As of 14 February 2018, 872 laboratory-confirmed listeriosis cases have been reported to NICD from all provinces since 01 January 2017 (Figure 1). Most cases have been reported from Gauteng Province (59%, 517/872) followed by Western Cape (13%, 111/872) and KwaZulu-Natal (7%, 62/872) provinces. Cases have been diagnosed in both public (64%, 559/872) and private (34%, 205/872) healthcare sectors. Diagnosis was based most commonly on the isolation of Listeria monocytogenes in blood culture (73%, 640/869), followed by CSF (22%, 183/869). Where age was reported (n=849), ages range from birth to 92 years (median 23 years) and 43% (352/829) are neonates aged ≤28 days (Figure 2). Of neonatal cases, 97% (342/346) had early-onset disease (birth to ≤6 days). Females account for 53% (466/868) of cases where gender is reported. Outcome is known for 597/872 (68%) patients of whom 164 (27%) have died.

No source has been determined – yet.

South Africa’s laws governing products liability closely parallel those found in many US jurisdictions. While the country has long-recognized that a manufacturer of unfit food can be held civilly liable in negligence, legislation introduced almost decade ago codified strict products liability principles applicable to every entity in a product’s supply chain. Further, South Africa also holds entities in a supply chain criminally liable for making contaminated or unfit food available to consumers.

Prior to enacting legislation in the early 2000’s, South African manufacturers of food could be held civilly liable under principles similar to those common in US tort law. Specifically, claimants alleging injury caused by unfit food could demonstrate that an entity was negligent in its manufacture of the product. The Muzik v. Cansone Del Mare case is a well-known example of a food-poisoning litigation where the court found in favor of a victim claiming a restaurant’s negligent preparation and service of seafood caused his serious injuries. The restaurant, Cansone Del Mare, served Muzik contaminated mussels which made him severely ill and led to his hospitalization. He subsequently sued the restaurant, and was awarded damages including his medical bills, lost wages, and loss of enjoyment of life because his fear of being poisoned again prevented him from enjoying a previously-loved food.

A few years after Muzik, South Africa provided foodborne illness claimants a powerful avenue of recovery when it enacted the Consumer Protection Act No. 68 of 2006 (CPA). Section 61 of the CPA establishes broad strict liability principles, specifically holding everyone in the supply chain of a product—manufacturers, importers, distributors, and retailers—liable for any harm their product causes, irrespective of whether or not they behaved negligently. The elements of strict products liability in South Africa is near-identical to the burden in the US: a claimant need only prove that their injury or illness was caused by (1) the supply of an unsafe product, (2) a product failure, defect, or hazard in the product, or (3) inadequate instructions or warnings. 61(1)(a)—(c).[1]

If a claimant prevails in demonstrating her burden, the responsible parties are held jointly and severally liable for, “the death of, or injury to, any natural person; an illness of any natural person…and any economic loss that results from,” that death, injury, or illness. 61(5)(a)—(d). While initially appearing to be broad-sweeping legislation, Section 61 may also limit the liability of so-called “passive retailers”—entities who merely obtain pre-prepared food to sell to consumers. The relevant language bars liability if, “it is unreasonable to expect the distributor or retailer to have discovered that the unsafe product characteristic, failure, defect or hazard, having regard to that person’s role in marketing the goods to consumers.” 61(4)(c).

Finally, despite its many similarities to US product liability laws, South Africa also holds entities criminally liable for making contaminated or unfit food available to the public. The Food, Cosmetics and Disinfectants Act 54 of 1972 makes it a criminal offense for any person to, “sell[], manufacture[] or import for sale, any foodstuff which is contaminated, impure or decayed, or is, in terms of any regulation deemed to be harmful or injurious to human health.” (2)(1)(b)(i). If the criminal offense is committed by an employee of a food service establishment, such liability attaches to the employer unless he can demonstrate that he took all reasonable measures to prevent the act or omission that led to the offense. (8)(1).[2]

__________

[1]           Section 53 of the CPA defines a “defect” as, “(i) any material imperfection in the manufacture of the goods or components, or in performance of the services, that renders the goods or results of the service less acceptable than persons generally would be reasonably entitled to expect in the circumstances; or (ii) any characteristic of the goods or components that renders the goods or components less useful, practicable or safe than persons generally would be reasonably entitled to expect in the circumstances.”

[2]           Simply forbidding the particular act or omission is insufficient to avoid liability. (8)(2).

At least 872 sickened – no cause of outbreak yet discovered.

Wendy Knowler of the Johannesburg Sunday Times reports that the National Institute for Communicable Diseases (NICD) continues to try and pinpoint what has now become the largest Listeria death toll in the world.

The number of confirmed listeriosis cases is now 872, and 164 of those have died – up from 107 last week. The current mortality rate is a staggering 27%.

Of those confirmed cases, 43% were babies of less than a month old – pregnant women being 20 times more likely to get listeriosis than other healthy adults.

Contracted by eating food containing the listeria pathogen, listeriosis is by far the deadliest of foodborne diseases.

