider that ban on FOX?
Raw milk related bacterial outbreaks have been an unfortunate and expanding part of business at Marler Clark. What now seems to be at least a yearly occurrence (we do not get retained in all outbreaks) raw milk illnesses are on the rise. And, because the proponents of the consumption of raw milks spend most of their time rejecting that the outbreaks – and illnesses related to them – even occurred, we expect continued business growth.
Until the proponents admit that the outbreaks are more than FDA conspiracies against them and learn something, they can never take the high moral ground that they desire. The fact is that Raw Milk produced by your favorite local farmer or hamburger or cookie dough made by some faceless mega-corporation, can sicken or kill your child if it is contaminated with a food borne pathogen like E. coli O157:H7, Campylobacter, Listeria or Salmonella. In this instance - size does not matter.
Below is a summary of the Raw Milk Outbreaks that we have been directly involved in representing victims. In each of the outbreaks, many of the victims, primarily children, were severely injured by the consumption of raw milk containing either E. coli O157:H7 or Campylobacter. Yes, Weston A. Price Foundation and The Complete Patient (a.k.a. David Gumpert), these outbreaks happened and people got sick, some horribly so.
Continue Reading...Well, not really, it was just the tape of my reaction when Larry King butchered the word "E. coli." Click on the below image and watch the last part of the third monologue segment:
In the Minneapolis Star Tribune Newspaper:
"In October 2007 when we learned there may be a problem, we immediately instituted a voluntary recall. A number of people were sickened, including Ms. Smith. Our hearts go out to Ms. Smith and her family, as well as the others whose lives have been so affected by O157:H7. Cargill conducts nearly 400,000 tests for pathogens each year using a testing methodology that exceeds U. S. Department of Agriculture standards. We also require our suppliers to test using a methodology that exceeds USDA standards. A complete food safety system combines antimicrobial interventions, employee training and safe food-handling procedures with testing. The testing verifies the effectiveness of all of these procedures. Over the past 10 years, Cargill has invested $1 billion in ongoing meat science research and new food safety technologies and interventions. We are committed to continuous improvement in the area of food safety."
An 86 year old Wisconsin woman has reached a confidential out-of-court settlement with the fresh produce growers and processors who she says poisoned her three years ago with a bag of spinach contaminated with E. coli O157:H7. Jane Majeska of Fond du Lac sued Dole, National Selection Foods, Mission Organics and Pick 'n Save on Sept. 1st for injuries she received from eating fresh bagged spinach, which was contaminated E. coli bacteria.
The parties agreed not to disclose the terms or the amount of the settlement that comes at the end of a series of litigation that follows one of the most troubling E. coli O157:H7 outbreaks in history because it involved fresh produce and spread across the country so quickly.
The bagged spinach outbreak involved 26 states. Half of the 205 confirmed cases required hospitalization and 31 developed the type of kidney failure called hemolytic uremic syndrome (HUS). Five deaths in confirmed cases are associated with the outbreak. A 2-year old in Idaho and elderly women in Wisconsin, Washington, Nebraska, and Maryland were among the fatalities.
It also cost Salinas Valley growers an estimated $100 million in lost sales. Litigation costs ans settlements are not reported.
Majeska was one of the HUS victims and was one of the most critically ill survivors of the E. coli outbreak. Her fight for life cost a half million in hospital and doctor bills, and put her on feeding tubes and a ventilator for an extended period.
U.S. Agriculture Secretary Tom Vilsack vacated Washington DC today to give a speech at the University of Minnesota. He was interviewed by Minnesota Public Radio following a major New York Times report over the weekend on flaws in the food safety system cited cases in Minnesota.
Here is the Press Release that went out this afternoon from FSIS in response to the New York Times article:
Statement by Agriculture Secretary Tom Vilsack Regarding Recent E. Coli Story
October 05, 2009
"The story we learned about over the weekend is unacceptable and tragic. We all know we can and should do more to protect the safety of the American people and the story in this weekend's paper will continue to spur our efforts to reduce the incidence of E. coli O157:H7. Over the last eight months since President Obama took office, USDA has been aggressive in its efforts to improve food safety, and has been an active partner in establishing and contributing to President Obama's Food Safety Working Group.
"Protecting public health is the sole mission of the USDA Food Safety and Inspection Service. FSIS has continued to make improvements to reduce the presence of E. coli O157:H7 and the agency is committed to working to reduce the incidence of foodborne illnesses caused by this pathogen.
"Shortly after coming into office, the Administration created a high-level Food Safety Working Group to coordinate food safety policies, focus greater resources on prevention, and improve response to outbreaks. Since doing so, we have taken the following actions:
* Launched an initiative to cut down E. Coli contamination (including in particular contamination from E. Coli O157:H7) and as part of that initiative, stepped-up meat facility inspections involving greater use of sampling to monitor the products going into ground beef.
* Appointed a chief medical officer within USDA's Food Safety Inspection Service to reaffirm its role as a public health agency.
* Issued draft guidelines for industry to further reduce the risk of O157 contamination.
* Started testing additional components of ground beef, including bench trim, and issuing new instructions to our employees asking that they verify that plants follow sanitary practices in processing beef carcasses.
* Designed the Public Health Information System (PHIS) in response to lessons learned in past outbreaks.
"USDA is also looking at ways to enhance traceback methods and will initiate a rulemaking in the near future to require all grinders, including establishments and retail stores, to keep accurate records of the sources of each lot of ground beef.
"No priority is greater to me than food safety and I am firmly committed to taking the steps necessary to reduce the incidence of foodborne illness and protect the American people from preventable illnesses. We will continue to make improvements to reduce the presence of E. coli O157:H7."
Now, back to his actual words to Minnesota NPR. If he had called I would have driven him and Mr. Cargill up to Cold Spring, Minnesota to meet the young woman profiled by the New York Times. Perhaps, they could help change her diapers? Help her in and out of her wheelchair? Explain that she will never walk again? Explain to her that she will never have children? That she will need multiple kidney transplants to live? Never have a meaningful job? And, never dance again?
Do you know what's in your hamburger? The truth might frighten you. According to the New York Times, tens of thousands of people get sick annually by the food-born pathogen E. coli. 22-year-old Stephanie Smith was one of those people. A dance instructor, she came down with an illness so severe that it shut down her kidneys, caused seizures and ultimately left her paralyzed from the waist down and partially brain damaged.
William Marler, Stephanie Smith’s lawyer, spoke with Ron Reagan about the seriousness of this issue.
Judging from my email and twitter traffic, people are opening up (actually they do not even need to do that) their New York Times this morning to the shocking and tragic story of my client's, Stephanie Smith's, struggle with a severe E. coli O157:H7 illness linked to Cargill hamburger. It is a difficult read. A few weeks ago another shocking and tragic story of yet another client, Linda Rivera, was on the front page of the Washington Post. Linda, who now has been hospitalized for 155 days is also struggling with a severe E. coli illness, this linked to Nestle Toll House Cookie Dough.
Senator Reid, I hope you have read both articles. I would also ask you to read the below:
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Subject: Linda Rivera Condition 10-2-2009
10-2-2009 @ 11:15pm PDT
Linda’s condition is improved though she is still seriously ill. She is still on the breathing machine (ventilator) but is being weaned off of it. Room air to supply good levels of oxygen in our blood is about 22% oxygen. Linda needs 30% to maintain the same level of good oxygenation. Just a few weeks ago she required around 50% and above, so things are looking good and improved. She is taking more of her own breaths with backup mandatory breaths being delivered. She has a tracheostomy to which the ventilator hose is attached.
She is able to move her left extremities more so than a few weeks ago. Her blood pressure is stable and low normal without any special medications to keep it up in the normal range. She has occasional fevers. She tries to talk, is now moving her mouth to attempt word formation, moves her hands, shows thumbs up or thumbs down as appropriate to questions or statements, and is moving her head. She is unable to speak out loud due to the tracheostomy, which must eventually be fitted for a special tracheostomy tube that will allow talking while it is in. Alternatively, but unlikely, she will eventually have the tracheostomy closed first before she can speak. To qualify for the special tracheostomy tube called a fenestrated tracheostomy tube, she would have to be able to breathe on her own while the tube is in. This will happen further on down the road.
Overall her condition has improved from critical, to now, serious condition. Her prognosis is guarded, not as poor as a few weeks ago. Richard is quite happy with her progress. Hopefully as her strength improves and she is more independent of the ventilator, she can become more communicative. I would think they should be getting her out of bed and into a chair for brief periods. Perhaps they can wheel her out of her room and into a more open area with a not so monotonous views.
I am encouraged at what Rich has told me. Perhaps the biggest threat to her is hospital acquired infection. There is room for cautious optimism, however, with prayer sealing the deal.
God Bless,
Ron R
New York Times Quotation of the Day:
"I ask myself every day, ‘Why me?’ and ‘Why from a hamburger?’
Michael Moss does a Pulitzer Prize winning job of exposing the underbelly of how our meat is produced in the United States. E. coli O157:H7 is a deadly bacteria that nearly took Stephanie Smith's life. Every day is a struggle for her now. Despite the odds, she promises to dance again. Read her story and see the video the NYT produced - "The Burger That Shattered Her Life." Click on picture to see video done by NYT.
And this guy should be fired:
Dr. Kenneth Petersen, an assistant administrator with the department’s Food Safety and Inspection Service, said that the department could mandate testing, but that it needed to consider the impact on companies as well as consumers. “I have to look at the entire industry, not just what is best for public health,” Dr. Petersen said.
Lawsuit Seeks to Cover Millions In Medical Expenses
Victims of an August, 2008 outbreak of E. coli O111 have joined together to file suit against the Country Cottage restaurant, where they were sickened. The lawsuit was filed today in the District Court in the State of Oklahoma, in and for the County of Mayes, on behalf of twelve families.
“Many of us regularly entrust restaurants with our health and safety,” said the families’ attorney, William Marler. “There are stringent rules and regulations that restaurants must follow, because any deviation from those rules can cause illnesses. Sadly, this outbreak shows how very wrong things can go, and how much suffering can result.”
The outbreak at the Country Cottage Restaurant in Locust Grove, Oklahoma sickened 341 people, hospitalized 70, and caused the death of one man. Investigators quickly pinpointed the restaurant as the source of infection, but were unable to determine the specific vehicle. E. coli is often contracted by consuming food or beverage that has been contaminated by animal (especially cattle) manure. E. coli outbreaks have been tied to meat, produce, unpasteurized milk, cheese, and cider, sprouts, juice, and even water. The lawsuit cites the restaurant’s use of water from an unpermitted, on-site well just before the outbreak—in violation of Department of Environmental Quality (DEQ) regulations – as a basis for punitive damages.
“These fourteen people collectively spent 250 days in the hospital, 84 of them on dialysis for kidney failure,” continued Marler. “Their medical bills are almost two million dollars, not to mention ongoing medical care that many will continue to need. Our job is to make sure that they don’t struggle to carry that immense burden by themselves.”
Over at E. sakazakii blog there is a discussion of the naming and renaming of this very nasty bug.
Whatever the name it is a rare, but life-threatening cause of neonatal meningitis, sepsis, and necrotizing enterocolitis. In general, E. or C. sakazaii kills 40-80% of infected newborns diagnosed with this type of severe infection. E. or C. sakazakii meningitis may lead to cerebral abscess or infarction with cyst formation and severe neurologic impairment. E. or C. sakazakii can cause a variety of infections, though central nervous system infection has been most commonly described. For infants, infection typically manifests through signs of sepsis in the first week of life: irritability or lethargy, temperature instability, and feeding intolerance. Meningitis often produces overwhelming infection that rapidly moves through cerebral hemorrhage, infarct, necrosis, liquefaction, and eventually, cyst formation.
E. or C. sakazakii invasive infections occur more frequently in infants than in older children. The neonate's immature immune system may increase the risk of acquiring an E. or C. sakazakii infection. In a study of E. or C. sakazakii cases over a 47-year period, investigators found that the median age at infection onset was two days and 94% of cases were less than 28 days old.
While the reservoir for E. or C. sakazakii is unknown in many cases, a growing number of reports have established powdered infant formula as the source and vehicle of infection. In several investigations of outbreaks of E. or C. sakazakii infection that occurred among neonates in neonatal intensive care units, investigators were able to show both statistical and microbiological association between infection and powdered infant formula consumption.
It has been another week with too much news in food safety. Here are six that you should not have missed.
Food Safety Education Month Winds Down
Shootout in Tulsa – OK vs Big Chicken
Q&A: Nestle on Food Safety Politics
Outbreak Victims to Sue OK Restaurant
Botulism is a rare, life-threatening paralytic illness caused by neurotoxins produced by an anaerobic, gram-positive, spore-forming bacterium, Clostridium botulinum. Unlike Clostridium perfringens, which requires the ingestion of large numbers of viable cells to cause symptoms, the symptoms of botulism are caused by the ingestion of highly toxic, soluble exotoxins produced by C. botulinum while growing in foods.
Overview
These rod-shaped bacteria grow best under anaerobic (or, low oxygen), low-salt, and low-acid conditions. Bacterial growth is inhibited by refrigeration below 4° C., heating above 121° C, and high water-activity or acidity. And although the toxin is destroyed by heating to 85° C. for at least five minutes, the spores formed by the bacteria are not inactivated unless the food is heated under high pressure to 121° C. for at least twenty minutes.
The incidence of foodborne botulism is extremely low. Nonetheless, the extreme danger posed by the bacteria has required that “intensive surveillance is maintained for botulism cases in the United States, and every case is treated as a public health emergency.” This danger includes a mortality rate of up to 65% when victims are not treated immediately and properly. Most of the botulism events that are reported annually in the United States are associated with home-canned foods that have not been safely processed. Very occasionally, however, commercially- processed foods are implicated as the source of a botulism events, including sausages, beef stew, canned vegetables, and seafood products.
Symptoms
Continue Reading...Experts from the Veterinary Laboratories Agency (VLA) said 33 of 102 samples were likely to contain the O157:H7 strain of the infection. This included samples from Lambs, pigs, goats, cattle, ponies and rabbit droppings at a Surrey farm at the centre of an E. coli outbreak. During its visit to Godstone Farm scientists found two samples of E. coli O157 on the floor of the main barn. Nigel Gibbens, Defra chief Veterinary officer, said: "Joint HPA and VLA investigations have confirmed the presence of E. coli O157:H7 bacteria in faeces from a wide range of animals on a premises in Surrey.
The Health Protection Agency (HPA) said the total number of E. coli cases linked to Godstone Farm had risen to 67. Eight children remain in hospital in a "stable or improving condition".
Let’s see, there is a long history of animal to human bacterial contamination in both England and the United States – see www.fair-safety.com. Here are a few that we have litigated – and continue to do so:
Lane, Oregon - County Fair E. coli O157:H7 Litigation - Marler Clark represented many of the 82 people, most of them young children, who were sickened by E. coli O157:H7 at the Lane County Fair in Eugene, Oregon, in the summer of 2002.
North Carolina State Fair E. coli O157:H7 Outbreak Litigation - The North Carolina State Department of Health and Human Services (DHHS) announced on November 8 that the North Carolina State Fair was the source of over 106 cases of E. coli O157:H7 amongst persons who attended the fair. On December 16, N.C. DHHS released an outbreak report, and stated that “Many activities in the Crossroads Farm Petting Zoo were associated with illness.”
AgVenture Farms E. coli O157:H7 Outbreak Litigation - The Florida State Department of Health (DOH) identified 22 confirmed cases of E. coli O157:H7 and Hemolytic Uremic Syndrome in Central Florida during March, 2005. At least 35 additional cases were suspected as of April 1, 2005.
What I find most bothersome is that each time it happens in either England or the United States, health officials and petting zoo owners seem to pretend it is happening for the very first time. Here is a PowerPoint I presented in 2004 - we seem never to learn.
This coming week we will be filing suit against Country Cottage Restaurant and its owners on behalf of a dozen seriously injured victims of this outbreak. Combined, our clients' medical bills are over $1,000,000 to date. Kim Archer of the Tulsa World has done a great job of recalling the horrors of the United States’ largest E. coli O111 outbreak.
• 341 were sickened
• 70 people were hospitalized, including 22 children
• 17 people received kidney dialysis, including eight children
• 1 man died
Although, we offered the owners, the restaurant, it's lawyers and insurance company the opportunity to resolve the case, they did not respond. Here is the final report of the outbreak:
Senator Harry Reid, majority leader of Senate, reached out by letter to my clients, the Rivera's, of Las Vegas.
Linda Rivera is one of 80 sickened by E. coli O157:H7-tainted Nestle Toll House Cookie Dough. She has struggled with her illness since May 1. She has lost her large intestine, gall bladder, and has been on dialysis. She is presently on life support. Here is Reid's letter:
Dear Rivera Family:
I want to express my personal thoughts and prayers to you as you struggle with Linda’s illness. I hope you will keep your faith strong and your hopes up that Linda will recover and find peace and comfort.
I want you to know that the seriousness of Linda’s illness highlights the need for action to improve our food safety laws and inspection systems. This fall, I plan to bring food safety legislation before the Senate so that we can strengthen our laws, better detect food borne pathogens, and better trace our food supply. As I work on this legislation it will be with the goal of ensuring that more families do not suffer as you do now.
Best wishes to you, Linda and your entire family.
It is great to have a leader like Senator Reid.
The ongoing problems in the US led the US Centers for Disease Control (CDC ) to publish recommendations for reducing the risk of transmitting E. coli and other human pathogens at animal exhibits. In the wake of devastating E. coli outbreaks, several states including Pennsylvania and North Carolina have enacted laws requiring similar precautions. Yet in representing dozens of children sickened in these outbreaks over the years, Marler Clark has seen animal exhibitors continue to disregard these basic precautions:
1. Source control: Animals need to be screened for pathogens, and removed if `shedding` those pathogens.
2. Effective manure management: Sanitary removal of animal manure followed by sanitation of bins and traffic areas.
3. Dust control: Fecal dust can spread infectious agents onto surfaces, which results in human illness through hand to mouth transfer of pathogens.
4. Clean up and sanitation: Sanitize all contact surfaces.
5. Environmental sanitation: Prevent cross contamination of areas adjacent to animal holding areas, particularly food courts and drinking fountains.
6. Hand washing and sanitation facilities: Require visitors to wash and sanitize upon entry and exit to animal holding areas and petting zoos.
7. Clear protocol for petting zoo and animal contact areas: Hand-to-mouth activities such as eating, drinking, smoking, carrying toys and pacifiers should be strictly prohibited in the interaction area. Gloves should be available for additional protection.
8. Information should be provided: Wherever there is public access to farm animals, information about the risk associated with the transmission of pathogens should be provided to visitors.
