Casey Blake of the Asheville Citizen Times reported today that the number of reported cases in a three-month Buncombe-based – Tempeh caused – Salmonella Paratyphi B outbreak is still climbing. The total number of reported cases linked to the outbreak was 83 as of Friday afternoon, 62 of which involved residents of Buncombe County. The total count includes cases of people who visited or otherwise had connections to Buncombe County and were believed to have been exposed to the bacteria here.

Agriculture officials have isolated the strain of salmonella that struck in late February — called paratyphi B — to one ingredient: A starter culture distributed by Tempeh Online of Rockville, Maryland to local company Smiling Hara Tempeh.

From January through April 30, 2012, the California Department of Public Health (CDPH) reports that at least 10 people with campylobacter infection were identified throughout California and reported consuming Organic Pastures raw milk prior to illness onset. Their median age is 11.5 years, with six under 18. The age range is nine months to 38 years. They are residents of Fresno, Los Angeles, San Diego, San Luis Obispo and Santa Clara counties. None of the patients have been hospitalized, and there have been no deaths.

It is becoming a harder for Organic Pastures to defend raw milk so vehemently after the dairy has now been linked to 4 outbreaks and 6 recalls.

In 2006, three strains of E. coli O157:H7 were cultured from Organic Pastures' heifers' feces.  That same year, the dairy was quarantined after six children became ill with E. coli infections - two with hemolytic uremic syndrome - linked to its raw milk.

In 2007, fifty strains of Campylobacter jejuni plus Campylobacter coli, Campylobacter fetus, Campylobacter hyointetinalis, and Campylobacter lari were cultured from OPDC dairy cow feces after eight people were sickened.  See the state report here. 

In 2007, Listeria monocytogenes was cultured from Organic Pastures Grade A raw cream.

In 2008, Campylobacter was cultured from Organic Pastures Grade A raw cream.

In November 2011, a cluster of five young children with Escherichia coli (E. coli) O157:H7 infection with matching pulse-field gel electrophoresis (PFGE) patterns was identified. All five children reported drinking commercially available raw (unpasteurized) milk from a single dairy (Organic Pastures) and had no other common exposures. The epidemiological findings led to a quarantine and recall of all Organic Pastures products except cheese aged more than 60 days. Environmental samples collected at Organic Pastures yielded E. coli O157:H7 isolates that had PFGE patterns indistinguishable from the patient isolates.  

Routine testing by the company revealed the presence of Salmonella in the papayas, according to the recall notice.  The company says no illnesses have been reported.

The recalled Papaya Maradol, Caribeña Brand cases were distributed in the Bronx, New York in wholesale stores and through retail stores from May 14 to May 17, 2012. The papayas were packed in 35 lb. cartons marked with the brand " Caribeña " and " Product of Mexico" stamped on the side. The papayas are sold individually, and each one bears a label that states "3112 CARIBEÑA Papaya MARADOL PRODUCT OF MEXICO www.grandeproduce.com" 

In 2001 Agromod Produce recalled papayas purchased prior to July 23, 2011 after an outbreak of Salmonella Agona that sickened 106 in California, Arizona, New York, Minnesota, Colorado, Washington, Ohio, Pennsylvania, Arkansas, Massachusetts, Georgia, Illinois, Kentucky, Louisiana, Missouri, Nebraska, Nevada, New Jersey, Oklahoma, Tennessee, Texas had been linked to the papayas. The outbreak related illnesses began after January 16 and continued to occur over several months. On August 25, the Food and Drug Administration banned imports of papayas grown in Mexico because of widespread and ongoing salmonella contamination. More than 15 percent of fresh papayas entering the U.S. from Mexico were contaminated with Salmonella.

River Ranch Fresh Foods, LLC, of Salinas, California, initiated the voluntary recall of bagged salads after routine sampling detected Listeria monocytogenes in two packages of shredded iceberg lettuce purchased from retail locations in California and Colorado. The recalled salad products were distributed nationwide to retail and foodservice outlets under various sizes and packaged under the brand names of River Ranch, Farm Stand, Hy-Vee, Marketside, Shurfresh, The Farmer’s Market, Cross Valley, Fresh n Easy, Promark, and Sysco.

While the bagged salads identified above are no longer being sold, CDPH is concerned that consumers may still have some of the recalled products in their homes. Consumers in possession of this recalled lettuce should discard it or return it to the store of purchase for a refund.

Symptoms of Listeria infection may include high fever, headache, and neck stiffness. Infants, the elderly, and people with weakened immune systems are at highest risk for severe illness and death. Listeria infection in pregnant women can lead to miscarriage or stillbirth, premature delivery, or infection of the newborn baby.