I got to speak today to the listeriosis workshop hosted by the South African Association of Food Science and Technology (SAAFoST) in Johannesburg via a webinar.  Here is the link to my speech outline:

https://www.slideshare.net/marlerclark/2018-south-africa-food-focus-webinar

I have thought a lot over the last 25 years about what lessons can be drawn from the tragedy that was the 1993 Jack in the Box E. coli O157:H7 outbreak. Knowing the children—many who are now nearing 35—who still bear the scars of eating a hamburger, and knowing the parents of those who died, makes it difficult for me to see the benefit of those losses.

My first reaction is, “Why does it always seem to take a tragedy before we seem to be able to act?” Whether it was reinforcing the cockpit doors after the horror of 9/11, or now finally having a dialogue about automatic weapons post-Newtown, we have seemed nearly incapable of preventing a tragedy before it has happened multiple times, or with such force that ignoring it any longer is impossible. Frankly, not being able to look ahead to prevent disasters seems so ingrained in human DNA that I am not sure of a ready fix.

Human evolution aside, I think there are lessons that can be learned from Jack in the Box that have meaning in the food safety world both in the past and in the future. First, like all food safety failures, and the outbreaks that stem from them, the Jack in the Box outbreak was completely preventable—in other words, Jack in the Box had warnings enough to have prevented the outbreak. And second, after the outbreak there will always be facts—and documents—that prove it.

In March of 1992 the Washington State Board of Health mandated that the internal cook temperature for ground beef should be 155 degrees, not the 140 degrees that all other of the 49 states used based on the Federal Food Code. Washington was ahead of the curve because health officials had investigated an earlier outbreak linked to undercooked ground beef. Officials reached out to all restaurants in the State with the new standards. Although Jack in the Box leaders initially claimed that they knew nothing of the changes—and perhaps they did not directly—but the new standards were found in files in corporate headquarters in San Diego.

Finding the Washington State Food Code in the bottom drawer of a cabinet was certainly not the best “find” in the litigation. Far from it; a bit of context might be in order.

Although the outbreak was announced in mid-January 1993, aggressive litigation and discovery did not really commence until late 1993. It lasted through the end of 1994. During that time, I received nearly 50 boxes of paper from the lawyers representing Jack in the Box and its meat suppliers. From those documents and the dozens of depositions taken, it became clear that Jack in the Box had more than just the new cook temperatures in its desk drawer. Scattered (on purpose) within the boxes were documents that showed that Jack in the Box knew of the new cook-temperature guidelines and simply chose to ignore them.

On June 18, 1992—five months before the Jack in the Box E. coli outbreak struck its hometown of San Diego and seven months before it would hit the Pacific Northwest—Wendy Cochinella, the shift leader at the Arlington, Washington restaurant faxed the below “IN THE SUGGESTION BOX” to Jack in the Box corporate headquarters in San Diego:

She wrote:

“I think regular patties should cook longer. They don’t get done and we have customer complaints.”

“If we change this we will be making our burgers done and edible.”

After just over a month, Wendy (and most of the Jack in the Box food safety team) received the below response from corporate headquarters. Wendy also received a pen highlighter (I always thought they should have made her at least Vice-President):

It reads:

We have received your suggestion regarding increasing the cook time for our regular patties.

Your suggestion is currently being researched within the corporate offices. You will again be notified with more detail as soon as a decision has been made regarding this suggestion.

We would like to acknowledge the time and effort you have taken to contribute to the success of JACK IN THE BOX by enclosing this pen/highlighter. Each person submitting suggestions is eligible to receive one gift per quarter with their first suggestion.

But it did not end there. No, Jack in the Box wanted to see if they could make “[their] burgers done and edible.” What they found in their corporate kitchen was that sometimes they could reach internal temperatures of 155 degrees and above on new grills with the two-minute cook time, but often—too often—internal temperatures of 140 degrees or below were reached on older grills with the two-minute cook time. E. coli O157:H7 bacteria can survive at 140 degrees for two minutes, but not at 155.

So, what was the response?

Yes, you guessed it, the two-minute cook time was more important than having “burgers done and edible.” Wendy’s next communication from corporate headquarters indicated that a cook time longer than two minutes made burgers “tough.”

Wendy and the Jack in the Box food safety team received the following communication from superiors:

We have researched your suggestion and determined that with the variability of our grill temperatures (350° – 400°) the two-minute cook time is appropriate. If the patties are cooked longer than two minutes, they tend to become tough. To ensure that you are meeting quality expectations for regular patties, please ensure that the grill temperature is correct and grill personnel are using proper procedures.”

And, as they say, the rest is history—a tragic history.  Weeks after the outbreak was announced Jack in the Box changed the cook time from two minutes to two minutes and fifteen seconds – yes, fifteen seconds.

  • Multistate Salmonella Outbreak, Jimmy John’s Restaurants Sprouts 2018

As of January 18, 2018, eight people infected with the outbreak strain of Salmonella Montevideo have been reported from Illinois, Wisconsin and Minnesota. Illnesses started on dates ranging from December 20, 2017 to January 3, 2018. Ill people range in age from 26 to 50, with a median age of 34. All 8 (100%) are female. No hospitalizations and no deaths have been reported.  Evidence indicates that raw sprouts served at Jimmy John’s restaurants are a likely source of this multistate outbreak.

Federal, state, and local health and regulatory officials are conducting traceback investigations from the six Jimmy John’s locations where ill people ate raw sprouts. These investigations are ongoing to determine where the sprouts were distributed, and to learn more about the potential route of contamination. 