9. Heightened precautions should be applied to high-risk groups: Children under age 5, people with weakened immune systems, and pregnant women fall in the category of high-risk for serious infection, and hence should strictly follow all the precautions enforced in the animal contact area.
We have been keeping track of most outbreaks involving petting zoos and county fairs and have compiled most of the information at www.fair-safety.com. Looks like I have to update it.
Which multi-billion dollar company raised this defense in response to a recent lawsuit where the consumer ate its product?
Under what circumstances should a consumer be held responsible when the purchased food product contains a bacteria or virus? Should the parent? Should the child?
On the third anniversary of the Dole Spinach E. coli outbreak, once again Lynne Terry of The Oregonian and Bill Keene super, senior epidemiologist, break yet another food poisoning story. This time, according to Ms. Terry, “[f]ederal and state health authorities are investigating a salmonella outbreak that peaked in Oregon in August.”
According to Dr. Keene, “[a]t least 124 were sickened across the country, with a clustering of cases in the West. In Oregon, seven people became sick between Aug. 4 to 16, including three in the Portland metro area. Two people got so sick they had to be hospitalized, and one had severe symptoms [a Marler Clark Client], Keene said.”
Scientists from the Centers for Disease Control and Prevention and the Food and Drug Administration still do not know exactly what poisoned people, though shredded lettuce is a leading suspect, Keene said.
Question - where did lettuce come from?
Interestingly, Tanimura & Antle, Inc. of Salinas, California expanded the geographic scope of its voluntary recall of bulk and wrapped romaine head lettuce last week due to positive Salmonella tests. The company extended the U.S. recall to all 50 states. The recall also included Puerto Rico and Canada. Originally, the recall was issued after a random test conducted by the Wisconsin Department of Agriculture tested positive for Salmonella. At the time of the recall no illnesses had been linked to the finding. Romaine lettuce included in the recall was harvested June 25 - July 2. Shelf life of the product typically is 14 n 16 days. At this point it is unclear if Tanimura & Antle is the source of this outbreak reported by Ms. Terry.
Or, perhaps it is not lettuce?
Muranaka Farm Inc. recalled 1,005 cases of parsley distributed in 10 states because it may be contaminated with Salmonella.
Frontera Produce of Edinburg, Texas recalled one lot of cilantro due to Salmonella. The recalled cilantro was available at select store chains in Texas, Oklahoma, Colorado, Louisiana and New Mexico.
And, what the hell is wrong with leafy greens? Some examples:
August 1993 - E. coli O157:H7 outbreak linked to a salad bar; 53 reported cases in Washington State
July 1995 - Lettuce (leafy green; red; romaine) E. coli O157:H7; 70 reported cases in Montana
September 1995 - Lettuce (romaine) E. coli O157:H7; 20 reported cases in Idaho
September 1995 - Lettuce (iceberg) E. coli O157:H7; 30 reported cases in Maine
October 1995 - Lettuce (iceberg; unconfirmed) E. coli O157:H7; 11 reported cases in Ohio
May-June 1996 - Lettuce (mesclun; red leaf) E. coli O157:H7; 61 reported cases in Connecticut, Illinois, and New York
May 1998 - Salad E. coli O157:H7; two reported cases in California
February.-March 1999 - Lettuce (iceberg) E. coli O157:H7; 72 reported cases in Nebraska
July-August 2002 - Lettuce (romaine) E. coli O157:H7; 29 reported cases in Washington and Idaho
October 2003 - thirteen residents of a California retirement home were sickened, and two people died, after eating E. coli-contaminated, pre-washed spinach
October 2003-May 2004 - Lettuce (mixed salad) E. coli O157:H7; 57 reported cases in California
April 2004 - Spinach E. coli O157:H7; 16 reported cases in California
September 2005 - Lettuce (romaine) E. coli O157:H7; 32 reported cases in Minnesota, Wisconsin, and Oregon
November-December 2006 - Taco Bell and Taco Johns E. coli shredded lettuce sickened hundreds in Mid-west and East
Several months after the Peanut Corporation of America forced the recall of over 4,000 different peanut products from some 200 companies, another company announced a recall on the FDA Website.
Kilwin's Quality Confections, Inc. of Petoskey, MI, is recalling all of our 7 ounce packages of chocolate-covered peanuts, and bulk chocolate-covered peanuts, sold in our retail stores, which were sold prior to April 1, 2009, because they have the potential to be contaminated with Salmonella, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella 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 recalled chocolate-covered peanuts were sold in Kilwin's retail stores located in the following states: Michigan, Florida, Illinois, Wisconsin, Colorado, Rhode Island, Georgia, Maryland, Pennsylvania, Tennessee, North Carolina, and South Carolina.
The product comes in a 7 ounce, gold foiled plastic package with a clear center section, and is labeled "Milk Chocolate Peanuts" and "Fresh dry roasted peanuts covered in creamy milk chocolate", Kilwin's Quality Confections, Petosky, MI 49770. The barcode on the package is 001615. Additionally, the product was sold in bulk bins, by weight, at Kilwin's retail stores.
The potential for contamination was noted after our peanuts supplier voluntarily recalled their product because these peanuts were subject to the PCA Texas facility recall.
A picture is worth multiple, multiple, millions of words:
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I spent the day today being feted at the University of Arkansas School of Law and meeting with Tysons and Wal-Wart. Linda, her parents, her husband and six kids spent the day watching Linda being admitted into another ICU, again. It is unlikely she will survive the weekend.
I won't recount the horror that Linda and her family have experienced since May when she ate E. coli-tainted Nestle Toll House Cookie Dough. I won't try my case on my blog.
By the way, this is a picture of Linda before E. coli O157:H7:
President Obama once said:
"There are certain things only a government can do. And one of those things is ensuring that the foods we eat are safe and do not cause us harm.”
A few days ago I penned this Op-ed (declined by the Washington post) - it seems a bit more on point tonight after our President's speech:
Linda Rivera’s excruciating case of food poisoning (Severe Case Gives Context to Issue of Food Safety Washington Post 9/1/09) should shine some light on a crucial reality that is missing from most health care reform plans: you can’t fix America’s health care unless you provide Americans with a safe food supply.
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The mother of six lies comatose in her Las Vegas hospital room as a consequence of eating cookie dough contaminated with E. coli O157:H7 - a vicious microbe previously associated with hamburger, spinach, lettuce, and raw milk as well as other products. But she is not an isolated case. According to federal health authorities, she is just one of the 76 million Americans sickened each year by tainted food, adding billions in costs to individuals, to food-producers and to our beleaguered medical system.
Yet food safety is rarely mentioned in the scream fest that has been national health care debate in and around Congress. In fact, our national squabble threatens to scuttle any hope for the much-needed food safety legislation that overwhelmingly passed the House this summer. The Food Safety Enhancement Act would give the Food and Drug Administration (FDA) the authority it needs to inspect food-processing plants and stop the distribution of food tainted with E. coli, Salmonella, Listeria or any of the other usual suspects. It would increase the agency’s ability to use emerging technologies to trace contaminated foods and additives back to their source, while imposing new safety standards on both domestic and imported food products.
The potential benefits - to our children, our parents, and our neighbors and to the U.S. economy - are enormous. While the food industry insists that we have the world’s safest food supply, the authoritative Centers for Disease Control suggest otherwise: 76 million sick people per year, 208,000 per day, 8,675 per hour. Most of those cases are relatively mild, but the CDC says 325,000 people will be hospitalized, and at least 5,000 of them will die of food poisoning.
Consider the costs to the health care system, such as it is. The Department of Agriculture estimates the combined medical costs, productivity losses, and the costs of premature death at a minimum of $6.9 billion per year. But that estimate excludes costs such as lost business opportunities, public costs, pain and suffering and much more. The Food and Drug Administration assigns a cost of $5 million per death, reaching a total cost of $17 billion per year. But using a more complex FDA formula that factors in the full societal cost, the savings reach an astronomical $357 billion.
There may be argument over the calculations, but these are not paper costs; they are real. In the 17 years I have been representing the victims of food-borne illness, we have collected more than $500 million in settlements and verdicts against food manufacturers. Most of that goes to cover the costs of medical bills, lost wages and the pain and suffering incurred by people whose only crime was to believe processors` claims that their products were safe. So what if we passed meaningful food safety legislation? What if we saved billions of dollars in medical care and treatment by avoiding poisoning in the first place? What if Linda Rivera and thousands of Americans like her never became infected with E. coli or Salmonella or Listeria?
It’s time to tone down the rhetoric on health care and do something positive: pass meaningful food safety legislation that will put lawyers like me out of business, while saving money and the lives and well being of innocent Americans.
The 2006 outbreak of E. coli tied to spinach sickened more than 205 people nationwide, many gravely. More than 31 developed Hemolytic Uremic Syndrome (HUS) and five lost their lives. One of the most critically ill was Jane Majeska of Fond du Lac, Wisconsin, an 85-year old woman whose fight to stay alive in the months after she consumed the Dole E. coli O157:H7-tainted spinach cost almost a $500,000 dollars. William Marler of the Seattle-based foodborne illness law firm Marler Clark, along with the Fond du Lac firm of Sager, Colwin Samuelsen, will file a lawsuit today in the Fond du Lac branch of the Wisconsin Circuit Court against Dole, Natural Selection Foods, Mission Organics and Pic-n-Save.
“This amazing woman fought through serious medical traumas and has continued to fight to win back her health,” said Marler. “Jane Majeska is alive today because she was incredibly healthy and active before she ate contaminated food, because she had tremendous medical care, and because she fought every hour of every day to get better,” continued Marler. “No one should have to go through that, but if they do, they certainly shouldn’t have to sue to be compensated for it. But sometimes, that’s what it takes.”
Jane Majeska ate Dole spinach in late August 2006. Within days, she was experiencing nausea, vomiting, and diarrhea that became bloody. She was admitted to the hospital as her kidneys failed and she was diagnosed with HUS. Her months in the hospital were marked by increasingly invasive procedures to address her cascading illnesses. In addition to renal failure, she experienced stroke, cognitive impairment, a collapsed lung, a pulmonary embolism, and the inability to eat or breathe on her own. She was given dialysis, blood transfusions, plasmapheresis, and survived on a feeding tube and ventilator. Even as she began to improve, she required aggressive physical, occupational, and speech therapy, as well as rehabilitation nursing. For more about here struggle, see summary. For copy of complaint, click below:
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Although E. coli outbreaks are often associated with meat, produce-borne outbreaks have become more frequent in recent years. The Center for Science in the Public Interest noted that fully 25 percent of E. coli outbreaks from 1990-1998 were traced to produce. Data from the Centers for Disease Control show that over the last 12 years, twenty-two E. coli outbreaks have been traced specifically to leafy greens. Interestingly, just before the 2006 E. coli outbreak, the St. Croix Wisconsin Health Department investigated Natural Selection Foods-linked Earthbound Farms after a vole was found in a salad served to a restaurant customer. Here is a PowerPoint presentation on that investigation, click below:
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ABOUT MARLER CLARK: William Marler has been a major force in food safety policy in the United States and abroad. His food safety blog, Marler Blog, is read by over 1,000,000 people around the world every year. He and his partners at Marler Clark have represented thousands of individuals in claims against food companies whose contaminated products have caused serious injury and death. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce. In 1998, Mr. Marler formed the not for profit, Outbreak Inc. He spends much of the year speaking on how to prevent foodborne illnesses.
I am always a bit humbled when a victim of food poisoning stands up to the corporations who poisoned them with food – especially food labeled “triple washed” and “ready to eat.”
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Jane and Ben Majeska have been married 60 years in August 2009. Their marriage never faced a challenge in those years of the sort that they endured in the fall of 2006. Were it not for her consumption of Dole spinach, September and October of 2006 would have been two more precious months spent active, happy, and together. Instead they were excruciating and terrifying. The impacts of Jane’s HUS involved nearly every body system. The extraordinary efforts of her doctors and Jane’s remarkable strength and will meant the difference between life and death. Jane reflects, and recalls her children consulting the folders where they kept their parent’s funeral plans and end of life wishes. Medical bills to date are nearly $500,000. The Majeskas deserve to be compensated for their deep suffering. To quote, I am sure someone famous, “We will see you in Court!” Here is the Majeska’s story:
"People just don't really understand how horrible food-borne illness is," said William Marler, a prominent Seattle-based food-safety lawyer who is representing the Rivera family and 23 other victims in the cookie dough outbreak. "They think food-borne illness is a tummy ache and diarrhea."
I was much younger when Martin Luther King gave his famous speech – “I have a dream.” But, if I could borrow that phase, I too “have a dream.” I dream that Tuesday morning the President and House and Senate members and their staff would read Lyndsey Layton’s story – “This Woman Might Die From Eating Cookie Dough - Severe Case Gives Context to Issue of Food Safety” and get to work - really get to work. In fact, I bet Mr. Rivera would love a call of support from the folks in Washington who could help fix this mess. Call me and I will set it up.
Summer, or at least August, is drawing to a close in the Northwest – temperatures have dropped below 100 and rain is expected. Really, no global warming?
I spent most of last week being supportive, but feeling helpless, as a client who ate E. coli O157:H7-tainted Nestle Toll House Cookie Dough, may well be slowing dying after spending over 100 days in the hospital (still there), loosing her large intestine and gall bladder and spending weeks on dialysis. It is crazy that people think a foodborne illness is a “tummy ache.”
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I have a very busy September coming up. I am looking forward to mediation in a few days on the last of the 2006 Dole Spinach E. coli O157:H7 outbreak cases. This client spent 51 days hospitalized, 18 days on dialysis and incurred $500,000 in medical bills. Will Dole, Natural Selection Foods and Mission Organics play hardball with this 80ish lady? We shall see.
I then have speeches at the Arkansas Law School, in Washington DC (with some insurance executives) and then off to China too yet another food safety conference.
So, I decided to take a “break” this weekend. I decided to get out of Seattle to focus a bit on the upcoming mediation - the travel and speeches - by spending a few days working/fly-fishing in Idaho. So, after a working/hiking/fly-fishing day, I decided to get a massage. I do not do massages – I’m just not that in to having strangers rub you for money – but that is just me. So, halfway through the massage and being naked (underneath a sheet), the lady starts telling me about the benefits of drinking raw milk. I decided to not tell her what I did for a living. So, on too the other bad raw milk stories:
Raw Milk Sickens 13 in Wisconsin
Wisconsin state agencies are cautioning residents to discard any unpasteurized milk. Selling or distributing raw milk and its products is illegal in Wisconsin. The state says the victims have tested positive for campylobacter jejuni. All victims had consumed raw milk or been in households where someone else consumed raw milk and became ill. Symptoms started Aug. 14 through Aug. 20.
3 Los Angeles Firms Charged with Selling Raw Milk Cheese
The Los Angeles city attorney has filed criminal charges against three local businesses for the alleged sale of dangerous, unpasteurized cheese from Mexico. The office said in a statement Thursday that it has charged El Agave Restaurant Oaxaqueno, Mario Brothers Market and Expresion Oaxaquena Market with misdemeanor violations of the Food and Agriculture Code for the sale of raw milk cheese and other unpasteurized dairy products.
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Kim Archer of the Tulsa World has done a great job of recalling the horrors of the United States’ largest E. coli O111 outbreak.
• 341 were sickened
• 70 people were hospitalized, including 22 children
• 17 people received kidney dialysis, including eight children
• 1 man died
Excerpts from the Article about just one of the victims:
His entire life, Kenneth Birkes has worked seven days a week from dawn to dark. Then he ate a meal in honor of his father's 85th birthday at Country Cottage in Locust Grove. It was Sunday, Aug. 17, 2008. Five days later, Birkes fell ill. The 61-year-old Grove man hasn't worked since.
"I was up in Kansas to get a drilling rig out in the country," he said. "It hit me so quick." He had just put the rig on a trailer and driven to the town of Edna, all the while calling his wife to tell her he needed help.
"That's really the last thing I remember," Birkes said. His wife initially took him to a hospital in Coffeyville, Kan., but he continued to get worse. He didn't wake up until six weeks later at St. Francis Hospital.
Birkes said he went from making $12,000 a month to nothing.
"This pretty well wiped us out," he said. After three months in the hospital, he had to learn to walk again. Now, he has migraines four days a week and is only able to go three hours at a time before needing to rest.
"I'm still alive, and that's all that matters," Birkes said.
Birkes is among a group of clients of Seattle attorney Bill Marler asking for a settlement from the restaurant's insurance company.
"If they turn us down, we have no choice but to sue the restaurant and the owners for the policy and all personal assets," Marler said.
Three Family Members Sickened in Wisconsin, One Gravely.
A Wisconsin family sickened in the JBS Swift Beef Company outbreak of E. coli O157:H7 will file suit against the company Wednesday. The lawsuit will be brought by the Seattle-based foodborne illness law firm Marler Clark in the Federal Court, Eastern District of Wisconsin. This is the third lawsuit filed by Marler Clark in the aftermath of the JBS Swift outbreak, which sickened at least 23 people in nine states, 12 of whom had to be hospitalized.
“This has been a very difficult summer for contaminated meat,” said the family’s attorney, Drew Falkenstein. “Not only have there been several E. coli recalls, but now there is also a large recall of beef contaminated with Salmonella by Beef Packers Inc. With the huge uptick of tainted meat in the last several years, it’s vital that we dedicate resources on every level to prevent more families from going through what the Rosplochs had to endure.”
Nicole and Gerard Rosploch purchased ground beef from a Pick N Save near their home in Brookfield; the meat was later determined to be part of the recall of 420,000 pounds of beef by the JBS Swift Company of Greeley, Colorado. The family (except for Nicole, a vegetarian) made and consumed hamburgers on Sunday, July 19. By Thursday, Gerard and their two sons began to have abdominal cramps and nausea. On Friday, the 7-year-old began to experience frequent episodes of vomiting and frequent diarrhea, some of it bloody. His parents took him to the ER, where he was checked and released, having submitted a stool sample. Meanwhile his older brother, 11, began to show increased signs of illness including vomiting and diarrhea. Gerard’s illness also continued, although not as severe as his sons’.
When the youngest child continued to worsen, he was returned to the ER, where it was learned that the stool sample he previously submitted was positive for E. coli O157:H7. He was admitted to the hospital, where he continued to be very ill. By July 28, tests revealed that he had developed hemolytic uremic syndrome, or HUS—a complication of E. coli infection. The child had to have dialysis for the next 10 days, as well as blood transfusions.
Meanwhile, Gerard began to improve, but his 11-year-old son was still sick at home. For several weeks, the parents split hospital and home care responsibilities.
Their younger son is now also at home, and continues to recover from his illness. He is still on medication to regulate his blood pressure. The genetic fingerprint of the E. coli in his stool sample was a match to that of the JBS Swift outbreak.