Perhaps it has nothing to do with the E. coli cases annoounced in Spartanburg earlier this week, but the timing is interesting.

Foods and G&W Incorporated are voluntarily recalling about 6,908 pounds of ground beef products that may be contaminated with E. coli according to the S.C. meat and poultry inspection department.

The products in the recall were produced between March 2 and May 11 at Lancaster Frozen Foods and between March 2 and April 12 at G&W. Products were delivered to wholesale and retail establishments in South Carolina. One direct delivery went to General IGA in Walterboro, S.C.

The following products are in the recall:

5 pound bulk packages “Lancaster Frozen Foods Fresh Ground Beef” with Est. # 20 inside the SC mark of inspection.

10 pound boxes of beef patties “Lancaster Frozen Foods Ground Beef Patties” with Est. # 20 inside the SC mark of inspection.

Various size tray packs of ground beef “Lancaster Frozen Foods Fresh Ground Beef”

5-lb. bulk packages “G&W Brand Hamburger” with Est. # 30 inside the SC mark of inspection.

10-lb. boxes of hamburger patties “G&W Brand Hamburger Patties” with Est. # 30 inside the SC mark of inspection.

Various size packages of hamburger “G&W Brand Hamburger”

Lab testing by the meat and poultry inspection department confirmed a positive result for E. coli in a ground product at Lancaster Frozen Foods. That lot was held by the company, but additional ungroud product from the same lot had been used in other production lots resulting in the recall.

No illnesses have been reported, but individuals concerned about an illness should contact a healthcare provider.

According to a press release today from the DHEC released (apparently worked on by the restaurant under investigation) the DHEC announced that it “finds no ongoing transmission of disease or current public health threat related to a Spartanburg-area Mexican restaurant.”

The DHEC further announced:

"While it is our policy not to release information during a pending investigation unless it affects the health of the citizens of South Carolina, the El Mexicano on East Main Street in Spartanburg has voluntarily agreed to release its name to the public." DHEC Director Catherine Templeton said. "We’ve found no conclusive link between the restaurant and those who have gotten sick during this outbreak."

Translation: Thank you El Mexicano for jumping in front of the bus. And, although the restaurant is the common denominator to the nearly dozen illnesses – including two children who have developed life threatening hemolytic uremic syndrome – no environmental or food samples tested positive for E. coli O157:H7. However, “[t]he most recent case began experiencing symptoms on May 3 and the restaurant was investigated “on May 11 where the facility scored an “A” rating.” Hmmm, I wonder if the same food was in the restaurant in April that was in the restaurant on May 11, or I wonder if the victims ate the evidence?

My strong suspicion is that DHEC Director Catherine Templeton knows nothing about public health and the good work of epidemiology. My bet is that she also cares a whit about the public’s right to know.

The South Carolina Department of Health and Environmental Control (DHEC)

DHEC is investigating an outbreak of Shiga toxin-producing Escherichia coli (STEC) related to dining at a Spartanburg-area Mexican restaurant during the last week of April, 2012. Preliminary lab results indicate the E. coli serotype being O157:H7. Of the 3 cases interviewed thus far, two reported the infection has progressed to hemolytic uremic syndrome (HUS), a severe condition associated with STEC infection that can lead to kidney failure. Interviews with an additional 8 cases are in progress.

A quick internet search found these restaurants in Spartanburg meeting the description:

1. Bronco Mexican Restaurant

2. Corona Mexican Restaurant

3. El Mexicano Restaurant

4. Mexico Lindo East

5. Moe's Southwest Grill

6. Monterrey Mexican Restaurant 

7. Taco Bell

8. Tijuana Restaurant

9. Mexico Lindo

10. Taco Dog

11. Chipotle Mexican Grill

Seriously, how pissed would you be if you owned ten of the restaurants above?  DEHC, if you have enough evidence to announce an outbreak, tell the public where it happened.

Update:  According to comments in Spartanburg Press, it is El Mexicano Restaurant.

The number of ill persons identified in each state is as follows: Alabama (1), Connecticut (1), Michigan (1), Missouri (3), North Carolina (3), New Jersey (1), Ohio (2), Pennsylvania (2), and Virginia (1). One new ill person was reported from Pennsylvania.  Additionally, one ill person has been reported from Canada.

Among the 10 patients with available information, 5 (50%) were hospitalized. No deaths have been reported.

Multiple brands of dry dog food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections.

That’s what one mother told Oregon Public Broadcasting this week.