  • Multistate E. coli O121 Outbreak, Jimmy John’s Restaurants Alfalfa Sprouts 2014

19 Sickened – Public health officials in California, Idaho, Michigan, Montana, Utah and Washington collaborated with their federal partners at the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to investigate an outbreak of E. coli O121 that occurred in May 2014.  A total of 19 persons with the outbreak strain, identified by PulseNet PFGE Pattern Identification Numbers EXKX01.0011/EXKA26.0001, were reported.  Among persons for whom information was available, dates of illness onset ranged from May 1, 2014 to May 20, 2014.  Ill persons ranged from 11 years to 52 years.  Seven of 16 persons for whom information was available were hospitalized.  No ill person developed hemolytic uremic syndrome and no deaths were reported.

Epidemiologic and traceback investigations conducted by public health officials implicated raw clover sprouts produced by Evergreen Fresh Sprouts, LLC of Hayden, Idaho as the likely source of this outbreak.  Thirteen (81%) of 16 ill persons reported eating raw clover sprouts in the week before becoming ill.  Ill persons in Washington and Idaho reported eating sprouts in sandwiches at several local food establishments including several Jimmy John’s Gourmet Sandwiches locations, the Pita Pit, and Daanen’s Deli.

As part of the investigation the FDA performed a traceback analysis and determined that Evergreen Fresh Sprouts supplied sprouts to seven restaurants with outbreak associated cases.  This analysis used documents collected directly from the distributors and the grower, Evergreen Fresh Sprouts, as well as documents collected by the states from the points of service.

The FDA conducted several inspections at the Evergreen Fresh Sprouts facility in May and June.  During the inspections FDA investigators observed a number of unsanitary conditions, including condensate and irrigation water dripping from rusty valves, a rusty and corroded watering system in the mung bean room, tennis rackets (used to scoop mung bean sprouts) that had scratches, chips and frayed plastic; a pitchfork (used to transfer mung bean sprouts) that had corroded metal, and a squeegee (used to agitate mung bean sprouts inside a soak vat) that had visible corroded metal and non-treated wood.

On June 26, 2014 the FDA and CDC held a meeting with the owner of Evergreen Fresh Sprouts to advise the firm of FDA’s concerns that the seed lot used to row clover sprouts linked to this outbreak might be contaminated and to encourage Evergreen Fresh Sprouts to discontinue using that seed lot.  The owner of Evergreen Fresh Sprouts agreed to stop using the suspected lot of seeds.

  • Multistate E. coli O26 Outbreak, Jimmy John’s Restaurants Alfalfa Sprouts 2012

29 Sickened – A total of 29 individuals infected with the outbreak strain of E. coli O26 were reported from 11 states, including:  Alabama (1), Arkansas (1), Iowa (5), Kansas (2), Michigan (10), Missouri (3), Ohio (3), Pennsylvania (1), Washington (1), Wisconsin (1), and West Virginia (1).

Of the 27 ill persons with available information, 23 (85%) reported consuming sprouts at Jimmy John’s restaurants in the 7 days preceding illness.  Among 29 ill persons, illness onset dates ranged from December 25, 2011 to March 3, 2012.  Ill persons range in age from 9 years to 57 years old, with a median age of 26 years.  89% of ill persons are female.  Among the 29 ill persons, 7 (24%) were hospitalized. None developed HUS, and no deaths were reported.

Preliminary traceback information identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John’s restaurant locations where ill persons ate.  FDA and states conducted a traceback that identified two separate sprouting facilities; both used the same lot of seed to grow clover sprouts served at these Jimmy John’s restaurant locations.  On February 10, 2012, the seed supplier-initiated notification of sprouting facilities that received this lot of clover seed to stop using it.

Results of the epidemiologic and traceback investigations indicated eating raw clover sprouts at Jimmy John’s restaurants was the likely cause of this outbreak.

  • Sprouters Northwest, Jimmy John’s Restaurants Clover Salmonella Sprouts Outbreak 2010

7 Sickened – Sprouters Northwest of Kent, Washington, issued a product recall after the company’s clover sprouts had been implicated in an outbreak of Salmonella Newport in Oregon and Washington. At least some of the cases had consumed clover sprouts while at a Jimmy John’s restaurant. Jimmy John’s Restaurants are a restaurant chain that sells sandwiches. Concurrent with this outbreak, a separate Salmonella outbreak (Salmonella, serotype I 4,5,12,i- ; see Multistate Outbreak, Tiny Greens Organic Farm, Jimmy John’s Restaurants), involving alfalfa sprouts served at Jimmy John’s restaurants was under investigation. The recall of Northwest Sprouters products included: clover; clover & onion; spicy sprouts; and deli sprouts. The Sprouters Northwest products had been sold to grocery stores and wholesale operations in Washington, Oregon, Idaho, Alaska, British Columbia, Saskatchewan, and Alberta. The FDA inspection found serious sanitary violations.