I must admit having the video of a former employee saying that she worked at McDonald's while infectious with Hepatitis A, and that she told her manager that she had Hepatitis A after the employee was released from the hospital, is priceless. However, having the inspection reports from the Rock Island County Health Department for 2008-2009 is even better. Click on the below to download and read the reports. Most interesting is the store manager's March 14, 2009 letter outlining what the restaurant would and would not do:
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In early June 2009, public health investigators noticed an increase in isolates submitted by multiple state public health laboratories to PulseNet with a two-enzyme pattern combination of EXHX01.0224 and EXHA26.0536. This is a relatively common pattern combination, appearing at least 364 times in the PulseNet database since 2005. Newly submitted isolates were tested by MLVA to further characterize genetic differences among isolates with PFGE pattern EXHX01.0224 and EXHA26.0536. MLVA pattern “A” was common to most of the newly submitted isolates.
Once investigators recognized the cluster, they administered a hypothesis-generating questionnaire to case patients to identify common exposures to the bacteria. Twenty-seven of 30 case-patients reported eating raw cookie dough before symptom onset.
The CDC developed protocol for a case-control study. Cases were defined as patients with E. coli O157:H7 with symptom onset on or after March 1, 2009, sharing an indistinguishable PFGE pattern combination of EXHX01.0224 /EXHA26.0536 and having an indistinguishable MLVA pattern A (or having a MLVA pattern differing at a single locus by one repeat).
One control (not ill) per case-patient was selected. Cases and controls were matched by sex, age group, and state of residence. Study participants were asked about a variety of foods consumed in the week before onset of illness of the matched case patients. As shown in the table below, a variety of food items were considered as the possible vehicle of E. coli O157:H7.
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(Note: these data are preliminary and may change slightly)
The only food item statistically associated with illness was raw cookie dough (Odds Ratio 55.6, 95% confidence limits 14.14-282.07). The association was highly significant (p = <0.0001), implying that there is a less than a 1 in 10,000 chance that the finding of an association between eating raw cookie and becoming ill with E. coli O157:H7 occurred by chance.
Strong epidemiologic data showing an association between consuming raw cookie dough and illness and molecular microbiologic data showing a 2-enzyme PFGE match and MLVA match, prompted Nestle USA to issue a recall on June 19, 2009 of Nestle Toll House refrigerated cookie dough products.
There are a lot of things I love about my job, but one is the science behind linking people in dozens of states to food that they consumed that poisoned them. Once that link is scientifically determined, and the outbreak stopped, then the time comes to learn from the mistakes so the next outbreak can be avoided. Frankly, we all need to appreciate (can you say increase funding) those public servants who toil in local, state and federal health agencies tracking food borne diseases. Without the work of dedicated people interviewing victims, testing stool and analyzing data, most outbreaks would never be determined, most victims would never be fairly treated, and most outbreaks would repeated without learning from past manufacturing mistakes. The science behind all the hard work is fascinating - especially, the "CSI" part.
The process of obtaining the DNA fingerprint is called PFGE (Pulse Field Gel Electrophoresis). This technique is used to separate the DNA of the bacterial isolate into its component parts. It operates by causing alternating electric fields to run the DNA through a flat gel matrix of agarose, a polysaccharide obtained from agar. The pattern of bands of the DNA fragments — or “fingerprints” — in the gel after exposure to the electrical current is unique for each strain and sub-type of bacteria. By performing this procedure, scientists can identify hundreds of strains of E. coli O157:H7 as well as strains of Listeria and campylobacter, and other pathogenic bacteria. The PFGE pattern of the bacteria can then be compared and matched up to the PFGE pattern of the strain of infected persons who consumed the contaminated product.
MLVA (Multiple Loci VNTR Analysis) is a method employed for the genetic analysis of particular microorganisms, such as pathogenic bacteria, that takes advantage of the polymorphism of tandemly repeated DNA sequences. "VNTR" means "Variable Number of Tandem Repeats". This method is well known in forensic science since it is the basis of DNA fingerprinting in humans. When applied to bacteria, it contributes to forensic microbiology through which the source of a particular strain might eventually be traced back. In a typical MLVA assay, a number of well-selected and characterized (in terms of mutation rate and diversity) loci are amplified by polymerase chain reaction (PCR) so that the size of each locus can be measured. From this size, the number of repeat units at each locus can be deduced. The resulting information is a code that can be easily compared to reference databases.
When PFGE and MLVA patterns match, they, along with solid epidemiological work (e.g., was the person exposed to the suspect food item), are proof that the contaminated product was the source of a person's illness.
In the Nestle Toll House Cookie Dough E. coli O157:H7 outbreak the science and epidemiological work produces the below partial “line list.” This list (as of June 25, 2009) lists 76 persons (that number is now 80) who are linked together by a common PFGE of E. coli O157:H7. Most have MLVA patterns reported - some were still pending. The bottom line is that this list, along with solid epidemiological work, show the “CSI” link between these 76 people and the Cookie Dough they consumed.
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OK, I admit, Lou Dobbs (and all the cable yammering heads) drive me nuts. Mainly because they prey on peoples' fears (left and right) and they are smart and sane enough (O.K., exclude Beck and Hannity) to know better. Lou is particularly bothersome with his constant complaints of illegal immigrants and the plagues (he yells loudly about) they allegedly bring across our borders.
So, today when Mexico's Sanitary Risk Agency banned the importation of JBS Swift ground beef (made in Colorado) out of concerns of E. coli O157:H7 contamination, I wondered what Lou had to say? Surprisingly, I have not found a word on his website. Perhaps, if I can stand it, I will watch his show tonight with a beer (preferably Mexican) in my hand.
As you might recall, the Centers for Disease Control and Prevention reported at least 23 people in nine states have been sickened by E. coli associated with contaminated meat produced by JBS Swift. Mexico has now recalled JBS Swift ground beef from stores. In June, JBS Swift recalled 380,000 pounds of beef due to connections with outbreaks of E. coli O157:H7. We have sued JBS in Colorado and Washington and will sue them again in Wisconsin next week.
So Lou, what say you? I wonder if he will notice that JBS is a Brazilian company?
Another lawsuit on behalf of a customer sickened in the Milan McDonald’s outbreak was filed today in the Circuit Court of the Fourteenth Judicial Circuit of Rock Island County. The lawsuit was filed against McDonald’s Inc., and Kevin Murphy, the owner of the McDonald’s restaurant at 400 West First Street in Milan, IL, by Marler Clark, the Seattle-based foodborne illness law firm, and Craig Mielke of the Illinois firm of Foote, Meyers, Mielke & Flowers LLC. This is the second illness lawsuit; a class action lawsuit was also filed on behalf of restaurant patrons who had to get a shot to avoid illness.
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The lawsuit is being brought by Karie Fiegel and her 14-year-old daughter, both of whom ate at the Milan McDonald’s in early June, 2009. Hepatitis A Virus (HAV) has an incubation period of 15-50 days, and it was not until early July that Ms. Fiegel fell ill with nausea, vomiting, fever, and jaundice. She sought medical care, but her symptoms only intensified, and she was admitted to the hospital where she remained for three days. In the hospital, tests revealed that she had been infected with HAV. Hepatitis infects the liver, and Ms. Fiegel’s liver enzymes were found to be elevated during her hospitalization. Although she has been released, her liver enzymes remain elevated.
Meanwhile, her daughter also began experiencing symptoms of HAV infection. The teenager was tested and also diagnosed with Hepatitis A.
“There are 30 confirmed cases of HAV,” said William Marler, the family’s attorney. “Given the incubation period of hepatitis A, it’s possible that the outbreak is not over, and we may see additional illnesses. It is very important for anyone who ate at the Milan McDonalds in June to monitor their health—and their family’s heath—very carefully.”
A food worker at the Milan McDonald’s had Hepatitis A, and a series of mistakes exposed as many as 10,000 restaurant patrons to the virus before the restaurant was closed and cleaned (it has since re-opened). A separate class action lawsuit was filed July 21 on behalf of those who had to get Immune Globulin (IG) shots after exposure to HAV at the Milan McDonald’s restaurant. Almost five thousand people have already received shots in mass clinics coordinated by the Rock Island County Health Department. Eligible individuals are still joining the class action suit.
CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.
As of Friday, July 31, 2009, 80 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 31 states. Of these, 70 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (5), Colorado (6), Connecticut (1), Delaware (1), Georgia (2), Iowa (2), Idaho (1), Illinois (7), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (8), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (4), Virginia (2), Washington (6), and Wisconsin (1).
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Most persons became ill during May and June. Ill persons range in age from 2 to 65 years; however, 66% are less than 19 years old; 69% are female. Thirty-five persons have been hospitalized, 10 developed hemolytic uremic syndrome (HUS). We represent 24 people sickened - most of them were hospitalized (one still is) - 6 developed HUS. Three lawsuits have been filed - Colorado, California and Washington.
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As of July 1, 2009, the CDC reported twenty-three persons infected with a strain of E. coli O157:H7 with a particular "DNA fingerprint" have been reported from 9 states – Wisconsin included. Of these, 17 (likely more now) have been confirmed by an advanced DNA test (MLVA) as having the outbreak strain. All have been linked to JBS Swift Meat Recall.
The number of ill persons identified in each state is as follows: California (4), Maine (1), Michigan (6), Minnesota (1), New Hampshire (1), New Jersey (2), New Mexico (1), New York (1) and Wisconsin (6). The first reported illness began on April 2, 2009, and the last began on June 13, 2009. This number is growing. Among 17 ill persons for whom hospitalization status is known, 12 (70%) were hospitalized. Two patients developed a type of kidney failure called hemolytic uremic syndrome (HUS).
Interestingly, last evening I got a call from a concerned father. Both son’s have been hit by E. coli O157:H7 – one still hospitalized with HUS. Both children, as of last night, have been linked to JBS Swift meat purchased at a Brookfield Wisconsin Pic n’ Save. I assume that FSIS and CDC will update their numbers.
What is also interesting is that during the 2006 Dole Spinach E. coli O157:H7 outbreak, 49 E. coli O157:H7 cases where confirmed in Wisconsin out of 205 nationally. Dozens of those Wisconsin cases purchased their spinach at Pic n’ Save and several specifically in Brookfield. Go figure
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The Outbreak
On May 12, 2008 the Lawrence County Health Department (LCHD) was notified of a case of HUS in a child with a history of bloody diarrhea. The health care provider reported that the child had consumed unpasteurized goat’s milk obtained from a local store, the Herb Depot, in Barry County, Missouri. The milk had been purchased on April 29, 2008. LCHD began an investigation of the illness. It was quickly learned that an additional Barry County child that had cultured positive for E. coli O157:H7 had also consumed unpasteurized goat’s milk from the same store. As a result, LCHD began a full epidemiological and environmental investigation of the illnesses. The investigation revealed that the milk consumed by both ill children had been produced at Autumn Olive Farms.
At the conclusion of its investigation, LCHD ultimately announced that there were four cases of E. coli O157:H7 associated with the outbreak. Of these, three were laboratory confirmed, and one was identified as a probable case (not stool culture positive but Epidemiologically linked to the outbreak). Each of these individuals resided in different counties in Southwest Missouri, and did not have any relation to each other. Nonetheless, each shared a common exposure to milk from Autumn Olive Farms. In addition, the three culture-confirmed cases shared a common, indistinguishable genetic strain of E. coli O157:H7. The strain was identified as a unique subtype of E. coli O157:H7, never before reported in Missouri. Each of the four cases had consumed milk from Autumn Olive Farms within 3-4 days of onset of illness. LCHD reported, “no other plausible sources of exposure common to all four cases were identified [other than the milk.]” LCHD ultimately concluded “the epidemiological findings strongly suggest the unpasteurized goat’s milk from Farm A [Autumn Olive] was the likely source of infection for each of the cases associated with this outbreak.”
The Children
We represent two of the HUS cases. Nicole Riggs is 9 years old. She lives in Willard, Missouri with her mother, Julie; father, Dustin; and her younger sister, Christina. Larry Pedersen is a 2-year-old toddler. He lives in Monett, Missouri with his parents, Brian and Angela, and his two older sisters, Hailey and Kelsey.
Their Acute Illness
Both had a severe episode of HUS as demonstrated by over a week of anuria [no urine output], oliguria [low urine output] for an additional week. Both needed dialysis to survive. Both were hospitalized for over a month. Medical bills were over $100,000 for each.
Their Future
It is likely that both children will develop renal complications in the future, including hypertension and renal insufficiency. Hypertension and renal insufficiency eventually lead to end stage renal disease (ESRD). The development of ESRD means they will require dialysis or transplantation for survival. Most Americans who suffer ESRD opt for a kidney transplant, but the wait for a donor kidney is often a year or more. The preferable course in a transplant situation is for a deceased or living relative (e.g. a parent or sibling over age 18 and compatible) to donate a kidney. While awaiting a donor, an ESRD patient must undergo dialysis treatment while on the waiting list for a deceased donor transplant. Children have the shortest waiting time on the deceased donor transplant list. The average waiting time for children age 0-17 years is approximately 275-300 days; the average waiting time for a transplant candidate who is 18-44 years old is approximately 700 days.
The Effects
Following transplantation the children will require immunosuppressive medications for the remainder of their lives to prevent rejection of the transplanted kidney. Medications used to prevent rejection have considerable side effects. Corticosteroids are commonly used following transplantation. The side effects of corticosteroids are Cushingnoid features (fat deposition around the cheeks and abdomen and back), weight gain, emotional instability, cataracts, decreased growth, osteomalacia and osteonecrosis (softening of the bones and bone pain), hypertension, acne, and difficulty in controlling glucose levels. The steroid side effects, particularly the effects on appearance, are difficult for children, particularly teenagers, and non-compliance with the treatment regimen is a problem with teenagers due to unsightly side effects. Cyclosporine and tacrolimus are also commonly used immunosuppressants. Side effects of these drugs include hirsutism (increased hair growth), gum hypertrophy, interstitial fibrosis in the kidney (damage to the kidney), as well as other complications. Meclophenalate and imuran are also commonly used, each of which can cause a low white blood cell count and increased susceptibility to infection. Many other immunosuppressive medications and other medications (anti-hypertensive agents, anti-acids, etc) are prescribed in the post-operative period. Immunosuppressants like those described above function to reduce the body’s immune response, thereby preserving the transplanted kidney, which the body would otherwise recognize as foreign and dangerous, thereby setting off a chain of events that would culminate in kidney rejection. But because a healthy and timely immune response is a critical host defense against illness, life-long immunosuppression necessarily dictates a life-long, heightened susceptibility to infection, accelerated atherosclerosis (hardening of the arteries), cancer, and chronic kidney rejection.
Bone disease is nearly universal in patients with chronic renal failure. As a result, the children will be prone to develop bone pain, skeletal deformities and slipped epiphyses (abnormal shaped bones and abnormal hip bones) and have a propensity for fractures with minor trauma. Treatment of the bone disease associated with chronic renal failure includes control of serum phosphorous and calcium levels with restriction of phosphorus in the diet, supplementation of calcium, the need to take phosphorus binders and the need to take medications for bone disease.
Another common complication of chronic renal failure is anemia. Patients with chronic renal failure gradually become anemic. The anemia can be treated with human recombinant erythropoietin (a shot given under the skin one to three times a week or once every few weeks with a longer acting human recombinant erythropoietin).
Another complication of ESRD is growth failure. Growth failure ultimately leading to short height as an adult is a very common complication of chronic renal failure in children. Growth hormone therapy with human recombinant growth hormone has been approved for use in children with chronic renal failure and such therapy has been shown to accelerate growth, induce persistent catch up growth and lead to normal adult height in children with chronic renal failure. Growth hormone therapy requires giving a shot under the skin once a day.
As the children develop ESRD, they will not immediately receive a kidney transplant. Instead they will require dialysis. There are two modes of dialysis he might undergo. They can be on peritoneal dialysis or on hemodialysis. Peritoneal dialysis has been a major modality of therapy for chronic renal failure for several years. Continuous Ambulatory Peritoneal Dialysis (CAPD) and automated peritoneal dialysis also called Continuous Cycling Peritoneal Dialysis (CCPD) are the most common form of dialysis therapy used in children with chronic renal failure. CAPD/CCPC. In this form of dialysis, a catheter is placed in the peritoneal cavity (area around the stomach); dialysate (fluid to clean the blood) is placed into the abdomen and changed 4 to 6 times a day. Parents and adolescents are able to perform CAPD/CCPD at home. Peritonitis (infection of the fluid) is a major complication of peritoneal dialysis. Hemodialysis has also been used for several years for the treatment of chronic renal failure during childhood. During hemodialysis, blood in taken out of the body by a catheter or fistula and circulated in an artificial kidney to clean the blood. Hemodialysis is usually performed three times a week for 3-4 hours each time in a dialysis unit.
Finally, no kidney transplant lasts forever. United States Renal Data Systems states that the half-life—i.e. the time at which 50% of transplanted kidneys are still functional and 50% have stopped functioning—is 10.5 years for children 0-17 whose transplanted kidney came from a deceased, unrelated donor, and 15.5 years where the kidney comes from a living, related donor. Similar data for a transplant at age 18 to 44 years is 10.1 years and 16.0 years for a deceased donor and a living related donor, respectively. Each transplant will be preceded by ESRD, dialysis, an increase in kidney-related medical problems and then the recovery from transplantation.
The Lesson?
Was and is the consumption of raw goats milk worth the risk?
According to the Quad-City Times, the total of hepatitis A cases in the Quad-City region has grown by one, and the latest patient lives in Henry County. The Rock Island County Health Department has finished a series of free inoculation clinics to provide protection against the illness.
A total of 5,366 doses of either hepatitis A vaccine, or a product called immune globulin, were given out in public clinics run by Rock Island County. All of those receiving free inoculations had visited a McDonald's restaurant at 400 W. 1st St., in Milan during July 13-14.
Henry County reported an additional documented case of hepatitis A, raising that county's total to two. There are now at least 26 actual cases in the region, with 15 in Rock Island County, five in Mercer County, one each in Warren and Woodford counties, all in Illinois, as well as two cases in Scott County, Iowa. County officials have said the reported cases are part of the same outbreak and are connected to the Milan McDonald's.
The incubation period for Hepatitis A can be greater than one month, so the number of ill may well rise over the coming weeks.
Salmonella is a bacterium that causes one of the most common enteric (intestinal) infections in the United States – Salmonellosis. In some states (e.g. Georgia, Maryland), salmonellosis is the most commonly reported cause of enteric disease, and overall it is the second most common bacterial foodborne illness reported (usually slightly less frequent than Campylobacter infection).
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). Click below to download complaint:
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A confidential settlement was reached this morning on behalf of twelve-year-old Rebecca Gosla, who was sickened in a 2007 E. coli O157:H7 outbreak linked to contaminated ground beef that were manufactured by United Foods. Rebecca’s illness stands apart from most E. coli O157:H7 infections, even for children who develop hemolytic uremic syndrome (HUS). She was hospitalized for over a month, suffered weeks of dialysis, and her medical bills were nearly $200,000.
The severity and duration of her HUS-related complications, including the complete failure of kidney function as indicated by the lack of urine-production, makes Rebecca’s prognosis concerning. It is possible that her kidney-function will decline over time to a point that kidney transplantation or maintenance-dialysis will be necessary for her survival.
Rebecca’s Illness was a result of E. coli O157:H7-tainted hamburger that was part of a recall announced on June 3, 2007 by United Food Group, LLC (“United Foods”). 75,000 pounds of ground beef products was recalled after testing conducted by health departments in California and Colorado revealed contamination with E. coli O157:H7. The company reported that the ground beef had been produced on April 20, 2007 and shipped to retail distribution centers in Arizona, California, Colorado, Oregon, and Utah. Three days later, on June 6, 2007, United Foods expanded its recall to 370,000 pounds of ground beef. Investigation by the CDC and state health department had uncovered a link between United Foods’ ground beef and illnesses “in several states.” The expanded recall included products produced on April 13, in addition to April 20, 2007. Additional states were now also involved, including Idaho, Montana, Nevada, Washington, and Wyoming.
Three days later, on June 9, 2007, United Foods was again forced to expand its recall, this time dramatically enlarging its scope. More United foods fresh ground beef, not originally included in the recall, had tested positive for E. coli O157:H7 in Arizona. The strain of E. coli O157:H7 isolated was genetically indistinguishable from the strain that had led to the original recall. The newly recalled ground beef tested in the Arizona had been sold under a major grocery store label as opposed to a pre-packaged chub shipped from United Foods. At this time, United expanded its recall to include 5.7 million pounds of its ground beef. The recall now extended to both fresh and frozen ground beef. By this time, United Foods ground beef had been linked to fourteen culture-confirmed E. coli O157:H7 infections in the following states: Arizona (6); California, (3); Colorado (2); Idaho (1); Utah (1); and Wyoming (1).
It is time to prevent the next Rebecca.
A lawsuit stemming from the recent outbreak of Salmonella illnesses was filed today in the Circuit Court for Shelby County, Tennessee against A&R Bar-be-que, LLC. The lawsuit was filed on behalf of a Memphis father and son by Seattle foodborne illness law firm Marler Clark and by John Day of the Tennessee firm Day & Blair.
Foodborne illnesses reported to the Shelby County Health Department by patrons of the A&R Bar-be-que restaurant at 3701 Hickory Hill Road prompted the Health Department to launch an investigation on July 14. The restaurant closed voluntarily on July 25 and remains closed at this time.
Eric Phillips Sr. bought food at the Hickory Hill A&R Bar-be-que on July 9, 2009. He and his son ate food from the restaurant on July 9 and 10. On Friday, July 10, the 15-year-old began to feel nauseous and ill. His condition worsened over the weekend, and he was taken to the doctor on Tuesday. The doctor instructed the family to keep the boy hydrated, and he was sent home. However, his symptoms increased in severity and he experienced vomiting, nausea, and diarrhea over the next few days. On the following Monday, July 20, his mother took him to Le Bonheur Children’s Hospital, where he was admitted and diagnosed with Salmonella.
Meanwhile, Eric Phillips Sr. was experiencing similar symptoms over the same period of time. He was eventually admitted to Methodist Germantown Hospital in Memphis.
Both father and son suffered acute kidney failure as a result of their Salmonella infections, requiring extensive medical treatment, including dialysis. They both remain in the hospital.
“The impact on this father and son—and family—will be life-long,” said the family’s attorney, Andy Weisbecker. “No one can change that, but what we can do is to make sure that they have a way to pay for the care they will need.”
Salmonella is a bacterium that causes one of the most common intestinal illnesses in the US: Salmonellosis. It can be present in uncooked or undercooked meat, poultry, eggs, or unpasteurized dairy products, as well as other foods contaminated during harvest, production, or packaging. Symptoms can begin 6 to 72 hours from consumption, and include diarrhea, abdominal cramps, fever, nausea, and/or vomiting. Dehydration is a concern, especially with the elderly, very young, or immune compromised.
“Anyone experiencing these symptoms should ask their healthcare providers to culture a stool sample,” continued Weisbecker. “The culture will indicate if Salmonella is present and can assist in determining if the illness is part of a larger outbreak.”
The Food Safety Bill is being debated on Capitol Hill as I write this post. Hopefully the human cost of foodborne illness will weigh on our Representatives' minds as they vote. The folks below have been involved. They have visited Washington DC, met with members and have testified.
Lindsey Jennings (below, center) was a healthy 21-year-old starting medical school in the fall of 2008. After eating lettuce contaminated with E. coli O157:H7, she was hospitalized for 11 days. Her medical bills to date total $55,444.49.
In 2006, Ashley Armstrong (below), age 2, became infected with E. coli O157:H7 after eating Dole brand baby spinach. She was hospitalized for 43 days with hemolytic uremic syndrome (HUS). She suffered acute renal failure and pancreatitis and was on dialysis for nearly 4 months. She has a 95 to 100 percent chance of end stage renal disease, and is expected to require a kidney transplant within three to ten years. Ashley will require a combination of kidney dialysis and transplants throughout the rest of her life. Ashley’s medical bills during her acute illness exceeded $200,000, and the value of her projected future medical expenses and future economic losses total between $6 and $7.5 million.
Heather Whybrew (below, in cap and gown) is a 20-year-old college student pursuing a double major in biology and psychology. In 2008, she was hospitalized for 18 days after consuming romaine lettuce contaminated with E. coli O157:H7. Her medical bills to date are $113.959.04.
Mora Lou Marshall (below) was functionally independent before her Salmonella Tennessee illness, which she contracted as a result of eating Con Agra’s Peter Pan Peanut Butter. As a result of her illness, Mora was hospitalized for more than 30 days at Willis-Knighton Medical Center and Life-Care Hospital. Furthermore, to date, Mora has never able to return home to her family. Since her multiple hospitalizations and illness, Mora Lou Marshall has lived at the Garden Park Nursing Home in Shreveport, Louisiana. Her medical expenses currently total $352,960.
Clifford Tousignant (below, with granddaughter) was a highly decorated Korean War veteran. He received 3 purple hearts and faithfully served his country for over 22 years. Mr. Tousignant became sick with Salmonella Typhimurium in December of 2008, as a result of eating peanut butter products manufactured by King Nut and the Peanut Corporation of America. Mr. Tousignant was hospitalized because of his infection and illness for 6 days at St. Joseph’s Hospital in Brainerd, Minnesota. As a result of his illness, Mr. Tousignant died on January 12, 2009. His medical expenses totaled $42,853.
The incubation period (time from exposure to onset of symptoms) is 15-50 days, with an average of 30 days. Thus far at least 25 people have contracted Hepatitis A and over 10,000 or more were exposed. 5,000 have received IG or Hepatitis A vaccines to hopefully prevent illness onset. It appears the second Ill McDonald’s employee last worked on July 13 or 14. That means that the number of ill may well rise over the next month during the height of the incubation period.
The Rock Island County Health Department will conduct walk-in clinics at its office at 2112 25th Ave., Rock Island, from 8 a.m. to 4:30 p.m. Monday and Tuesday. These additional dates are being made available for those who went to the Milan, Ill., McDonald's on July 13 or 14. If they went there previous to these dates, receiving either of these shots may be beyond the time period to provide protection from potential exposure.
A second dose of hepatitis A vaccine, administered six months after the first one, will provide additional effectiveness against the disease. Second doses will be available at the health department, but they will not be free as the first-dose clinics have been. The cost of the second dose will be $45 for adults and $15-$25 for pediatric patients, depending upon income guidelines.
The first lawsuit on behalf of a customer sickened in the Milan McDonald’s outbreak was filed today in the Circuit Court of the Fourteenth Judicial Circuit of Rock Island County. The lawsuit was filed against McDonald’s Inc., and Kevin Murphy, the owner of the McDonald’s restaurant at 400 West First Street in Milan, IL, by Marler Clark, the Seattle-based foodborne illness law firm, and the Illinois firm of Foote, Meyers, Mielke & Flowers LLC.
The lawsuit is being brought by the family of a Rock Island County teenager who fell ill after eating at the Milan McDonald’s and was diagnosed with hepatitis A virus (HAV). On July 12 the 16-year-old came down with a very high fever, aches, and fatigue. His fever continued for several days, and he became visibly jaundiced. When his symptoms continued to worsen, he was hospitalized for four days. He has returned home, but continues to recover from his illness.
“I’ve been concerned by some information surrounding this outbreak indicating that Hepatitis A is not a serious illness,” said William Marler, the family’s attorney. “Hepatitis A can make you very sick, and in rare cases, endanger the liver. This is not a disease to be taken lightly, and the medical costs associated with cannot be taken lightly either. These families need help, and our job is to get it for them.”
A food worker at the Milan McDonald’s had Hepatitis A, and in a cascade of mistakes and miscommunications, as many as 10,000 were exposed to the virus before the restaurant was closed and cleaned (it has since re-opened). At least 23 people in four counties are confirmed ill with Hepatitis A; eleven required hospitalization due to the severity of their illnesses.
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According to the Quad-City Times, the number of people who have contracted Hepatitis A in the Quad-City region has grown to 23 confirmed cases – 2 of who are in Iowa. The 21Illinois Hepatitis A cases are in Rock Island, Henry, Mercer and Warren counties, as well as one in Woodford County
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The cases are connected with Rock Island County businesses, including a McDonald's restaurant, 400 W. 1st St., Milan. Earlier this month, two food handlers at McDonald's were found to have hepatitis A, and the restaurant was closed for three days for a deep cleaning. Employees also received instructions on how to properly wash their hands, especially after using the restroom.
The Rock Island County Health Department finished on Tuesday a two-day clinic to vaccinate more than 4,000 individuals who ate at the McDonald's during the periods of July 6-10 and 13-14.
Marler Clark is assisting people who were exposed to the Hepatitis A Virus at the Milan, Illinois McDonald's Restaurant. A class action lawsuit has been filed on behalf of those who had to get shots. Marler Clark is also preparing additional hepatitis lawsuits on behalf of those who have been infected with Hepatitis A.
My daughter is 17 and took a partime job busing tables as a local restaurant. Can you imagine being a parent and urging your kid to get a Summer job at McDonald's? Here is an email I received tonight:
My son Dillon is 16 and had to be hospitalized because he caught Hepatitis A after he took back an application for a job and ate at McDonald's in Illinois. He was admitted on a Thursday and hasn't eaten since Sunday while running a fever. He became very jaundice and wasn't released from the hospital till Sunday evening. Thank you for your time.
Goodness!
A fast food worker at the Milan Illinois McDonald's tested positive for Hepatitis A back in mid-June, more than three weeks before the case was reported to county and state health officials. Cheryl Schram is going public tonight about who she says she told and when.
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It is going to be interesting to see what McDonald's, the Health Department and the medical providers say about who knew what and when.
Ten Thousand People May Have Been Exposed to Hepatitis A at Milan Restaurant
A class action lawsuit was filed today in the Circuit Court of the Fourteenth Judicial Circuit of Rock Island County against McDonald’s Inc., and Kevin Murphy, the owner of the McDonald’s restaurant at 400 West First Street in Milan, Illinois. Marler Clark, the Seattle-based foodborne illness law firm, and the Illinois firm of Foote, Meyers, Mielke & Flowers LLC, filed the lawsuit on behalf of the named plaintiff, Cody Patterson, and all others who were forced to receive Immune globulin (IG) shots after being exposed to the hepatitis A virus (HAV) at the Milan McDonald’s.
An estimated 10,000 people were exposed to Hepatitis A at the Milan McDonald’s. If a person exposed to HAV can get a shot of IG within 14 days of exposure, they can avoid getting sick.
“This lawsuit is on behalf of the thousands of people who have to get IG shots because of exposure to Hepatitis A at McDonald's,” said William Marler, attorney on behalf of the plaintiffs. “These consumers chose McDonald’s in part because of the convenience, and now they have to wait hours in line or pay for a shot, and very likely miss work in order to do either one. Filing a class action suit on their behalf is a way to compensate them for the time, wage loss, and expense.”
“Our experience in handling large Hepatitis A exposures has allowed us to develop a system for helping as many people as possible recover for injuries sustained without the process being too taxing on individuals or the legal system,” continued Marler. “We filed a class action on behalf of the exposed who are able to avoid infection, and then help individuals who fall ill on a case by case basis.”
In 2007, Marler Clark represented members of a class action arising out of a hepatitis A outbreak at a Houlihan’s in Southern Illinois, where 3000 people received IG shots. Marler Clark represented 9000 people who received shots after a 2003 outbreak at a Pennsylvania Chi-Chi’s along with nearly 100 who became ill with HAV. The case of one individual resolved for $6,250,000. The firm also represented the state of Pennsylvania in recovering the cost of the investigation of the outbreak.
Marler Clark represented customers of Boston-area Quizno’s and Friendly’s Restaurant, both of which had HAV outbreaks in 2004. Additional HAV class action suits handled by Marler Clark include over 1,500 people who received shots after an HAV outbreak at D’Angeleo’s Deli in Massachusetts (2001) and 1,400 people after exposure at a Carl’s Jr. in Spokane, Washington (2000). Marler Clark has represented many victims who were unable to avoid infection and fell ill with HAV including suits against McDonald's, Subway and Taco Bell. The most recent group of cases involved those sickened at a San Diego-area Chipotle Grill in 2008.
Hepatitis A is a viral infection of the liver. The hepatitis A virus is commonly spread through the fecal-oral route, and symptoms include nausea, abdominal cramping, fatigue, and fever. In young children these symptoms can appear flu-like, but in some cases do not appear at all. Symptoms most often begin two to six weeks after exposure and can last several weeks. Preventative treatment (the IG shot) is only effective when administered within 14 days of exposure to the virus, after 14 days there is no treatment.
ABOUT MARLER CLARK: William Marler has been a major force in food safety policy in the United States and abroad. His food safety blog, Marler Blog, is read by over 1,000,000 people around the world every year. He and his partners at Marler Clark have represented thousands of individuals in claims against food companies whose contaminated products have caused serious injury and death. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce. In 1998, Mr. Marler formed the not for profit, Outbreak Inc. He spends much of the year speaking on how to prevent foodborne illnesses.
Nearly two weeks ago, the CDC and FSIS reported that 23 persons infected with a strain of E. coli O157:H7 with a particular "DNA fingerprint" have been reported from 9 states. Of these, 17 have been confirmed by an advanced DNA test as having the outbreak strain; confirmatory tests are pending on others. The number of ill persons identified in each state is as follows: California (4), Maine (1), Michigan (6), Minnesota (1), New Hampshire (1), New Jersey (2), New Mexico (1), New York (1) and Wisconsin (6).
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In light of the illnesses, FSIS issued a notice about a recall of 41,280 pounds of beef products from JBS Swift Beef Company that may be contaminated with E. coli O157:H7. On June 28, the recall was expanded to include 380,000 pounds of assorted pieces of beef (beef primal products) from the same company.
Samples from unopened packages of ground beef recovered from a patient's home were tested by the Michigan Public Health Laboratory yielded an E. coli O157:H7 isolate that matched the "DNA fingerprint" of the outbreak strain.
It appears, however, that the outbreak may well be larger – more ill people - perhaps an expanded recall?
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We have been retained by several families in this outbreak and have already filed suit on behalf of a New Mexico boy who suffered HUS. Yesterday we were contacted by a Washington State family whose child suffered severe HUS (weeks hospitalized on dialysis) that may well be linked to this outbreak after the purchased JBS Swift meat at [an unnamed store]. What we know thus far is:
[The] PulseNet database team has checked the profile against our database and it does seem to be indistinguishable from EXHX01.0074/EXHA26.0569 which is the pattern combination associated with 0906WIEXH-1 and the JBS Swift Company recall. Since this pattern combination is common, all isolates with this pattern combination are subtyped by MLVA and only isolates indistinguishable by both PFGE and MLVA are considered as possibly being outbreak related.
More to come today I imagine.
According to the FDA, as of July 10, the CDC reports that 76 persons from 31 states have been infected with the outbreak strain of E. coli 0157:H7. Thirty-five persons have been hospitalized, 11 with a severe complication called Hemolytic Uremic Syndrome.
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Hemolytic Uremic Syndrome (HUS) is a severe, life-threatening complication that occurs in about 10% of those infected with E. coli O157:H7 or other Shiga toxin (Stx) producing E. coli (E. coli). HUS was first described in 1955, but was not known to be secondary to E. coli infections until 1982. It is now recognized as the most common cause of acute kidney failure in infants and young children. Adolescents and adults are also susceptible, as are the elderly who often succumb to the disease.
I spent the last 24 hours traveling from Seattle to Atlanta, Atlanta to Columbus, and Columbus to Charlotte - home Wednesday.
I spoke to one family whose 55-year-old mother, who will be released from the hospital later this week, after being confined since early May. She has had a portion of her large intestine removed and was only recently removed from dialysis. She now faces a lifetime of complications and the loss of health insurance if she is unable to return to work as a special education teacher by Labor Day.
I spent time today with a wonderful family whose 4-year-old suffered severe HUS – three weeks of dialysis, CNS involvement (seizures) and months of hospitalization and Rehab. For any parent, you can imagine the nightmare.
When you meet the people, the numbers have meaning. Perhaps, the heads of FSIS and FDA should travel with me?
I had a long talk with Carolyn Lochhead, San Francisco Chronicle Washington Bureau Reporter about her article, “Crops, ponds destroyed in quest for food safety” that appeared this morning. It is a good opening discussion of the balance that we somehow have to forge between food safety, consumer convenience, industrialized agriculture and the environment. The discussion reminds me a bit of a post I did nearly four years ago - "Bagged "Pre-Washed" Lettuce: Is Convenience Worth the Risk?" Much to discuss. Here is part of the article:
Seattle trial lawyer Bill Marler, who represented many of the plaintiffs in the 2006 E. coli outbreak in spinach, said, "If we want to have bagged spinach and lettuce available 24/7, 12 months of the year, it comes with costs."
Still, he said, the industry rules won't stop lawsuits or eliminate the risk of processed greens cut in fields, mingled in large baths, put in bags that must be chilled from packing plant to kitchen, and shipped thousands of miles away.
"In 16 years of handling nearly every major food-borne illness outbreak in America, I can tell you I've never had a case where it's been linked to a farmers' market," Marler said.