  • Multistate Salmonella Outbreak, Tiny Greens Organic Farm, Jimmy John’s Restaurants Alfalfa Sprouts 2010

140 Sickened – On December 17, the Illinois Department of Health announced that an investigation was underway into an outbreak of Salmonella, serotype I4,[5],12:i:-. Many of the Illinois cases had eaten alfalfa sprouts at various Jimmy John’s restaurants in the Illinois counties of: Adams, Champaign, Cook, DuPage, Kankakee, Macon, McHenry, McLean, Peoria, and Will counties. The sprouts were suspected to be the cause of the illnesses. On December 21, Jimmy John Liautaud, the owner of the franchised restaurant chain, requested that all franchisees remove sprouts from the menu as a “precautionary” measure. On December 23, the Centers for Disease Control revealed that outbreak cases had been detected in other states and that the outbreak was linked with eating alfalfa sprouts while at a nationwide sandwich chain. On December 26, preliminary results of the investigation indicated a link to eating Tiny Greens’ Alfalfa Sprouts at Jimmy John’s restaurant outlets. The FDA subsequently advised consumers and restaurants to avoid Tiny Greens Brand Alfalfa Sprouts and Spicy Sprouts produced by Tiny Greens Organic Farm of Urbana, Illinois. The Spicy Sprouts contained alfalfa, radish and clover sprouts. On January 14, 2011, it was revealed that the FDA had isolated Salmonella serotype I4,[5],12:i:- from a water runoff sample collected from Tiny Greens Organic Farm; the Salmonella isolated was indistinguishable from the outbreak strain. The several FDA inspections of the sprout growing facility revealed factors that likely led to contamination of the sprouts.

  • CW Sprouts, Inc., SunSprout Sprouts, “restaurant chain (Chain A),” a.k.a. Jimmy John’s Salmonella Outbreak 2009

256 Sickened – In February, Nebraska Department of Health and Human Services officials identified six isolates of Salmonella Saintpaul. Although this is a common strain of Salmonella, during 2008, only three cases had been detected in Nebraska and only four subtypes of this outbreak strain had been identified in 2008 in the entire USA. As additional reports were made, a case control study was conducted; alfalfa sprout consumption was found to be significantly related to illness. The initial tracebacks of the sprouts indicated that although the sprouts had been distributed by various companies, the sprouts from the first cases originated from the same sprouting facility in Omaha, Nebraska. Forty-two of the illnesses beginning on March 15 were attributed to sprout growing facilities in other states; these facilities had obtained seed from the same seed producer, Caudill Seed Company of Kentucky. The implicated seeds had been sold in many states. On April 26, the FDA and CDC recommended that consumers not eat raw alfalfa sprouts, including sprout blends containing alfalfa sprouts. In May, FDA alerted sprout growers and retailers that a seed supplier, Caudill Seed Company of Kentucky, was withdrawing all alfalfa seeds with a specific three-digit prefix.  Many of the illnesses occurred at “restaurant chain (Chain A).”

  • Jimmy John’s Restaurant Alfalfa Sprouts and Iceberg Lettuce E. coli Outbreak 2008

28 Sickened – Several University of Colorado students from one sorority became ill with symptoms of bloody diarrhea and cramping. Additional illnesses were reported. E. coli O157:NM(H-) was determined to be the cause. Consumption of alfalfa sprouts at the Jimmy John’s Restaurants in Boulder County and Adams County were risk factors for illness. In addition, the environmental investigation identified Boulder Jimmy John’s food handlers who were infected with E. coli and who had worked while ill. The health department investigation found a number of critical food handling violations, including inadequate handwashing. The fourteen isolates from confirmed cases were a genetic match to one another.

According to the Pierce County Department of Health, the week started with 41 reports of ill diners, which led to the closure of El Toro in Tacoma’s Westgate neighborhood Monday. By Wednesday, reports of ill customers had extended to its sister restaurant in University Place and that location also closed for sanitizing.

So far, about 10-15 people have reported illness after dining at the University Place location at 3820 Bridgeport Way W. The Tacoma location had 391 reports as of Thursday at its Westgate location at 5716 N. 26th St.

Diners who became ill reported they dined at the University Place location Jan. 6. At the Westgate location, diners became ill after visiting the restaurant between Dec. 31 and Jan. 8.

There might be more: The health department still is investigating reports. The numbers could increase.

“We don’t yet have an exact number because we have not interviewed all the people who have made illness reports. We continue to receive additional illness reports,” the health department said in a statement.

“We know two staff members at the Tacoma location worked while ill during the time customers there dined and later got sick. It’s still unclear if the outbreaks at the two locations are connected,” the health department reported. “Because of the nature of norovirus outbreaks, we may never know the exact affected items that caused illness. We know all the cases have dining at the El Toro Restaurants in common.”

If you ate at an El Toro and became ill, contact the health department to file a report at 253-798-4712. Email food@tpchd.org or make an online report at tpchd.org/reportfoodborneillness.

Vomiting, diarrhea and generally feeling horrible. Also, some patients will experience a fever and headache. If you’re struck with norovirus, staying hydrated is important. The illness usually lasts one to three days. Symptoms after an infection can appear between 12 to 48 hours later.

The CDC, several states, and the FDA are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections in 13 states. Seventeen illnesses have been reported from California (3), Connecticut (2), Illinois (1), Indiana (1), Michigan (1), Nebraska (1), New Hampshire (2), New York (1), Ohio (1), Pennsylvania (1), Virginia (1), Vermont (1) and Washington (1). Illnesses started on dates from November 15 through December 8, 2017. Two individuals developed HUS and there has been one death in California.