"Could it happen? Absolutely. But the big problem has been the mass-produced product. What you're seeing is this rub between trying to make it as clean as possible so they don't poison anybody, but still not wanting to come to the reality that it may be the industrialized process that's making it all so risky."
Ms. Lochhead added in a few of the major outbreaks (all of which I am squarely in the middle of). I added in one she missed, corrected a date and added a bit – all in bold.
June 2009: E. coli O157:H7 linked to JBS Swift meat sickening 23 in nine state, two with acute kidney failure. FISS instituted a recall of 420,000 pounds of meat.
June 2009: E. coli O157:H7 found in Nestle Toll House refrigerated cookie dough manufactured in Danville, Va., resulted in the recall of 3.6 million packages. Seventy-two people in 30 states (now seventy-four in 32 states) were sickened. No traces found on equipment or workers; investigators are looking at flour and other ingredients.
February 2009: Salmonella found in peanut butter from a Peanut Corp. of America plant in Georgia. Nine people died, and an estimated 22,500 were sickened. Criminal negligence was alleged after the product tested positive and was shipped.
June 2008: Salmonella Saint Paul traced to Serrano peppers grown in Mexico. More than 1,000 people were sickened in 41 states, with 203 reported hospitalizations and at least one death. Tomatoes were suspected, devastating growers.
April 2007: E. coli O157:H7 found in beef, sickening 14 people. United Food Group recalled 5.7 million pounds of meat (at least four suffered acute kidney failure).
December 2006: E. coli O157:H7 traced to Taco Bell restaurants in New Jersey and Long Island, N.Y. Green onions suspected, then lettuce. Thirty-nine people were sickened, some with acute kidney failure.
September 2006: E. coli O157:H7 found in Dole bagged spinach processed at Earthbound Farms in San Juan Bautista (San Benito County). The outbreak killed four people (actually five), sent 103 to hospitals, and devastated the spinach industry (devastated over 30 families with hemolytic uremic syndrome).
After inspecting the Danville Plant on 06/18/2009(Thu), 06/19/2009(Fri), 06/22/2009(Mon), 06/23/2009(Tue), 06/24/2009(Wed), 06/25/2009(Thu), 06/26/2009(Fri), 07/07/2009(Tue), 07/08/2009(Wed), and 07/09/2009(Thu), the FDA posts a 1, yes, 1 page "483" online last night, or early this morning - yes, even I sleep sometimes. Here are the 2, yes, 2 Observations. Looks like I am heading to Danville soon.
OBSERVATION 1
The workmanship of equipment does not allow proper cleaning. Specifically, inside the "Toll House" brand cookie dough preparation room, dry ingredients are placed inside hoppers. The dry ingredients are gravity fed to blending mixers through gate valves that are installed on the hoppers. As a result of this investigation, the firm disassembled all gate valves from all hoppers on production lines 8, 10, 11, and 12. The gate valves appear to have food contact surfaces that are not easily cleanable as evidenced by rough, pitted and discolored cast metal alloy.
OBSERVATION 2
Lack of appropriate design to enable manufacturing systems to be maintained in an appropriate sanitary condition. Specifically, as "Toll House" brand cookie dough was mixed on 6-18-09, ice build-up surrounded pipes that transport a processing aid to mixers on production lines 8, 10, 11, and 12. On line 8, condensate from the ice dripped onto a metal rake that personnel then used to scrape cookie dough from the mixer into a dough trough for transport to the filling line.
Click on image to download:
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From a Nestle’s Press Release:
On June 29, 2009, the FDA confirmed evidence of E. coli O157:H7 in a retained production sample of 16.5 oz. Nestle Toll House refrigerated chocolate chip cookie dough bar. The product has a day code of 9041 and a "Best before 10 JUN 2009" notation.
"We are very concerned about those who have become ill from E. coli O157:H7 and deeply regret that this has occurred," said Paul Bakus, General Manager of Nestle's Baking Division.
Today, the FDA provided its summary findings resulting from its recent inspection of the Nestle Danville facility. The report is called a "Form FDA 483". The 483 reflects the inspector's observations and is designed to ensure that the company's manufacturing operations are in compliance with current regulatory requirements.
Federal investigators, who spent more than a week at the Danville facility, did not detect E. coli O157:H7 inside the factory or on equipment. Nestle testing reflects the same results.
The 483 reported two observations. Neither of these observations is believed to have any relationship to the presence of E. coli O157:H7 found in the retained production sample. The first observation was related to the design of a gate valve used on a hopper for dry ingredients. The valve required a smoother and more polished surface to allow for easier cleaning. The second observation noted by the FDA was condensate dripping from a refrigeration pipe onto a metal "rake" (i.e., a large metal spatula) used to scrape cookie dough from the mixer. Both of the observations have been corrected.
It will be interesting to see what the 483 says when the FDA releases it to the rest of us. So much for transparency.
I know, I know, a trial lawyer who reads the Wall Street Journal? Yes, a bit counter-intuitive, but you have to love Bill Tomson’s article today – “U.S. Beef Safety Plan Languishes Amid New Illnesses,” and getting some juicy quotes by an “R” I admire, Richard “Dick” Raymond. Now retired, but until last October, USDA Undersecretary of FSIS - SEND DICK RAYMOND BACK TO WASHINGTON - You know, the one Obama and Vilsack cannot seem to fill despite my resume sitting on their desks! Here is the poop, errr, E. coli:
A June beef recall by JBS Swift & Co. for deadly E.coli contamination could have been prevented if a plan devised during the Bush administration to build new barriers between the bacteria and the public had been enacted.
The proposed safety measures would have had U.S. Department of Agriculture inspectors testing more beef, a move the meat industry argued was unnecessary. Inspectors now routinely test ground beef for the E. coli bacteria and any meat that is designated to be turned into ground beef -- usually the part of the carcass called "trim," but nothing else.
That's a mistake and people continue to get sick because of it, former USDA Food Safety Under Secretary Richard Raymond told Dow Jones Newswires in an interview. "We first tested ground beef and now we're testing trim. We need to start testing whole cuts."
More than a year ago, USDA officials began warning that primal cuts -- the large chunks of beef from which whole cuts that produce steaks and roasts come -- can be dangerous sources of E. coli contamination. Although steaks are considered safe even if the bacteria is present, portions of the primals they come from are often used to also make ground beef, which has been sickening consumers.
Steaks and the whole cuts they come from aren't considered dangerous to human health, or "adulterated," even if E. coli bacteria is present because, unlike ground beef, steaks don't provide bacteria access into the meat below the surface.
But those whole cuts and other primal beef often get turned into ground beef even though that wasn't the intended purpose of the meat, especially in summer months when grilling weather drives up consumer demand for hamburger meat.
The USDA has been considering for more than a year a policy change that would allow whole beef cuts to be considered "adulterated" -- and thus subject to recall -- even if they aren't "intended for use in ground beef," according to Daniel Engeljohn, a deputy assistant administrator for USDA's Food Safety and Inspection Service, or FSIS.
The policy change is still under consideration, he said.
Also still under consideration is a method devised last year by the USDA for slaughterhouses to detect unacceptable levels of E. coli in the primals they are producing.
In an August 2008 draft "guidance guideline" for slaughterhouses, FSIS suggested that when four out of 91 trim tests show a positive result for E. coli in beef trim -- the material primarily used to make ground beef -- that should be considered a "high-event day." If that happens, Engeljohn said, all of the beef -- not just the trim -- could be dangerous.
However, the decision on whether to treat primals as a potential source of E. coli poisoning and whether to allow them into commerce is still up to the producers, Engeljohn said, and that won't change unless policy is changed.
"That issue didn't get changed in the prior administration, and so now it comes to this new administration," Engeljohn said.
American Meat Institute Foundation President Jim Hodges said there was no need to divert primals away from the raw market, just because E. coli was found in the carcass trim.
Primals are much more valuable to the producer when they can be sold and turned into raw beef cuts like the steaks sold by retailers. The alternative is to sell the beef to processors that produce only pre-cooked meat products.
Administering antimicrobial treatments to those primals at the slaughterhouse is sufficient to kill the bacteria before they are sold for further processing, he said.
In events leading up to the JBS Swift & Co. June 24 recall, the company's Greeley, Colo., plant detected E. coli in carcass trim, Chandler Keys, the company's vice president of government affairs & industry relations told Dow Jones Newswires. Back in April, the trim was diverted for the production of cooked product, as the cooking process kills the bacteria, but the steak- and roast-producing primals were not. They were supposed to have been treated to kill the bacteria, but for reasons that remain unclear, that didn't happen. Several weeks later, the recall was initiated.
Primals, or parts of them, were recalled in late June by JBS Swift & Co. after at least 18 illnesses were connected to the beef. The company recalled 41,280 pounds of beef, all of which was "intact cuts of beef" that are "typically used for steaks and roasts rather than ground beef."
Even though primals aren't considered a health threat, or adulterated, even in the event of E. coli contamination, JBS Swift & Co. voluntarily recalled the meat because people were getting sick.
Another separate but related safety gap is a lack of government testing for E. coli in "bench trim," which is the leftover material once steaks and roasts and other cuts are produced from beef primals. That bench trim is often turned into ground beef, but it isn't the original trim from the slaughterhouse that FSIS and company inspectors focus on for E. coli detection.
Representatives of the U.S. meat packing industry like the AMI have fought the USDA's FSIS "tooth and nail" since officials there began talking about allowing whole beef cuts to be considered adulterated with E. coli and government testing for bench trim, according to Tony Corbo, the senior lobbyist for the nonprofit consumer organization Food & Water Watch.
The JBS Swift & Co. recall, Corbo said, is an example of why the industry is wrong.
I spent the morning on the phone with two young fathers whose children are both victims of Hemolytic Uremic Syndrome caused by E. coli O157:H7 that has been linked by the CDC to Nestle Toll House Cookie Dough. One child, an 8-year-old from Michigan has been hospitalized for nearly a week and has received at least one blood transfusion. The other child is a 4-year-old from South Carolina. She was recently released from an Atlanta Rehab center after three and a half weeks. This is on top of nearly two months in the hospital, weeks on dialysis and suffering from a stroke.
I also followed up with a Nevada woman, who too has been linked to the outbreak, and who is still hospitalized after over two months in the hospital. She has suffered the removal of a portion of her large intestine and was on dialysis until the last few days. A week ago she was just learning how to walk again. E. coli O157:H7 is a very, very nasty bug.
The new CDC numbers also came out today:
* 74 cases from 32 states - all match by PFGE testing
* Onset ranges from March 16 to June 11
* 72% female, age range 2-65 years (median age 15)
* 34 Hospitalizations
* 10 with Hemolytic Uremic Syndrome (HUS)
Mr. E. coli (aka Brian Hartman) once again scoops all in the ongoing Cookie Dough caper. Here is part of his story:
Federal investigators have linked at least three different kinds of E. coli to Nestle’s cookie dough but remain stumped about how the bacteria got into the product, ABC News has learned.
The U.S. Food and Drug Administration has completed DNA testing of E. coli recently found in an unopened package of cookie dough at Nestle’s plant in Danville, Va.
Those tests, according to sources familiar with the investigation and confirmed by the FDA, determined the genetic fingerprint of the E. coli found at the plant is different than E. coli that has been linked to a 30-state outbreak that has sickened at least six dozen people.
Sources also say an altogether different strain of E. coli was found in dough recovered from the home of a victim, meaning at least three different types of E. coli have been found in cookie dough made by Nestle.
It is my understanding that E. coli O157:H7 found in the stools of the 72 people in 30 states share the same PFGE pattern (outbreak strain) and that 51 of those have been linked by advanced testing methods (MLVA). Interestingly, but not surprisingly (1), a separate E. coli O157:H7 PFGE pattern was found in a retained sample of Nestle Cookie Dough for in the Danville Plant.
In addition, one of our client’s (a Minnesota Family) leftover Cookie Dough tested positive for a separate Shiga-toxin E. coli – E. coli O124. However, both sick children tested positive for the outbreak strain.
(1) Proctor ME, Kurzynski T, Koschmann C, et. al. Four strains of Escherichia coli O157:H7 isolated from patients during an outbreak of disease associated with ground beef: importance of evaluating multiple colonies from an outbreak-associated product. J Clin Microbiol. 2002 Apr;40(4):1530-3.
The CDC says 72 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 51 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (6), Connecticut (1), Delaware (1), Georgia (1), Iowa (2), Illinois (5), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (4), Virginia (2), Washington (6), and Wisconsin (1).
Now, here is a question - you must assume that some of these people had left-over cookie dough and that local, state and federal health authorities have tested some of it? So, results? Same E. coli? Same E. coli O157:H7? Different E. coli? Different bugs?
And, what about the retained sample of cookie dough from the Nestle Danville, Virginia plant? We know the FDA and CDC said it tested positive for E. coli O157:H7, but is it the same genetic fingerprint as the E. coli O157:H7 found in the stools of the 72 ill people?
Thursday should be interesting.
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OK, so the CDC likely would not even recognize that they know me or that what I do is useful, but I must say, this post (unauthorized here) on the CDC Blog is perhaps the best explanation of why we need a CDC and Epidemiologists. Plus the author is kinda hot - for a Doctor. Here is her post:
Contaminated raw cookie dough wasn’t on anyone’s mind as my public health colleagues and I were searching for the cause of a multistate outbreak of E. coli infections.
I’m one of the Epidemic Intelligence Service officers in CDC’s Enteric Diseases Epidemiology Branch, which monitors and investigates foodborne diseases together with CDC’s Enteric Disease Laboratory Branch and state health departments. On any given day we are working on several clusters and outbreaks of illness.
In mid-May, CDC’s PulseNet Team alerted us about a cluster of E. coli O157 infections. We began working with state and local health departments to investigate these infections. We originally suspected ground beef, which is one of the “usual suspects” for E. coli O157, along with leafy greens and sprouts. As the labs in states and at CDC found more and more people infected with the same strain, the demographics shifted; patients were generally young and female, which isn’t what is normally seen with ground beef-associated outbreaks.
We got copies of the interviews on standard questionnaires that state investigators did with ill people and looked through them for other suspicious food sources, but nothing was conclusive. None of the food items implicated in past E. coli O157 outbreaks appeared to be associated with this one. Therefore, we decided to conduct what we call “open-ended hypothesis-generating interviews,” in which we call the people affected and just talk about everything that they had eaten and done the week before they became ill, looking for things in common among them. Standard questionnaires are useful, but they are only asking for answers to a series of questions. Sometimes something with a broader scope, like this sort of wide-ranging interview, is needed to find things that are unusual and might not be asked on our questionnaires.
Washington State was kind enough to let CDC do the interviews on their five patients. Mark Sotir and I reached the mother of the first patient on a Saturday. She mentioned that her child had eaten raw prepackaged cookie dough during the days before he got sick. On Sunday, I reached a second patient, and she told me she had eaten at an ice cream shop and had ice cream with cookie dough and brownie mix-ins.
Nestle toll house package.
Cookie dough? When cases three, four, and five all confirmed that they ate raw cookie dough, it appeared we had a surprising new possible culprit in our outbreak. (It wasn’t until later that we learned that the second patient also had eaten raw cookie dough at home.)
During an outbreak investigation, we hold a series of multistate conference calls in which CDC and affected states share what we’re finding. Representatives from many of the affected states were on our June 16, 2009 conference call, and I mentioned my cookie dough hypothesis. On the face of it, cookie dough was the most unlikely culprit, but epidemiologists in several other states said, “Oh, yes, I had a case mention that, too”. It became a “Eureka” moment for the group.
At the end of the call we agreed that cookie dough, strawberries, fruit roll-ups, apples, and ground beef were all possible causes. Time to go back to the cases and ask more questions!
A lot of our work is like that. Our branch chief, Patricia Griffin, sometimes says there is a certain “head banging quality” to what we do. It can take many, many interviews and requires a wide-ranging curiosity to consider all the possibilities.
There are no short cuts. We talk to the patients, we look at the combined information, and we generate hypotheses about the cause. Then we can refine our questions and go back to the patients again to see which hypothesis holds true.
CDC acts to expedite foodborne data sharing
Such single-point reporting may be a weakness of the new system, because it cannot establish trends in the way that multi-year analyses do, said prominent food-safety attorney Bill Marler of Seattle. "It you looked just at 2006, you would think that produce is a terrible risk, but in 2007 and 2008 there were fewer outbreaks in produce and many more in meat," he said. Marler and other food-safety advocates, though, applauded the move to get data out to the field more quickly.
Administration Urged to Boost Food Safety Efforts
"Part of the problem with how we currently deal with food-borne illness cases is we wait until people get sick and die and then we announce an outbreak," said Bill Marler, a veteran food safety litigator who writes a blog about the issue. "It seems that the focus here is a bit on preventing it before we have sick and dead people as opposed to counting the bodies after salmonella or E. coli is out of the barn."
Suit Says NM Boy Was Sickened By JBS Swift Beef
Their lawyer, Bill Marler, said Tuesday that Alex developed hemolytic uremic syndrome, a type of kidney failure, after eating shish kabobs made from the meat in May. Marler's firm also represents a California client who developed the illness after eating the meat.
N.M. teen sues Swift over E. coli
Roerick's family ate the same meat, but he had more than the others, said his attorney, William Marler. Of concern is that Roerick was sicked by whole muscle meat, not ground beef, as is typically the case with E. coli. "It just shows how virulent the bacteria is," Marler said. "This is more than just a hamburger problem."
The first lawsuit stemming from the current E. coli O157:H7 (E. coli) recall by JBS Swift Beef Company of Greeley, Colorado that has been linked to 23 E. coli illnesses in California, Maine, Michigan, Minnesota, New Hampshire, New Jersey, New Mexico, New York and Wisconsin was filed today on behalf of an Albuquerque-area child who was infected with E. coli after eating kabobs prepared by his grandmother on Mother’s Day. The lawsuit was filed on behalf of the family of 14 year old Alex Roerick by his attorneys, William Marler of the Seattle-based foodborne illness law firm Marler Clark and Kara Knowles of the Denver firm Montgomery, Little, Soran, & Murray.
Alex ate dinner with his grandma on May 10, 2009. He began to experience flu-like symptoms including fatigue, fever, nausea, diarrhea, and vomiting by May 13. Alex’s symptoms worsened and he was admitted to Presbyterian Hospital on May 15. He was released several days later, before being rushed back again due to severe bloody diarrhea. His doctors determined that Alex had developed hemolytic uremic syndrome, or HUS, a devastating complication of his E. coli O157:H7 infection. The genetic fingerprint of the E. coli found in Alex’s stool matches that of others sickened in the nationwide outbreak tied to recalled JBS Swift Beef. He continues to experience effects of his illness.