On December 28, the CDC announced that because the CDC has not identified a source of the infections, CDC is unable to recommend whether U.S. residents should avoid a particular food. This investigation is ongoing, and more information will be released as it becomes available.

In Canada, the Public Health Agency of Canada has identified romaine lettuce as the source of the outbreak in Canada. Currently, there are 41 cases of E. coli O157 illness under investigation in five eastern provinces: Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 3 and 85 years of age. The majority of cases (73%) are female.

On December 28, the Public Health Agency of Canada announced that because of the ongoing risk in eastern Canada, the Public Health Agency of Canada is advising individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

On January 3, 2018, Food safety experts at Consumer Reports are advising that consumers stop eating romaine lettuce until the cause of the outbreak is identified and that product is removed from store shelves.

I certainly understand that many romaine lettuce growers would like the CDC to call the “outbreak over” because the last onset of illness – thus far in the US – was December 8, and given that lettuce is a perishable product, it is not likely the product is still in stores or restaurants.  Generally, I would agree with that, however, because neither Canada or the US has been able to confirm where the contamination occurred – on farm, in processing, in transit – I think I agree with the Canadian and Consumer Reports approach – “When in doubt, throw it out.”

There have been several romaine lettuce related E. coli outbreaks in both Canada and the United Sates in the past decades.

In April 2012, an outbreak of E. coli O157 which sickened 28 was linked to romaine lettuce grown and distributed by Amazing Coachella Inc., which is the parent company of Peter Rabbit Farms, both based in Coachella, California. Health officials in New Brunswick, Canada identified at least 24 people with bloody diarrhea beginning on April 23, 2012. Ill persons lived in the communities of Miramichi, St. John and Bathurst. Most of the patient’s laboratory confirmed with E. coli O157:H7 ate at Jungle Jim’s Restaurant in Miramichi. Food samples collected at Jungle Jim’s were negative for E. coli O157:H7. On June 29, 2012, the Government of New Brunswick issued a press release saying that a case control study involving 18 ill persons and 37 non-ill persons linked illness to consumption of romaine lettuce. The strain found in ill persons in this outbreak was also isolated in persons in Quebec and in at least 9 people California. Most of the California victims ate at a “single unnamed restaurant” according to California public health officials.

In October 2011, an outbreak of E. coli O157:H7 which sickened 58, was first identified in the region around Saint Louis, Missouri. Cases were found in Saint Louis, Jefferson, Saint Charles, and Saint Clair counties and in the city of Saint Louis. The cases ranged in age from 1 to 94. At least six persons were hospitalized. Many of the cases had eaten items from salad bars prior to becoming ill. On October 28, Illinois state health officials revealed that they were investigating an illness that might be linked to the outbreak in Missouri. The link was not described. On October 31, health department officials acknowledged that Schnucks salad bars were a focus of the investigation, however other sources had not been excluded. Cases were identified in Minnesota and Missouri that were linked to college campuses. Additional cases were found in other states; the exposure location in these states was not described. Traceback analysis determined that a common lot of romaine lettuce, from a single farm, was used to supply the Schnucks’ grocery stores and the college campuses. The lettuce was sold to Vaughn Foods, a distributor, that supplied lettuce to the university campus in Missouri, but records were not sufficient to confirm that this lot was sent to this university campus. Preliminary findings of investigation at farm did not identify the source of the contamination.

In May 2010, Cases of a genetically-identical strain of E. coli O145 which sickened 33 were identified in the states of Michigan, Ohio, Tennessee, Pennsylvania, and New York. Illness onsets occurred between April 10 and 26. Several of the cases were students at Ohio State University, the University of Michigan, and Daemen College (Buffalo, New York). Several of the ill in Ann Arbor, Michigan, had eaten at a common restaurant. At least four students in the Wappinger Central School District, in New York State, were also involved in the outbreak. Shredded lettuce served in the school district tested positive for E. coli bacteria. Romaine lettuce was named as the vehicle for this outbreak, on May 6, after the same strain of E. coli O145 was found in a Freshway Foods romaine lettuce sample in New York state. Freshway Foods issued a voluntary recall of various bagged lettuces. The traceback investigation suggested that the source of the lettuce was a farm in Yuma, Arizona. In Ohio, a second, independent strain, of pathogenic E. coli was isolated from Freshway Foods bagged, shredded, romaine lettuce, E. coli O143:H34. This strain was not linked to any known food-borne illness. The isolation of the second strain of E. coli led to an additional recall of lettuce. Andrew Smith Company, of California, launched a recall of lettuce sold to Vaughan Foods and to an unidentified third firm in Massachusetts. Vaughan Foods of Moore, Oklahoma, received romaine lettuce harvested from the same farm in Yuma, Arizona; the romaine lettuce had been distributed to restaurants and food service facilities.

In September, 2009, a cluster of 29 patients who had been infected with an indistinguishable strain of E. coli O157:H7 was identified. Initially case-patients were identified in Colorado, Utah, and New York State. Additional case-patients were identified subsequently in South Dakota, Wisconsin, and North Carolina. The Colorado case-patients had all eaten at the same Chipotle Restaurant in Boulder, Colorado, on September 4, 2009. In Utah, all case-patients had eaten at the Cafe Rio Restaurant located in Salt Lake City, Utah, between August 31 and September 4, 2009. The New York State case patient had eaten at a Chipotle Restaurant. A case control study involving Utah and Colorado case-patients was conducted; it showed that eating romaine, or iceberg, lettuce was associated with risk of illness. The New York State case-patient had eaten romaine lettuce at the Chipotle Restaurant. A traceback of the romaine lettuce led to a common harvester/shipper, Church Brothers, LLC, located in Salinas, California. No lettuce remained for testing and environmental samples collected at Church Brothers, LLC, did not show the presence of E. coli O157:H7. Investigation of the cases in South Dakota, Wisconsin, and North Carolina did not provide useful information for the trace-back investigation. Lettuce was the most likely vehicle for this outbreak because of the common lettuce source for the cases in Utah, Colorado, and New York State. These cases represented 16 out of the 19 confirmed cases. Although Cotija cheese, pinto beans, and pico de gallo consumption were also associated with illness, it was likely that these results reflected confounding as lettuce is usually served with these ingredients in Mexican style restaurants. Cotija cheese was not used in the Colorado and New York Chipotle Restaurants. A common source of cilantro, the most suspect ingredient in pico de gallo, was not identified for Cafe Rio or for the Chipotle Restaurants.

In September 2009, public health officials in Colorado, Minnesota, North Carolina, Iowa, Connecticut, and Missouri identified a cluster of 10 patients with an indistinguishable strain of E. coli O157. The cluster was assigned 0910MLEXH-1. Two Colorado cases ate at Giacomos, a restaurant located in Pueblo, Colorado on the same date, September 6. Cases in Minnesota and Iowa ate at the same restaurant in Omaha, Nebraska. The suspected source of the outbreak was romaine lettuce.

In October 2008, an outbreak of E. coli O157:H7 which sickened 12 was associated with eating at M.T. Bellies Restaurant, Welland, Ontario, Canada. This was one of four, concurrent, restaurant-associated, outbreaks of E. coli O157:H7 that occurred in Ontario, Canada. Romaine lettuce was the suspected outbreak vehicle in this outbreak.

In October 2008, Johnathan’s Family Restaurant in Burlington, Ontario, Canada, was implicated in an outbreak of E. coli O157:H7 which sickened 43 involving romaine lettuce. This outbreak was one of four, concurrent, restaurant-associated outbreaks in Ontario, Canada. The E. coli O157:H7 strain was said to be different from the strain of E. coli O157:H7 outbreak associated with the Harvey’s Restaurant (235 sick) in North Bay, Ontario, the largest of the four outbreaks. The E. coli O157:H7 strain from Johnathan’s was said to be the same as the strain implicated in the restaurant outbreaks occurring at Little Red Rooster (21 sick) and M.T. Bellies Restaurants (12 sick).

In September 2005, genetic fingerprinting test results for an E. coli O157:H7 isolate were posted by the state of Minnesota on the national PulseNet website. Later the state of Minnesota received additional reports of illness among persons who were found to carry the same strain of E. coli O157:H7 bacteria. Epidemiologists, through food histories and a case control study, identified pre-packaged, bag lettuce, produced by the Dole Food Company, Inc., as the likely vehicle of transmission. E. coli O157:H7 was subsequently found in bagged lettuce samples and a public health alert and a FDA recall about the product was issued. Oregon and Wisconsin also found case-patients who had eaten the lettuce. The total number of sickened was 32.

In July 2002, an outbreak of E. coli O157:H7 which sickened 78 occurred among attendees of a dance camp held between July 11-14 on the campus of Eastern Washington University. The camp was for middle and high school girls. Attendees were from Washington, Montana, and Minnesota. Some of the ill girls attended a church camp in Spokane at the conclusion of the dance camp. Secondary cases were subsequently reported at the church camp and also in the girls’ home communities. The cases shared a Pulsed Field Gel Electrophoresis (PFGE), genetic fingerprint, pattern. Case-control study results strongly showed that the Caesar salad, made with Romaine lettuce and served during the July 11 dinner meal and the July 12 lunch, was associated with illness.

Food Safety News reports that the investigation continues, but initial test results show turkey was the source of Salmonella that sickened employees at a pre-Thanksgiving dinner at a Georgia tire factory.

At least five people had to be hospitalized and lab tests confirmed dozens were suffering from Salmonella infections after the Nov. 14-15 catered meals at the Toyo Tire production plant in White, GA. Angelo’s New York Style Pizza and Bistro of Cartersville, GA, catered the two-day event, which included turkey.

“Preliminary findings implicate catered turkeys as the cause of a recent Salmonella outbreak among employees attending an event at Toyo Tire,” according to Logan Boss, risk communicator for the Georgia Department of Health.

The Georgia Department of Public Health Northwest Health District continues the investigation to confirm the test results. Representatives of the department interviewed about 1,800 Toyo Tire employees after the department started getting reports of illnesses.

Angelo Nizzari, owner of the implicated restaurant, issued a statement in late November through his attorney John T. Mroczko. Nizzari said he was heartbroken about the incident and offered his sympathy to those sickened in the outbreak.