“JBS Swift and the FSIS were much too slow about releasing information on where the beef was distributed,” said Marler. “Even with widespread consumer pressure, the information was only released a day before the 4th of July holiday, not nearly enough time to get the word out to families that might have the contaminated meat in their homes. Our government agencies need to work faster in recall situations to prevent more people from suffering what Alex and his family have experienced.”
In the early morning hours of Sunday, June 28, the JBS Swift Beef Company expanded its earlier recall of 41,280 pounds of beef contaminated with the highly toxic pathogen E. coli to include an additional 380,000 pounds. The beef recalls are FSIS (Food Safety and Inspection Service) Class I, meaning that the "use of the product will cause serious, adverse health consequences or death." After years of large recalls, focused efforts by meat regulators brought down E. coli contamination recalls to a low of 182,000 pounds in 2006. Recalls shot up again in 2007, and in the ensuing years (2007-2009), over 41 million pounds of beef have been recalled due to contamination with E. coli.
ABOUT MARLER CLARK: William Marler has been a major force in food safety policy in the United States and abroad. His food safety blog, Marler Blog, is read by over 1,000,000 people around the world every year. He and his partners at Marler Clark have represented thousands of individuals in claims against food companies whose contaminated products have caused serious injury and death. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce. In 1998, Mr. Marler formed the not for profit, Outbreak Inc. He spends much of the year speaking on how to prevent foodborne illnesses.
Good to see USDA/FSIS and JBS Swift are working on the 4th. The list of retailers is now is 82 pages long. The E. coli O157:H7 Illnesses are at least 23 in 9 states.
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I am off to California and New Mexico in the morning to meet with two HUS victims of this recall.
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JBS Swift USA and the U.S. Department of Agriculture's Food Safety and Inspection Service (FSIS) have released a list of retailers that received meat that may have been tainted with E. coli. JBS Swift USA has recalled more than 420,000 pounds of beef that left the Greeley packing plant in April. The retail outlets include:
»Price Chopper stores.
»Hannaford stores in Maine, New Hampshire, Vermont, Massachusetts and New York.
»Stop & Shop stores in Maine, Massachusetts, Rhode Island, Connecticut, New Hampshire, northern Kentucky, southeastern Indiana, western Tennessee and Arkansas.
»Kroger stores in Mississippi and Illinois.
»Food 4 Less in the Chicago area
»Fry's stores in Arizona.
»Smith's stores in Arizona, Utah and other Western states.
» Costco.
The Centers for Disease Control and Prevention (CDC) and FSIS say illnesses have been reported in California (4), Maine (1), Michigan (6), Minnesota (1), New Hampshire (1), New Jersey (2), New Mexico (1), New York (1) and Wisconsin (6).
Health officials with The Atlanta based Centers for Disease Control and Prevention say at least twelve people have been hospitalized in connection with a possible E. coli outbreak in beef. WGPB's John Sepulvado reports some three hundred eighty thousand pounds (actually 420,000) of beef have been recalled in connection to the outbreak:
Colorado's JBS Swift Beef Company processed the suspect meat in April, and the recall began last week. While many national grocery chains have begun pulling meat from the shelves, some stores and vendors that sell JBS products have not been identified publicly. Food safety advocates, like Seattle based attorney Bill Marler, are urging federal authorities to reveal those vendors as the July 4th holiday approaches.
We know that this meat has gone to every state and internationally, we know it has sickened at least twenty three people in nine states, we as the public have an absolute right to know where this meat went.
Marler represents two men (actually kids) who suffered kidney failure (HUS) after eating the meat. Federal officials have ten days from the date of the recall to compile a list of all the vendors---meaning by law, that list must be finished by July 3rd.
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We have been retained by 20 of these linked cases (4 HUS) and have thus far filed suit in 3 cases. We have not filed any suits this week waiting to see if Nestle will offer to pay the acute phase medical expense and wage loss of its customers. From the CDC last night:
72 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 51 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (6), Connecticut (1), Delaware (1), Georgia (1), Iowa (2), Illinois (5), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (4), Virginia (2), Washington (6), and Wisconsin (1).
Ill persons range in age from 2 to 65 years; however, 65% are less than 19 years old; 71% are female. Thirty-four persons have been hospitalized, 10 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.
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In an epidemiologic study, ill persons answered questions about foods consumed during the days before becoming ill and investigators compared their responses to those of persons of similar age and gender previously reported to State Health Departments with other illnesses. Preliminary results of this investigation indicate a strong association with eating raw prepackaged cookie dough. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.
On June 29, 2009, the U.S. Food and Drug Administration announced that a culture of a sample of prepackaged Nestle Toll House refrigerated cookie dough currently under recall yielded E. coli O157:H7. The contaminated sample was collected at the firm on June 25, 2009. Further laboratory testing is underway to determine whether the E. coli strain in the product matched the strain causing the outbreak.
A few days before many of us light up the barbeque, JBS Swift and the FSIS finally publish the list of retailers who received the tainted-meat (click on below).
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Frankly, the retailer names had trickled out over the last few days as responsible stores alerted thier customers. Whats a bit odd, it that the location of the stores that received the meat do not seem to completely match up to where the illnesses are located. According to the CDC, twenty three persons infected with a strain of E. coli O157:H7 with a particular "DNA fingerprint" have been reported from 9 states. Of these, 17 have been confirmed by an advanced DNA test as having the outbreak strain; confirmatory tests are pending on others. The number of ill persons identified in each state is as follows: California (4), Maine (1), Michigan (6), Minnesota (1), New Hampshire (1), New Jersey (2), New Mexico (1), New York (1) and Wisconsin (6). So, begs the question? "Where is ALL of the beef?"
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On June 24, FSIS issued a notice about a recall of 41,280 pounds of beef products from JBS Swift Beef Company that may be contaminated with E. coli O157:H7. On June 28, the recall was expanded to include 380,000 pounds of assorted pieces of beef (beef primal products) from the same company.
The CDC reports today that twenty three persons infected with a strain of E. coli O157:H7 with a particular "DNA fingerprint" have been reported from 9 states. Of these, 17 have been confirmed by an advanced DNA test as having the outbreak strain; confirmatory tests are pending on others. The number of ill persons identified in each state is as follows: California (4), Maine (1), Michigan (6), Minnesota (1), New Hampshire (1), New Jersey (2), New Mexico (1), New York (1) and Wisconsin (6).
Among 17 ill persons for whom hospitalization status is known, 12 (70%) were hospitalized. Two patients developed a type of kidney failure called hemolytic uremic syndrome (HUS).
Now, a week into the recall FSIS and JBS Swift Beef has not disclosed the names of all stores that received the E. coli-tainted beef. Why? As I said to ABC News:
But Bill Marler, an attorney focused on food poisoning cases with the Seattle-based law firm Marler Clark, said if the FSIS waits 10 days, the information would be of little help to consumers who have already prepared for the holiday weekend -- even if the FSIS is following the rule.
"It just seems inconceivable to me that they can't release this information more timely so people who have this in their refrigerator know what to do with it or know what not to do with it," Marler said.
"Whether they're absolutely following the rule or not, this is the kind of information that JBS Swift should have at their fingertips," he added.
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72 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 30 states. Of these, 51 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (6), Connecticut (1), Delaware (1), Georgia (1), Iowa (2), Illinois (5), Kentucky (2), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), New York (1), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (4), Virginia (2), Washington (6), and Wisconsin (1).
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Ill persons range in age from 2 to 65 years; however, 65% are less than 19 years old; 71% are female. Thirty-four persons have been hospitalized, 10 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.
Brian Hartman of ABC reports that FDA investigators today found E. coli O157:H7 at the plant in Danville, Virginia where Nestle makes Toll House Cookie Dough.
The bacteria, according to an FDA official, was found at the plant in an unopened package of raw chocolate chip cookie dough. It had been manufactured on February 10, 2009 but had not yet been shipped.
Investigators still do not know how the E. coli got into the dough. But finding this “smoking gun” package confirms they pushed for a recall of the correct product.
Well done Brian.
69 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 29 states. Of these, 46 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (5), Connecticut (1), Delaware (1), Georgia (1), Iowa (2), Illinois (5), Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (1), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (6), and Wisconsin (1).
Ill persons range in age from 2 to 65 years; however, 64% are less than 19 years old; 73% are female. Thirty-four persons have been hospitalized, 9 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.
I spent time yesterday visiting with a feisty “50 something” woman and her adoring husband (they have six kids) in a Nevada hospital as she spent her 50th day hospitalized with severe complication of Hemolytic Uremic Syndrome from an E. coli O157:H7 infection linked directly to Nestlé Cookie Dough. For a woman who has lost part of her large intestine, is still on dialysis, and is learning to walk again, her spirit was amazing. Still on a feeding tube and between retching because of ongoing gastroenterological problems, she still was able to lovingly tease her husband and make a lawyer feel welcome. The husband kept saying, "I would not wish this on my worst enemy."
I was stuck at their lack of anger towards Nestlé whose product contained a bacteria that has nearly taken her life and for a government that over the years failed to protect the public. I am not sure they will feel the same after they read Jane Zhang’s article in this mornings Wall Street Journal – “Nestlé Unit Denied FDA Requests.” Here are excerpts:
The Nestlé USA plant at the center of a federal probe into an E. coli outbreak involving cookie dough refused to give inspectors access to pest-control records, environmental-testing programs and other information, according to newly released inspection reports covering the past five years.
In a September 2006 visit, for example, managers at the Danville, Va., plant refused to allow a Food and Drug Administration inspector to review consumer complaints or inspect its program designed to prevent food contamination. The inspector found dirty equipment and "three live ant-like insects" on a ledge but nothing severe enough to give the plant a failing grade.
A year earlier, officials at the Nestlé plant presented another FDA inspector with a list of things it wouldn't do. "Among these are the refusal to review the firm's consumer complaint file, refusal to permit photography, refusal to sign affidavits or receipts and refusal to provide specific information on interstate commerce," the inspector wrote.
Companies aren't required to show those records to FDA inspectors and Nestlé's practice isn't out of line with the rest of the food industry, FDA and industry officials said.
When will companies realize that it really is a bad idea to poison customers? When will government realize that standing up for consumers is the right thing to do? And, when will us taxpayers realize that we need to compel our lawmakers to pass laws and regulations, and then to spend the money necessary to protect the public?
Lindsay Phillips, age 18, consumed Nestle cookie dough on several occasions in early May 2009. On May 11, 2009, Lindsay began to suffer from severe lower abdominal pain accompanied by profuse diarrhea that turned bloody. After Lindsay’s symptoms failed to subside, on May 13, 2009 her mother took her to the emergency room (“ER”). Initially diagnosed with dysentery, she was treated and given a prescription for antibiotics and anti-cramping medication and instructed to return if her symptoms did not improve or worsened. Lindsay returned home after the ER visit, but her symptoms continued to worsen. She returned to the ER a short time later and was admitted to the hospital for further evaluation. During her hospitalization a stool sample was obtained and cultured. It ultimately tested positive for E. coli O157:H7, and was later determined to match the strain of E. coli O157:H7 associated with the Nestle cookie dough outbreak. On May 16, 2009, Lindsay was discharged from the hospital and taken home to continue her recovery. Cause No. C09-05337RBL
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| Nestlé Toll House Cookie & Brownie Dough Product Description | Consumer Unit Code (UPC) |
|---|---|
|
COOKIE & BROWNIE DOUGH BAR |
|
|
Chocolate Chip bar 16.5oz |
0 50000 62231 3 |
| Chocolate Chip bar 16.5oz | 0 50000 11308 8 |
| Chocolate Chunk bar 16.5oz | 0 50000 62235 1 |
| Walnut Chocolate Chip bar 16.5oz | 0 50000 62233 7 |
| Jumbo Chocolate Chip bar 16.5oz | 0 50000 62237 5 |
| Oatmeal Raisin bar 16.5oz | 0 50000 06219 5 |
| Sugar Cookies bar 16.5oz | 0 50000 62244 3 |
| Sugar Cookies bar 16.5oz | 0 5000012178 6 |
| Mini Chocolate Chip bar 16.5oz | 0 50000 62242 9 |
| Mini Chocolate Chip bar 16.5oz | 0 5000012188 5 |
| Mini Brownie Bites bar 16oz | 0 50000 62227 6 |
| Fudgy Brownie With Peanut Butter Filling 19oz | 0 50000 00820 9 |
|
COOKIE DOUGH TUB |
|
| Chocolate Chip tub 40oz | 0 50000 62246 7 |
| Chocolate Chip tub 80oz (5 lb) | 0 50000 00934 3 |
| Sugar tub 40oz. | 0 50000 62253 5 |
| Gingerbread tub 40oz | 0 50000 44060 3 |
| Peanut Butter tub 40oz | 0 50000 44062 7 |
|
TUBE (CHUB) DOUGH |
|
| Chocolate Chip tube 16.5oz | 0 50000 62239 9 |
| Chocolate Chip tube 32oz | 0 50000 00400 3 |
|
ULTIMATES COOKIE BAR DOUGH |
|
| Ultimates Peanut Butter Cups, Chips & Chocolate Chunks bar 16oz | 0 50000 00922 0 |
| Ultimates White Chip Macadamia Nut bar 16oz | 0 50000 00923 7 |
| Ultimates Chocolate Chip & Chunks with Pecans bar 16oz | 0 50000 00925 1 |
| Ultimates Chocolate Chip Lovers 16oz | 0 50000 00926 8 |
| Ultimates Turtles bar 16oz | 0 50000 00928 2 |
| Ultimates Peanut Butter Lovers bar 16oz | 0 50000 00507 9 |
| Ultimates Chocolate Chip with Caramel Filling bar 16oz | 0 50000 44066 5 |
| Ultimates Chocolate Chip with Chocolate Filling bar 16oz | 0 50000 44069 6 |
|
SEASONAL COOKIE & BROWNIE DOUGH |
|
| Valentine Hearts Sugar Cookie Shapes 15.5oz | 0 50000 12009 3 |
| Valentine Swirled Chocolate Chip bar 16oz | 0 50000 00931 2 |
| Fudgy Brownies With Raspberry Filling 19oz | 0 50000 20090 0 |
| Easter Eggs Sugar Cookie Shapes 15.5oz | 0 50000 52009 1 |
| Easter Swirled Chocolate Chip bar 16oz | 0 50000 00932 9 |
| Easter Swirled Mini Brownie Bites bar 18 oz | 0 50000 20093 1 |
| Red, White & Blue Swirled Choc Chip bar 16oz | 0 50000 00937 4 |
| Halloween Pumpkin Pals Sugar Cookies 13.5oz | 0 50000 06217 1 |
| Halloween Swirled Chocolate Chip bar 16oz | 0 50000 00929 9 |
| Halloween Swirled Fudgy Brownies bar 18oz | 0 50000 00088 3 |
| Christmas Shapes Sugar Cookies 15.5oz | 0 50000 00505 5 |
| Christmas Swirled Chocolate Chip bar 16oz | 0 50000 00930 5 |
| Christmas Swirled Fudgy Brownies bar 18oz | 0 50000 00089 0 |
| Limited Edition Mint Swirled Chocolate Chip 16oz | 0 50000 00827 8 |
|
DISCONTINUED VARIETIES |
|
| Valentine Hearts Sugar Cookies 13.5oz | 0 50000 44056 6 |
| Easter Brownie Bar 18oz | 0 50000 00518 5 |
| Easter Bunnies Sugar Cookies 13.5oz | 0 50000 44058 0 |
| Halloween Sugar Shapes 15.5oz | 0 50000 00829 2 |
| Christmas Sugar Cookie Tube 16oz | 0 50000 00448 5 |
| Oatmeal Cranberry Cookie Tub 48 oz. | 0 50000 62229 0 |
Still in Atlanta at the National Environmental Health Association Conference on my way home (or not) in a few hours. In between doing a mock deposition of a Health Inspector, I had time to talk to California, Minnesota and Oregon press about the state of Food Poisonings - specifically E. coli:
By Matt McKinney, Star Tribune
No one really wants to meet Bill Marler, a food safety lawyer from Seattle, because those who do are likely A) critically sickened by contaminated food and in need of legal help, or B) responsible for selling the food.
Yet there seems to be no shortage of people who know Marler after several high-profile food illness outbreaks in recent years from spinach, tomatoes, frozen pizza, peanut butter, hamburger meat and, last week, Nestlé Tollhouse cookie dough. He has a national practice, but has had several cases in Minnesota recently, including several in which he's sued Cargill on behalf of clients such as the 10-year-old girl from Mahtomedi who became seriously ill in December after eating hamburger contaminated with E. coli O157:H7.
Marler rose to prominence during the Jack in the Box E. coli outbreak of 1993. He maintains multiple food-related blogs while crisscrossing the country to speak about food safety. He's supportive of federal legislation winding its way through Congress that would require more inspections of food plants and give more authority to the Food and Drug Administration (FDA) to order food recalls, among other things. Marler, who's often quoted saying that he wishes food companies would put him out of business, also says that people must learn how to properly handle risky foods while companies must own up to the risks inherent in their products.
Marler's reaction to the Nestlé Tollhouse cookie dough outbreak: "It's almost un-American."
Ill girl's Highlands Ranch family sues over dough
By Jennifer Brown, The Denver Post
The lawsuit is the first in Colorado related to the outbreak and follows one filed Monday in California by an 18-year-old woman. Both cases were filed by William Marler, a Seattle attorney who specializes in food-safety cases.
It's unknown how this E. coli strain, one usually found in cattle manure, could have gotten into dough, but Marler speculated there could have been a contaminated ingredient, such as flour.
"That's pretty remarkable that it found its way into cookie dough," the attorney said. "A lot of Americans tend to eat cookie dough raw. It's pretty well-known, certainly in the industry, that people do consume cookie dough in that way."
Nestle ready to apologize to sickened Gresham teen
By Lynne Terry, The Oregonian
With the investigation under way, a Seattle attorney filed a second lawsuit against Nestle USA on Tuesday. The first, filed Monday, was on behalf of an 18-year-old California woman who was hospitalized for seven days after eating Nestle cookie dough, said attorney Bill Marler, who specialized in foodborne illness cases.
Tuesday's suit, filed in Colorado, concerns a 6-year-old girl who was hospitalized twice after eating cookie dough. She developed a type of kidney failure associated with E. coli O157:H7 known as hemolytic uremic syndrome, which often brings lifelong complications such as dialysis.
Nestle's labels carry warnings not to eat raw dough, but Marler brushed them off as insufficient to protect consumers.
"The warning issue is not very relevant, especially in light of the fact in that all the reported literature on what consumers do with cookie dough is that they eat it raw," Marler said. "The reality is that Nestle knew or should have known that their consumers were consuming that product raw and that they were handling it raw."
Another lawsuit filed in cookie dough E. coli scare
By Matt Tomsic, Danville Register & Bee
William Marler is one of the attorneys representing the child, Madison Sedbrook. He works for Marler Clark, a firm that represents victims of food poisoning.