The restaurant closed temporarily for cleaning. Health department officials inspected it and Angelo’s reopened Nov. 22. Employees of the restaurant received “rigorous training in safe food handling from Bartow County Health Department environmental health specialists,” the department reported.

The Washington State Department of Health announced today a Salmonella outbreak involving pre-cut watermelon, cantaloupe, or fruit mixes containing watermelon or cantaloupe in both Washington and Oregon.

People who purchased these products on or about Oct. 25 up to Dec. 1 from QFC, Fred Meyer, Rosauers, and Central Market in Washington and Oregon are urged not to eat the fruit and throw it away.

Eighteen people from King (5), Mason (1), Pierce (1), Snohomish (7), Thurston (1), and Yakima (1) counties and two individuals from Oregon have been diagnosed with Salmonella.

Lab results identified Salmonella Newport as the cause.

In Minnesota, the Bemidji Pioneer reported two Burger King restaurants in Bemidji temporarily closed Thursday after more than two dozen people contracted salmonella after eating there.  Doug Schultz, a spokesperson with the Minnesota Department of Health, said the department has confirmed 27 cases, and received reports of four more probable cases.

Both Burger King sites voluntarily decided to close Thursday. Most cases were identified in September, he said, but the victims may have been exposed to salmonella before then. Two additional cases came to light this week, prompting the closures.

 

According to local press reports, Westchester County has treated 250 people who may have been exposed to hepatitis A at Sleepy Hollow Country Club, officials said today.

Those people received preventive treatment after a club employee was infected by one of the five people who were exposed to hepatitis A at bartaco in Port Chester, said Caren Halbfinger, a spokeswoman for the Westchester Department of Health.

The department is offering free treatment at its clinic at 134 Court St. in White Plains for anyone who ate or drank at the club between Oct. 30 and Nov. 4.

The Health Department will offer hepatitis A vaccine to most people. Infants under 1 year old and people with immune-compromising conditions will be given immune globulin.

The county clinic is providing treatment from 9 a.m. to 4 p.m. today and Tuesday, 9 to 11 a.m. on Wednesday and Thursday, and 9 a.m. to 3 p.m. on Friday. Officials said treatment is most effective within two weeks of exposure.

Phelps Hospital in Sleepy Hollow is offering treatment for anyone who attended its gala at the country club on Nov. 3. Treatment is available at the hospital at 755 N. Broadway from 10 a.m. to 5 p.m. Monday through Friday this week.

Anyone who ate or drank at the club between Oct. 21 and Oct. 29 may also have been exposed, but the treatment is only effective within two weeks of exposure, officials said. Anyone who is too late for treatment is still urged to contact their health care provider immediately, though, so that anyone they may have exposed can receive treatment.

Health officials said they did not expect this outbreak to affect as many as people as bartaco’s outbreak, which included treatment of more than 3,000 people who were potentially exposed to hepatitis A.

Not  to be confused with the Seven Deadly Sins: pride, greed, lust, envy, gluttony, wrath and sloth, although, perhaps some of these outbreaks were sinful.  I had the honor to represent many of the ill and the families of those who died.

Jack-in-the- Box E. coli Outbreak – 1992 – 1993

708 ill, 171 hospitalized and 4 dead

An outbreak of E. coli O157:H7 was linked to the consumption of hamburgers from the Jack-in-the-Box Restaurant chain. Cases were reported from the states of Washington (602 cases/144 hospitalizations/3 deaths), Idaho (14 cases/4 hospitalizations/no deaths), California (34 cases/14 hospitalizations/1 death), and Nevada (58 cases/9 hospitalizations/no deaths). A case control study implicated the chain’s hamburgers resulting in a multistate recall of the remaining hamburgers. Only 20 percent of the product remained at the time of the recall; this amounted to 272,672 hamburger patties. Subsequent testing of the hamburger patties showed the presence of E. coli O157:H7. The strain of E. coli O157:H7 found in ill people matched the strain isolated from uncooked hamburger patties. The outbreak illustrated the potential for large, foodborne illness outbreaks associated with restaurant chains receiving shipments of contaminated food. At the time, many clinical laboratories in the United States were not routinely culturing patients’ stool for E. coli O157:H7 by using the correct culture medium. Additionally, many local and state health departments were not actively tracking and investigating E. coli O157:H7 cases.


Chi Chi’s Green Onion Hepatitis A Outbreak – 2003

565 ill, 130 hospitalized and 3 dead

Pennsylvania State health officials first learned of a hepatitis A outbreak when unusually high numbers of hepatitis A cases were reported in late October 2003. All but one of the initial cases had eaten at the Chi Chi’s restaurant at the Beaver Valley Mall, in Monaca, PA. Ultimately, at least 565 cases were confirmed. The victims included at least 13 employees of the Chi Chi’s restaurant, and residents of six other states. Three people died as a consequence of their hepatitis A illnesses. More than 9,000 people who had eaten at the restaurant, or who had been exposed to ill people, were given a post-exposure injection as a prevention against developing hepatitis A. Preliminary analysis of a case-control study indicated fresh, green onions were the probable source of this outbreak. The investigation and tracebacks by the state health department, the CDC, and the FDA, confirmed that the green onions had been grown in Mexico.