According to Marler’s blog, Sedbrook, 6, ate the cookie dough several times in April. The Denver-area child developed flu-like symptoms and kept eating the cookie dough into May, when she developed ab-dominal cramps, fever and bloody diarrhea. Sedbrook was admitted to the hospital and released before being taken back.
She developed hemolytic uremic syndrome, a type of kidney failure that can be fatal. Doctors tested the genetic fingerprint of Sedbrook’s illness and compared it to the fingerprint of the nationwide outbreak of E. coli that may be linked to eating raw cookie dough. The two prints matched.
An E. coli lawsuit was filed today on behalf of a Denver-area child who became gravely ill with E. coli O157:H7 after eating refrigerated Nestle Toll House cookie dough. The lawsuit was filed on behalf of the family of Madison Sedbrook by her attorneys, William Marler of the Seattle-based foodborne illness law firm Marler Clark and Kara Knowles of the Denver firm Montgomery, Little, Soran, & Murray.
Six-year-old Madison ate Nestle Toll House refrigerated cookie dough several times in mid-April, 2009. She began to experience flu-like symptoms including fatigue, fever, nausea, and vomiting. Not knowing the source of her illness, she continued to eat Nestle cookie dough, and by the first week of May, she had abdominal cramps, fever, and bloody diarrhea. Over the next several weeks, the family sought medical care several times for Madison’s illness, which deepened in severity. She was admitted to the hospital and then released before being rushed back and admitted to pediatric intensive care. It was determined that Madison had hemolytic uremic syndrome, or HUS, a complication of her E. coli infection, which was not diagnosed until her second hospital stay. The genetic fingerprint of the E. coli O157:H7 found in her stool matches that of the nationwide outbreak tied to cookie dough.
“This child – and this family – have been through a terrible ordeal, not the least of which is how many times they sought care before E. coli was detected,” said Marler, who spoke from the National Environmental Health Association (NEHA) convention.. “In order to detect and limit foodborne illness outbreaks, we have to make changes in our healthcare system; doctors and emergency health providers need to be encouraged to test for foodborne pathogens any time these symptoms – especially bloody diarrhea - are present.”
On Monday, the CDC released updated information on the nationwide outbreak, which now encompasses 70 ill in 30 states. Thirty people have been hospitalized, and 7 have developed HUS. Almost seventy percent of the victims are female and under the age of 19. Nestle USA has voluntarily recalled the product, and stopped production at the facility that made it and are cooperating with FDA and CDC to pinpoint the cause.
“State health departments did a great job of getting to the bottom of this outbreak, and getting the word out,” continued Marler. “But more resources are needed to speed the process up. Every day saved means dozens, maybe hundreds of families spared the Sedbrook family experience.”
ABOUT MARLER CLARK: William Marler has been a major force in food safety policy in the United States and abroad. His food safety blog, Marler Blog, is read by over 1,000,000 people around the world every year. He and his partners at Marler Clark have represented thousands of individuals in claims against food companies whose contaminated products have caused serious injury and death. His advocacy for better food regulation has led to invitations to address local, national, and international gatherings on food safety, including recent testimony to US Congress Committee on Energy and Commerce. In 1998, Mr. Marler formed the not for profit, Outbreak Inc. He spends much of the year speaking on how to prevent foodborne illnesses.
According to the CDC, 70 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint (Pulsed Field Gel Electrophoresis - PFGE) have been reported from 30 states. Ill persons range in age from 2 to 65 years; however, 66% are less than 19 years old; 75% are female. Thirty persons have been hospitalized, 7 developed hemolytic uremic syndrome (HUS). Interestingly, this PFGE pattern has been seen on PulseNet before with over 300 being seen in last four years.
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Of 70 linked in this outbreak, 41 have been confirmed by an advanced DNA test (likely MLVA, or Multiple Loci VNTR Analysis) as having the outbreak strain; these confirmatory test results are pending on the others. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.
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The number of ill persons identified in each state is as follows: Arizona (2), California (3), Colorado (5), Connecticut (1), Delaware (1), Georgia (1), Hawaii (1), Iowa (2), Illinois (5), Kentucky (3), Massachusetts (4), Maryland (2), Maine (3), Minnesota (6), Missouri (2), Montana (1), North Carolina (2), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (3), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (5), and Wisconsin (1).
We have been contacted by over a dozen culture-confirmed cases in the last few weeks. We filed suit yesterday in California on behalf of and 18 year old young woman hospitalized for seven days and will be filing this morning on behalf of a Colorado 6 year old who developed HUS - acute kidney failure.
A young woman who was hospitalized for seven days after eating raw cookie dough made by Nestle USA filed suit today against the company in California Superior Court, San Mateo County. The lawsuit was filed on behalf of 18-year-old Jillian Collins by her attorneys, William Marler of the Seattle-based foodborne illness law firm Marler Clark and Terry O’ Reilly of the San Mateo firm O'Reilly Collins.
San Mateo resident Jillian Collins ate uncooked Nestle Toll House cookie dough in late May, 2009. On May 26, she fell ill with painful abdominal cramps and diarrhea that soon turned bloody. Her symptoms worsened to the point where she sought urgent care. She was later admitted to the hospital, where tests revealed that she was infected with E. coli O157:H7. The genetic fingerprint of her test matched that of the outbreak strain which has infected 65 people in 29 states to date.
This outbreak is an example of how virulent E. coli bacteria can be, and how many people can be affected when it enters the national food supply, Nestle USA is a company with a good food safety record, and they worked very quickly to get a voluntary recall of the product started. But even that isn’t enough for those who were sickened in this outbreak. It points to how vigilant we need to be in our food safety regulation and oversight.
The first announcement about the multi-state outbreak was made on Thursday, June 18 by the Colorado Department of Health and Environment (CDPHE), warning consumers about consuming the uncooked Nestle Toll House cookie dough product, and revealing that more than sixty were confirmed ill in 28 states. It wasn’t until late Friday, June 19 that the CDC released their outbreak information, which updated the totals to 65 ill in 29 states.
Nestle has stopped production at the Virginia facility that produced the cookie dough. Everyone I talk to is stumped by how a bacteria normally associated with cattle feces made its way into the facility, and then into such a highly processed product. We may not solve that mystery; what we can do is work to prevent this type of event from happening again. The way to do that is better food safety surveillance – and that comes down to legislation and funding.
Between speaking at the American College of Trial Lawyers in Minnesota on Friday, visiting on Saturday with a young dancer who now is confined to a wheelchair because of an E. coil O157:H7-tainted hamburger, and seeing an Ohio family today who lost their seven-year-old daughter to E. coli O157:H7, I am a bit tired and saddened, but determined. I am now in Atlanta for the National Environmental Health Association Convention. Tomorrow too we are also launching both a lawsuit and an investigation in how nearly 70 of our fellow citizens were sickened by E. coli O157:H7-contaminated cookie dough. Click on below to download complaint:
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The average E. coli O157:H7 victim without hospitalization will spend at least $1,000 in medical expenses and loose a week’s wages. For those hospitalized, medical bills can run from $10,000 to $100,000 in a very short time period. Those families whose children develop HUS, bills can push well into $1M depending on the severity of the illness. If the HUS is severe, future complications – including kidney transplant can add untold millions.
Nestle should step up now and pay E. coli 0157:H7 culture-positive victims’ medical bills and lost wages.
Without assistance in the form of monetary compensation for medical expenses and lost wages, many of the families with members in the hospital will face financial hardship in the coming months when the bills start coming in. Nestle should do the right thing and begin compensating victims of this outbreak for those most basic needs now. Of course, Nestles will still be responsible for the costs of long-term medical care for victims, but it is better to step up now.
This is not as odd as it might sound. Other companies like Dole, Odwalla, ConAgra and Jack in the Box willingly paid medical bills and wage loss when their products were identified as the source of E. coli outbreaks. Nestles knows it’s going to pay those medical expenses in the end in the form of a settlement or jury verdict. The question is, since they know their product was the cause of these illnesses, why wait?
In other news:
New York Times - Nestlé Cookie Dough Is Recalled
Bill Marler, a food-safety lawyer, scoffed at that statement.
“Those three words do not constitute an adequate warning,” Mr. Marler said, “and Nestlé should not be blaming their victims for doing what everyone in America does, and that is to eat and handle cookie dough before it’s cooked.”
Reuters - Raw Cookie Dough: So Tasty, So Dangerous
The outbreak "points to the need for better funding for health surveillance," said lawyer Bill Marler, who sues food companies for a living. Oddly quoting himself on his blog, Marler wrote that the " 'fact that this outbreak was not detected until more than sixty people were ill in 28 states is precisely why we urgently need increased funding for the agencies responsible for public health,' said Marler. 'From the CDC to state and local health agencies, many dedicated people are working hard to protect consumers from tainted food, but they just don't have enough resources to do the job we ask of them.
Washington Post - Nestlé Recall Leaves A Mystery in Its Wake
William Marler, a prominent food safety lawyer in Seattle who is representing six of the E. coli O157 victims, said Nestlé's warning label is not a defense. "It doesn't absolve them of liability," he said.
ABC - Nestle Voluntarily Recalls Raw Cookie Dough
Bill Marler, an attorney focused on food poisoning cases with the law firm Marler Clark, said he recently noticed that this season's cases of E. coli did not look like others.
"Summer season is high season for E. coli cases -- normally you'd expect them to be related to hamburger consumption," Marler told ABCNews.com on Friday. "So we started tracking cases in May and June, and not very many of them had hamburger consumption."
Still, cookie dough "was certainly not on the list of things we've asked them," Marler said, adding that he is "surprised" the possible contamination may have occurred in such a "highly processed product."
"We're now going back and getting all the health department records on the people who contacted us over the last three months to see if they match this outbreak," Marler said.
The Blount Daily Times reports on yet another death caused by E. coli O157:H7 and Hemolytic Uremic Syndrome (HUS) – this time it is eight-year-old Joseph Coning. I received an email tonight from his devastated family.
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Just a few weeks ago, seven-year-old Abby Fenstermaker died of E. coli O157:H7 and HUS in Ohio. I will be meeting with yet another anguished family on Father’s Day.
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When will it stop?
I was reviewing the 300 plus claims amounting to over $300,000,000 that companies and individuals have filed against the Peanut Corporation of America and found a claim for $601,506.96 by Stewart Parnell - No, really, the Stewart Parnell - the guy who took the 5th in front of Congress. I need to stop being amazed by what people do.
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Ray Reed of the Lynchburg News and Advance reported today that “[c]laims totaling $202 million had been filed Thursday against the Peanut Corporation of America in U.S. Bankruptcy Court in Lynchburg, as next Monday’s deadline for filing claims approached."
He continued:
Among the claims were eight involving deaths attributed to a nationwide salmonella outbreak that was traced to PCA plants in Blakely, Ga., and Plainview, Texas, according to the Centers for Disease Control. PCA was headquartered in suburban Lynchburg, on Wiggington Road in Bedford County. Its president, Stewart Parnell, asserted his Fifth Amendment rights and refused to answer questions during appearances this year before Congress and in U.S. Bankruptcy Court in Lynchburg.
The Marler Clark law firm in Seattle, Wash., filed the death claims, each of which seeks $10 million for the victims’ estate or relatives. Marler Clark also had filed 86 [actually 87] claims of $1 million each for people who said they were sickened by salmonella. Another claim was being filed Thursday, said William Marler, a principal in the firm….
The CDC said a total of 714 illnesses nationwide were caused by the strain of salmonella identified in the PCA plants, and nine of those victims died.
CDC just today published its 2006 data on Foodborne Disease Outbreaks. Here is the Report - no wonder I have been so busy:
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Foodborne illnesses are a major health burden in the United States. Most of these illnesses are preventable, and analysis of outbreaks helps identify control measures. Although most cases are sporadic, investigation of the portion that occur as part of recognized outbreaks can provide insights into the pathogens, food vehicles, and food-handling practices associated with foodborne infections. CDC collects data on foodborne disease outbreaks (FBDOs) from all states and territories through the Foodborne Disease Outbreak Surveillance System (FBDSS). This report summarizes epidemiologic data on FBDOs reported during 2006 (the most recent year for which data have been analyzed). A total of 1,270 FBDOs were reported, resulting in 27,634 cases and 11 deaths. Among the 624 FBDOs with a confirmed etiology, norovirus was the most common cause, accounting for 54% of outbreaks and 11,879 cases, followed by Salmonella (18% of outbreaks and 3,252 cases). Among the 11 reported deaths, 10 were attributed to bacterial etiologies (six Escherichia coli O157:H7, two Listeria monocytogenes, one Salmonella serotype Enteritidis, and one Clostridium botulinum), and one was attributed to a chemical (mushroom toxin). Among outbreaks caused by a single food vehicle, the most common food commodities to which outbreak-related cases were attributed were poultry (21%), leafy vegetables (17%), and fruits/nuts (16%). Public health professionals can use this information to 1) target control strategies for specific pathogens in particular foods along the farm-to-table continuum and 2) support good food-handling practices among restaurant workers and the public.
State, local, and territorial health departments voluntarily submit reports of FBDOs using a web-based standard form to the electronic Foodborne Outbreak Reporting System (eFORS). An FBDO is defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Information regarding clinical syndromes, incubation period, and laboratory testing for various etiologic agents is available to guide reporting officials.* Officials report an etiology as either confirmed (at least one etiologic agent found) or suspected (based on clinical and epidemiologic information). Analysis was limited to FBDOs with a single etiology (i.e., suspected or confirmed). Food vehicles are food items linked to illnesses by an outbreak investigation. CDC classifies the foods vehicles implicated in outbreak reports into the following 17 food commodities: fish, crustaceans, mollusks, dairy, eggs, beef, game, pork, poultry, grains/beans, oils/sugars, fruits/nuts, fungi, leafy vegetables, root vegetables, sprouts, and vegetables from a vine or stalk.
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During 2006, public health officials reported a total of 1,270 FBDOs from 48 states. A confirmed or suspected single etiologic agent was indentified in 884 (70%) FBDOs (621 confirmed and 263 suspected), accounting for 22,510 (81%) cases. The number of outbreaks reported by each state or territory ranged from zero to 76. The median rate was 0.21 (range: zero to 1.3) per 100,000 population. For seven states (Hawaii, Maine, Minnesota, North Dakota, Oregon, Vermont, and Wisconsin), the rate of reporting was greater than three times the median. Rates of reported outbreaks varied markedly by etiology group. Among the 621 outbreaks (with 18,111 cases) with a confirmed single etiologic agent, 343 (55%) outbreaks and 11,981 (66%) cases were caused by viruses, 217 (35%) outbreaks and 5,781 (32%) cases were caused by bacteria, 52 (8%) outbreaks and 219 (1%) cases were caused by chemical agents, and nine (1%) outbreaks and 29 (1%) cases were caused by parasites. Calicivirus caused 337 (98%) of the confirmed FBDOs attributed to viruses; all calicivirus outbreaks reported in 2006 were attributed to norovirus. Salmonella, the most commonly reported bacterial etiologic agent, caused 112 (52%) of the confirmed FBDOs attributed to bacteria; Salmonella serotype Enteritidis caused the most outbreaks (28 [13%]). Shiga toxin--producing E. coli (STEC) caused 29 (13%) of confirmed FBDOs attributed to bacteria, of which 27 were serogroup O157.
Eleven multistate outbreaks, defined as outbreaks in which exposures occurred in more than one state, were detected; 10 of these were attributed to bacteria. One attributed to chemical agents was transmitted by baked goods contaminated by a floor sealant (11 cases). Four of the bacterial outbreaks were attributed to E. coli O157, of which three were transmitted by leafy vegetables (395 cases) and one was transmitted by beef (44 cases). Four were attributed to Salmonella, of which two were transmitted by tomatoes (307 cases), one by peanut butter (715 cases), and one by fruit salad (41 cases). An outbreak of Vibrio parahaemolyticus infections was transmitted by oysters (177 cases). An outbreak attributed to C. botulinum toxin was transmitted by carrot juice (four cases).
Public health officials identified a food vehicle in 528 (42%) FBDOs, of which 243 (46%) outbreaks with 6,395 (50%) cases were classified as having ingredients belonging to only one of the 17 commodities. Among the 243 outbreaks attributed to a single commodity, the most outbreaks were attributed to fish (47 outbreaks), poultry (35 outbreaks), and beef (25 outbreaks), and the most cases were attributed to poultry (1,355 cases), leafy vegetables (1,081 cases), and fruits/nuts (1,021 cases). Pathogen-commodity pairs responsible for the most outbreak-related cases were Clostridium perfringens in poultry (902 cases), Salmonella in fruits/nuts (776 cases), norovirus in leafy vegetables (657 cases), STEC in leafy vegetables (398 cases), Salmonella in vine-stalk vegetables (331 cases), and V. parahaemolyticus in mollusks (223 cases).
Although the dairy commodity accounted for only 3% of single commodity outbreak-related cases (16 outbreaks and 193 cases), 71% of dairy outbreak cases were attributed to unpasteurized (raw) milk (10 outbreaks and 137 cases). A wide range of bacterial pathogens were associated with unpasteurized milk outbreaks, including Campylobacter (six outbreaks), STEC O157 (two outbreaks), Salmonella (one outbreak), and Listeria (one outbreak), resulting in 11 hospitalizations and one death.
The largest outbreaks with a known etiology and single food commodity were attributed to baked chicken contaminated with C. perfringens (741 cases), peanut butter contaminated with Salmonella (714 cases), and spinach contaminated with E. coli O157 (238 cases). In the spinach outbreak, 31 persons developed hemolytic uremic syndrome, and five died, including a child. The contaminated spinach was traced back to a single farm, where the outbreak strain was isolated from nearby cattle feces and feral swine feces.
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NPR Joanne Silberner interviewed Peter Hurley, father of three-year-old Jacob Hurley, who was poisoned by Salmonella-tainted peanut butter for Morning Edition, June 10, 2009 · Congress is taking the first step toward major changes in monitoring the safety of the nation's food supply. The broad plan is to give more money and power to an agency that has come under a lot of criticism in recent years — the Food and Drug Administration.
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On September 15, 2008, Ingham County Health Department (ICHD) was notified that nine students of Michigan State University (MSU) were seen in the emergency department over the weekend with gastrointestinal symptoms of abdominal pain, diarrhea, and bloody diarrhea. Lab cultures had confirmed that at least two of them were positive for E. coli O157:H7. The ICHD then launched an investigation with help from the Michigan Department of Community Health (MDCH), and both the United States & Michigan Department of Agriculture (MDA).