Dole Baby Spinach E. coli Outbreak – 2006

238 ill, 103 hospitalized and 5 dead

On Sept. 13, 2006, public health officials in Wisconsin, Oregon and New Mexico noted E. coli O157:H7 infections with matching pulsed-field gel electrophoresis (PFGE) patterns. These illnesses were associated with eating fresh, bagged spinach produced by Dole Brand Natural Selection Foods. By Sept. 26 that year, infections involving the same strain of E. coli O157:H7 had been reported from 26 states with one case in Canada. A voluntary recall was issued by the company on Sept. 15. E. coli O157: H7 was isolated from 13 packages of spinach supplied by patients in 10 states. Eleven of the packages had lot codes consistent with a single manufacturing facility on a particular day. The PFGE pattern of all tested packages matched the PFGE pattern of the outbreak strain. The spinach had been grown in three California counties – Monterey, San Benito and Santa Clara. E. coli O157:H7 was found in environmental samples collected near each of the four fields that provided spinach for the product, as designated by the lot code. However, E. coli O157:H7 isolates associated with only one of the four fields, located on the Paicines Ranch in San Benito County, had a PFGE pattern indistinguishable from the outbreak strain. The PFGE pattern was identified in river water, cattle feces and wild pig feces on the Paicines Ranch, the closest of which was less than one mile from the spinach field.


Peanut Corporation of America Salmonella Outbreak – 2008 – 2009

714 ill, 171 hospitalized and 9 dead

Beginning in November 2008, CDC’s PulseNet staff noted a small and highly dispersed, multistate cluster of Salmonella Typhimurium isolates. The outbreak consisted of two pulsed-field gel electrophoresis (PFGE) defined clusters of illness. Illnesses continued to be revealed through April 2009, when the last CDC report on the outbreak was published. Peanut butter and products containing peanut butted produced at the Peanut Corporation of America plant in Blakely, GA, were implicated. King Nut brand peanut butter was sold to institutional settings. Peanut paste was sold to many food companies for use as an ingredient. Implicated peanut products were sold widely throughout the USA, 23 countries and non-U.S. territories. Criminal sanctions were brought against the owners of PCA.


Jensen Farms Cantaloupe Listeria Outbreak – 2011

147 ill, 143 hospitalized and 33 dead

A multistate outbreak of Listeria monocytogenes involving five distinct strains was associated with consumption of cantaloupe grown at Jensen Farms’ production fields near Granada, CO. A total of 147 ill people were reported to the CDC. Thirty-three people died, and one pregnant woman miscarried. Seven of the illnesses were related to pregnancy – three newborns and four pregnant women. Among 145 ill people with available information, 143 – 99 percent – were hospitalized. Source tracing of the cantaloupes indicated that they came from Jensen Farms, and were marketed as being from the Rocky Ford region. The cantaloupes were shipped from July 29 through Sept. 10, 2011, to at least 24 states, and possibly distributed elsewhere. Laboratory testing by the Colorado Department of Public Health and Environment identified Listeria monocytogenes bacteria on cantaloupes collected from grocery stores and from ill persons’ homes. Laboratory testing by FDA identified Listeria monocytogenes matching outbreak strains in samples from equipment and cantaloupe at the Jensen Farms’ packing facility in Granada, Colorado.  Criminal sanctions were brought against the two owners of Jensen Farms.


Bidart Caramel Apple Listeria Outbreak

35 ill, 34 hospitalized and 7 deaths

On December 19, 2014, the CDC announced a multistate outbreak of Listeria monocytogenes linked to commercially produced, prepackaged caramel apples. A total of 35 people infected with the outbreak strains of Listeria monocytogenes were reported from 12 states. Of these, 34 were hospitalized. Listeriosis contributed to at least 3 of the 7 deaths reported. Eleven illnesses were pregnancy-related with one illness resulting in a fetal loss. here invasive illnesses were among otherwise healthy children aged 5-15 years. Twenty-eight (905) of the 31 ill persons interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill. The Public Health Agency of Canada identified one case of listeriosis that was genetically related to the US outbreak. The investigation was assigned Cluster ID #1411MNGX6-1. On December 24, 2014, Happy Apples issued a voluntary recall of Happy Apple brand caramel apples with best use by date between August 25th and November 23rd, 2014 due to a connection between the apples and outbreak associated cases. California Snack Foods brand caramel apples issued a similar recall on December 27th. Both companies used apples supplied by Bidart Brothers. On December 29 Merb’s Candies recalled Bionic Apples and Double Dipped Apples. On January 6, 2105 Bidart Bros. of Bakersfield, California recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility. On January 8, 2015 FDA laboratory analyses using PFGE showed that environmental Listeria isolates from the Bidart Bros. facility were indistinguishable from the outbreak strains.


Andrew and Williamson Cucumber Salmonella Outbreak – 2015

907 ill, 204 hospitalized and 6 dead

On September 4, 2015 the CDC announced an outbreak of Salmonella Poona linked to consumption of cucumbers grown in Mexico and imported by Andrew & Williamson Fresh Produce. On March 18, 2016 the outbreak was declared to be over. A total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states. Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Two hundred four ill people were hospitalized and six deaths were reported. Salmonella infection was not considered to be a contributing factor in two of the 6 deaths. Epidemiologic, laboratory, and traceback investigations identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.