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Over the ensuing days it became clear that the outbreak was not limited to MSU. While at MSU, the reported number of E. coli O157:H7 cases had risen to 18 (3 confirmed, 15 probable), there were also a reported 12 cases at Lenawee County Jail (5 confirmed, 7 probable). In fact, by September 29, a total of 26 confirmed cases of E. coli O157:H7 with the same genetic fingerprint had been reported to MDCH, from eight Michigan counties. Additionally, nine individuals in Illinois and three from the Province of Ontario had also been identified with the same genetic strain of E. coli O157:H7.
By this point, there was also strong epidemiological evidence linking the outbreak to institutional size, bagged iceberg lettuce. Two separate case-control studies had been conducted by MDCH at MSU and the Illinois Department of Public Health, and both implicated iceberg lettuce as the source of contamination. As a result, the MDA coordinated a traceback investigation of iceberg lettuce and found that the common supplier of all iceberg lettuce to MSU, the Lenawee County Jail, a restaurant in Illinois, as well as other foodservice locations identified by ill individuals, was Fresh-Pak Inc., distributed under the name, “Aunt Mid’s.”
The MDA subsequently conducted product and environmental sample testing at Aunt Mid’s. Though the tests did not find E. coli, testing was on current products, not on products from the outbreak timeframe. Lettuce from the outbreak timeframe was not available for testing during the investigation due to the perishable nature of the product.
Meanwhile, the toll of people affected by the E. coli O157:H7 outbreak had increased. By October 3rd, Michigan had identified 34 cases in nine counties with the same PFGE pattern by two enzymes. This included: nine students from MSU (Ingham County), five inmates at the Lenawee County Jail, three students at the University of Michigan and one in Washtenaw County, five in Macomb County, five in Wayne County, three in Kent County, and one each in St. Clair, Oakland, and Genesee Counties. The onset dates of symptoms of these confirmed genetically linked E. coli O157:H7 patients ranged from September 8 to 19.
The epidemiological investigation by MDA, which had already identified Aunt Mid’s as the common supplier of iceberg lettuce, soon revealed the likely origin of the contamination Using illness dates, ship dates, and delivery dates, the MDA was able to narrow the origin to California. The California Department of Public Health then assisted the investigation by surveying 15 possible supplier farms. By October 10, Michigan and California had both traced the lettuce supplied to the initial cases to Santa Barbara Farms in Santa Barbara, California.
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This outbreak was clearly linked to Ready Pac lettuce served in Taco Bell restaurants in the northeastern United States. As of December 14, 2006, Thursday, 71 persons with illness associated with the Taco Bell restaurant outbreak have been reported to CDC from 5 states: New Jersey (33), New York (22), Pennsylvania (13), Delaware (2), and South Carolina (1). States with Taco Bell restaurants where persons confirmed to have the outbreak strain have eaten are New Jersey, New York, Pennsylvania, and Delaware. (The patient from South Carolina ate at a Taco Bell restaurant in Pennsylvania). Other cases of illness are under investigation by state public health officials. Among these 71 ill persons, 53 (75%) were hospitalized and 8 (11%) developed a type of kidney failure called hemolytic-uremic syndrome (HUS). Illness onset dates have ranged from November 20 to December 6.
Cases in 52 of the 71 patients are confirmed, meaning that the patients’ E. coli O157:H7 strains have the outbreak “DNA fingerprint.” E. coli O157 strains are routinely “DNA fingerprinted” at public health laboratories in all states as part of PulseNet (the network of public health laboratories that sub-type bacteria). E. coli O157 strains from other cases are being tested by PulseNet. As a result of testing by PulseNet, cases with the outbreak strain “fingerprint” pattern are being re-classified as confirmed cases, and cases with an unrelated “fingerprint” pattern are being dropped from the outbreak case count.
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I. THE OUTBREAK
On October 2, 2008, the California Department of Public Health (CDPH) issued a report linking an outbreak of Campylobacter illnesses to unpasteurized milk from Alexandre Eco Farms Dairy. The report was the result of an investigation commenced on July 14, 2008, when Dr. Thomas Martinelli, the County Health Officer for Del Norte County, California reported four cases of laboratory confirmed Campylobacter infections and five additional cases of diarrhea in Del Norte County residents. Eight of the original nine sick individuals were members of the Alexandre Eco Farms “cow-leasing” program. Eight of these individuals had consumed milk produced on the farm. The ninth sick individual worked with cattle on the Alexandre Eco Farms Dairy. One of the eight individuals who were sick, Mari Tardiff, had already been hospitalized with GBS, following the onset of acute gastroenteritis after consumption of the milk.
As part of the investigation, health department officials retrieved a refrigerated carton of partially consumed Alexandre Eco Farms milk from Mari Tardiff’s home. Mari had consumed a portion of the milk before her illness. The specimen tested positive for Campylobacter jejuni DNA using a test called polymerase chain reaction (PCR). Testing indicated that multiple strains of Campylobacter jejuni were present in the milk. Del Norte County officials eventually identified 16 cases of Campylobacter jejuni associated with the outbreak. Fifteen of those were persons who consumed milk from Alexandre Eco Farms Dairy. The 16th case was the farm employee. CDPH and Del Norte county officials concluded that “the available epidemiologic and laboratory data support the conclusion that this cluster of acute diarrheal illness in Del Norte County was an outbreak of C. jejuni infections caused by consumption of unpasteurized milk from [Alexandre Eco Farms Dairy.]”
The causal link between Alexandre Eco Farms Dairy and Mari’s illness was so clear, and her injuries so remarkable, that the physicians that treated her published a report on her case in the medical journal. “Investigation of the First Case of Guillain-Barre Syndrome Associated with Consumption of Unpasteurized Milk – California, 2008.” Amy K. Earon, T. Martinelli, W. Miller, C. Parker, R. Mandrell, D. Vugia. The authors explained the laboratory methods used in investigating Mari’s illness:
We reviewed the patient’s medical record and interviewed her husband to assess her symptoms and exposures. We used polymerase chain reaction (PCR) and multilocus sequence typing (MLST) to test a six-week old unpasteurized milk sample, obtained from the cow leasing-program and partially consumed by the patient, for genes encoding the bacterial membrane component lipooligosaccharide (LOS) in GBS-associated Campylobacter jenuni.
In addition to the DNA testing, the authors also tested Mari’s blood for anti-bodies to GBS. The authors then explained that the PCR and MLST testing of the milk detected Campylobacter jejuni gene. In addition, the blood test was positive for anti-bodies that indicated the presence of GBS. The authors concluded, “Combined laboratory and epidemiologic evidence established the first reported association between GBS and unpasteurized milk consumption.”
II. MARI TARDIFF’S ILLNESS
On the weekend after Mari drank raw milk, she developed flu-like symptoms, including diarrhea and vomiting. By Thursday, June 12, the food poisoning was overwhelming her body with an amazingly swift force. First her vision blurred. Then her hands went numb. Mari went to an emergency room, and there lab work was done and abdominal X-rays were taken. But doctors could not determine what was wrong. On Friday, Peter took Mari to a neurologist. An MRI was normal but the doctor and radiologist mentioned a frightening possibility – Guillain-Barré syndrome, or GBS, a potentially fatal inflammatory disorder.
Hours later Mari’s legs were on fire, searing with pain that, ironically, only hot water helped to soothe. Her legs hurt so much that she soon retreated to bed, wrapping her legs in warm towels and a heating blanket. During that night, Mari awoke and realized she could not move. Peter bear-hugged her to lift her to the toilet and then carried her back to bed. In the early hours of the morning, he called for help, which led to an ambulance ride to the small Sutter Coast Hospital, and then a medivac flight to the Intensive Care Unit at the larger, better-equipped Rogue Valley Medical Center (RVMC) in Medford, Oregon. She remained hospitalized for two and one-half months.
Mari was moved to Redding Rehabilitation Hospital and was finally able to come home on November 1, 2008. Today, Mari lives in her family room, which now is equipped with a hospital bed, portable toilet, a Hoyer lift and a stand-up frame, all purchased by the Tardiffs. Using their own resources, they also renovated a downstairs half-bath and laundry room into a handicapped-accessible bathroom and shower. The Tardiffs pay two nurses $10.50 an hour to care for Mari from 7:30 A.M. until 7:00 P.M. five days a week while Peter is at work. Home health physical and occupational therapists also come to the house five days a week.
Mari works very hard at therapy but it is a slow, painful process. Peter has found it so upsetting that he no longer can watch. Every improvement is celebrated, but he knows how much discomfort and frustration goes into each minute, regained movement. Mari may never walk again. She lost her job, she lost her dreams and plans that she held dear. The illness has been a long, arduous journey for Mari, her family and friends, and while she has made progress, there remains a long way to go.
READ MORE ON CAMPYLOBACTER AND GULLAIN BARRE SYNDROME
Continue Reading...I spend a lot of time trying to convince companies why it is a bad idea to poison their customers - either suing them through Marler Clark or educating them through Outbreak Inc.
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Educating consumers is also something we all need to do for ourselves. We need to pay attention to what we consume. However, in our search for knowledge about what may be good for us, shouldn't we expect that the manufacturers and sellers of our food be fair and unbiased about the risks of consuming the food they sell us?
Warning Labels - the "Holy Grail" of manufacturers and sellers. Many manufacturers and sellers think that a warning label saves them from their customer (or the customer's child) from suing them if the product in fact has a defect - in the case of food - a pathogen that can sicken or kill. But, a warning label is a "double-edged sword." If you are too honest - "the product may contain E. coli, Listeria or Campylobacter - consume this product and it may kill you" - that might be bad for sales? Too vague and what do you get?
What do you think about Organic Pastures' warning label? Real or Imaginary? Perhaps it is just best to keep the shit out.
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California Code of Regulations
Title 17. Public Health
Division 1. State Department of Health Services
Chapter 5. Sanitation (Environmental)
Subchapter 2. Foods and Drugs
Article 3.7. Raw Milk and Raw Milk Products
S 17:11380. Required Health Warning on Labels of Raw Milk and Raw Milk Products.
(a) Raw Milk and raw milk products shall bear the following warning on the principal display panel or panels of the label:
WARNING
Raw (unpasteurized) milk and raw milk dairy products may contain disease-causing micro-organisms. Persons at highest risk of disease from these organisms include newborns and infants; the elderly; pregnant women; those taking corticosteroids, antibiotics or antacids; and those having chronic illnesses or other conditions that weaken their immunity.
'Raw milk product' means any food which contains raw milk, and shall include, but not be limited to, cheese (except when ripened or cured at least 60 days pursuant to sections 37975 and 38001 Food & Agric. of the Food and Agricultural Code), cream, butter and kefir.
Hmm, I wonder if Organic Pasture's Warnings are sufficient?
KFC E. coli Outbreak – Ohio - 1999
In late July of 1999, Ohio public health officials began receiving reports that patients at local hospitals were suffering from E. coli O157:H7 infections. By August 2, 1999, fifteen cases had been confirmed, and through investigative interviews the Ohio Department of Health learned that eleven of those fifteen people had eaten foods purchased from KFC restaurants in southwestern Ohio counties in the week before becoming ill.
Marler Clark represented a woman who became ill with an E. coli infection and hemolytic uremic syndrome after eating foods purchased from a Cincinnati KFC restaurant. She was hospitalized for nearly a month with acute renal failure and other life-threatening complications and nearly died twice. As a result of her E. coli O157:H7 infection, the woman suffered permanent and irreversible injury to her kidneys, pancreas, heart, lungs, and brain. Her claim was resolved in 2001.
ConAgra Ground Beef E. coli Outbreak – Nationwide (including Ohio) - 2002
On June 30, 2002, the USDA Food Safety and Inspection Service (FSIS) announced the recall of 354,200 pounds of ground beef manufactured at the ConAgra Beef Company plant in Greeley, Colorado. The contaminated ground beef had been produced at the plant on May 31, thirty days prior to the recall, and was distributed nationally to retailers and institutions. On July 19, 2002, FSIS expanded the ConAgra ground beef recall to 18.6 million pounds of ground beef. In the weeks that followed the nationwide recall, more than 45 people in 23 states reported illnesses linked to the contaminated ground beef.
Marler Clark represented 23 victims of the ConAgra E. coli outbreak, which led to at least 46 illnesses and one death. Among the victims was the death of an Ohio childcare worker, a Colorado security officer who was battling forest fires, and young children in Colorado, Nebraska, and South Dakota. Several of them were hospitalized with hemolytic uremic syndrome, a frightening complication of E. coli O157:H7 infection that can lead to kidney failure and neurological impairment. Their claims were resolved in 2004.
Nebraska Beef E. coli Outbreak – Nationwide (including Ohio) - 2008
On August 8, 2008 Nebraska Beef recalled an additional 1.2 million pounds of meat after a cluster of Boston illnesses was traced to Whole Foods, whose processor, Coleman Natural Meats, purchased the meat from Nebraska Beef. As many as 30 illnesses are reported in California, Colorado, Connecticut, Idaho, Illinois, Massachusetts, New Jersey, New Mexico, Ohio, Pennsylvania, Virginia, and Canada.
On August 14, Nebraska Beef added another 160,000 pounds to the recall, bringing the total to 1.36 million pounds. Numerous stores and supermarkets have initiated voluntary recalls. 49 confirmed cases have been linked both epidemiologically and by molecular fingerprinting to the first part of this outbreak, 21 in Michigan and 20 in Ohio, 4 in Georgia, and one each in New York, Kentucky, Indiana, and Utah. Onset of illness in these patients occurred from 5/27/08 to 7/1/08. Twenty-seven ill persons have been hospitalized. One patient has developed a type of kidney failure called hemolytic-uremic syndrome (HUS). Kroger initiated a voluntary recall on June 27, but did not name their meat supplier.
Marler Clark filed the first lawsuit stemming from the outbreak on the morning of June 30. Late that night, the FSIS announced that the tainted meat had been traced back to Nebraska Beef Products, and a recall of 531,707 pounds of ground beef products was initiated. On July 2, the Kroger recall widened to 20 states. On July 3, the Nebraska Beef recall was widened to include 5.3 million pounds.
E. coli O157:H7 is one of hundreds of strains of the bacterium Escherichia coli. Most strains of E. coli are harmless and live as normal flora in the intestines of healthy humans and animal. The E. coli bacterium is among the most extensively studied microorganism. The combination of letters and numbers in the name of the E. coli O157:H7 refers to the specific markers found on its surface and distinguishes it from other types of E. coli. The testing done to distinguish E. coli O157:H7 from its other E. coli counterparts is called serotyping. Pulsed-field gel electrophoresis (“PFGE”), sometimes also referred to as genetic fingerprinting, is used to compare E. coli O157:H7 isolates to determine if the strains are distinguishable.
E. coli O157:H7 was first recognized as a pathogen in 1982 during an investigation into an outbreak of hemorrhagic colitis associated with consumption of hamburgers from a fast food chain restaurant. Retrospective examination of more than three thousand E. coli cultures obtained between 1973 and 1982 found only one isolation with serotype O157:H7, and that was a case in 1975. In the ten years that followed there were approximately thirty outbreaks recorded in the United States. This number is likely misleading, however, because E. coli O157:H7 infections did not become a reportable disease in any state until 1987 when Washington became the first state to mandate its reporting. As a result, only the most geographically concentrated outbreak would have garnered enough notice to prompt further investigation.
The virulence of E. coli O157:H7 is a result of its ability to produce Shiga-like toxins. It has been theorized that generic E. coli picked up this deadly ability through horizontal transfer of virulence genes from the Shigella bacteria. Genome sequencing of E. coli O157:H7 has since confirmed that gene transfer did in fact occur, and that the evolution of ever more virulent forms of bacteria will likely continue to occur. The CDC has emphasized the prospect of emerging pathogens as a significant public health threat for some time.
Foods of a bovine origin are the most common cause of both outbreaks and sporadic cases of E. coli O157:H7 infections. Surveys performed on feedlots have demonstrated that cattle can be infected with E. coli O157:H7 through close contact, and under muddy conditions. The prevalence of E. coli O157:H7 among cattle in these feed lots can reach 63-100%, especially during the summer. The prevalence of E. coli O157:H7 in the summer, which is when outdoor grilling of hamburgers becomes most common, is a significant public safety risk.
According to a recent study, an “estimated 73,480 illnesses due to E. coli O157:H7 infections occur each year in the United States, leading to an estimated 2,168 hospitalizations and sixty-one deaths annually.” The hemorrhagic colitis caused by E. coli O157:H7 is characterized by severe abdominal cramps, diarrhea that typically turns bloody within twenty-four hours, and sometimes fevers. The typical incubation period—which is to say the time from exposure to the onset of symptoms—in outbreaks is usually reported as three to eight days. Infection can occur in people of all ages but is most common in children. The duration of an uncomplicated illness can range from one to twelve days. In reported outbreaks, the rate of death is 0-2%, with rates running as high as 16-35% in outbreaks involving the elderly, like those at nursing homes.
What makes E. coli O157:H7 truly and decidedly dangerous is its very low infectious dose, and how relatively difficult it is to kill these bacteria. Unlike Salmonella, for example, which usually requires something approximating an “egregious food handling error, E. coli O157:H7 in ground beef that is only slightly undercooked can result in infection.” As few as twenty organisms have been said to be sufficient to infect a person and, as a result, possibly kill them. And unlike generic E. coli, the O157:H7 serotype multiplies at temperatures up to 44 degrees Fahrenheit, survives freezing and thawing, is heat resistant, grows at temperatures up to 111 degrees Fahrenheit, resists drying, and can survive exposure to acidic environments.
And, finally, to make it even more of a dangerous threat, E. coli O157:H7 bacteria are easily transmitted by person-to-person contact. There is also the serious risk of cross-contamination between raw meat and other food items intended to be eaten without cooking. Indeed, a principle and consistent criticism of the USDA E. coli O157:H7 policy is the fact that it has failed to focus on the risks of cross-contamination versus that posed by so-called improper cooking. With this pathogen, there is ultimately no real margin of error, and the cost of error can be death. It is for this precise reason that the USDA has repeatedly rejected calls from the meat industry to hold consumers responsible for E. coli O157:H7 surviving after cooking.
Hemolytic Uremic Syndrome (HUS)
E. coli O157:H7 infections can lead to a severe, life-threatening complication called hemolytic uremic syndrome (“HUS”). HUS accounts for the majority of the acute and chronic illness and death caused by the bacteria. HUS occurs in 2-7% of victims, primarily children, with onset five to ten days after diarrhea begins. It is the most common cause of renal failure in children. Approximately half of the children who suffer HUS require dialysis, and at least 5% of those who survive have long-term renal impairment. The same number suffers severe brain damage. While somewhat rare, serious injury to the pancreas, resulting in death or the development of diabetes can also occur. There is no cure or effective treatment for HUS. And, tragically, as too many parents can attest, children with HUS too often die.<
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