Jill, who asked not to be identified on-air, described the ordeal that her two-year-old daughter has had to endure since becoming sick from raw milk. 

"She had strokes early on and pressure in the brain, and most recently had emergency surgery to remove some dead bowel and colon. And now has an ostomy, that will get reversed in six to eight weeks," Jill told OPB News.

 Click here to download and listen to the full show.

Jill's child's illness is part of an outbreak at an Oregon farm whose raw milk is the suspected source of an E. coli outbreak that has sickened 19 has now been associated with two more foodborne illness victims.  Health officials also repoted that two adults who had consumed raw milk from Foundation Farm had contracted infections from two different pathogens - Campylobacter and Cryptosporidium.

The US Food and Drug Administration is already involved in tracing the origin of the ingredient to identify source of contamination as well as the potential for other Salmonella outbreaks in the US.

As of May 10 the County Department of Health reported 58 cases associated with salmonella outbreak. North Carolina Department of Public Health reports 63 cases, which includes cases in North Carolina, South Carolina, Tennessee and New York.

Consumers are strongly urged to dispose of any Organic Pastures products of these types remaining in their refrigerators, and retailers are to pull those products immediately from their shelves.

From January through April 30, 2012, the California Department of Public Health (CDPH) reports that at least 10 people with campylobacter infection were identified throughout California and reported consuming Organic Pastures raw milk prior to illness onset. Their median age is 11.5 years, with six under 18. The age range is nine months to 38 years. They are residents of Fresno, Los Angeles, San Diego, San Luis Obispo and Santa Clara counties. None of the patients have been hospitalized, and there have been no deaths.

According to CDPH, symptoms of campylobacteriosis include diarrhea, abdominal cramps, and fever. Most people with campylobacteriosis recover completely. Illness usually occurs 2 to 5 days after exposure to campylobacter and lasts about a week. The illness is usually mild and some people with campylobacteriosis have no symptoms at all. However, in some persons with compromised immune systems, it can cause a serious, life-threatening infection. A small percentage of people may have joint pain and swelling after infection. In addition, a rare disease called Guillain-Barre syndrome that causes weakness and paralysis can occur several weeks after the initial illness.

A Recent Organic Pastures E. coli Outbreak:

In November 2011, a cluster of five young children with Escherichia coli (E. coli) O157:H7 infection with matching pulse-field gel electrophoresis (PFGE) patterns was identified. Illness onsets were from August 25 to October 25, 2011. All five children reported drinking commercially available raw (unpasteurized) milk from a single dairy (Organic Pastures) and had no other common exposures. Statistical analysis of case­ patients' exposures with a comparison group of E. coli O157:H7 patients with non­ cluster PFGE patterns indicated a strong association with raw milk. The epidemiological findings led to a quarantine and recall of all Organic Pastures products except cheese aged more than 60 days, and investigations by the California Department of Public Health (CDPH) Food and Drug Branch (FOB) and the California Department of Food and Agriculture (CDFA). Environmental samples collected at Organic Pastures yielded E. coli O157:H7 isolates that had PFGE patterns indistinguishable from the patient isolates. Organic Pastures raw milk consumed by the case-patients was likely contaminated with this strain of E. coli O157:H7, resulting in their illnesses.  Final Report.

Organic Pastures has been involved in recalls and outbreaks in the past:

Organic Pastures products were recalled for pathogens in 2006, 2007 and 2008. It was tied to a 2007 outbreak of Campylobacter. Most notably, it was quarantined in 2006 after six children became ill with E. coli infections - two with hemolytic uremic syndrome.  The State Report from 2006. 

See also, Raw Milk Myth Buster 1 - Organic Pastures 2006 Raw Milk E. coli Outbreak was caused by Spinach.

2006: 3 strains of E. coli O157:H7 cultured from OPDC heifer feces.  Press Release.

2007: 50 strains of Campylobacter jejuni plus Campylobacter coli, Campylobacter fetus, Campylobacter hyointetinalis, and Campylobacter lari cultured from OPDC dairy cow feces after eight people were sickened.  State Report.

2007: Listeria monocytogenes cultured from Organic Pastures Grade A raw cream.  Press Release.

2008: Campylobacter cultured from Organic Pastures Grade A raw cream.  Press Release.

For more about the risks of raw milk, see Real Raw Milk Facts Dot Com.

The US Food and Drug Administration is already involved in tracing the origin of the ingredient to identify source of contamination as well as the potential for other Salmonella outbreaks in the US.

As of May 10 at 2 PM, Buncombe County Department of Health reports 58 cases associated with salmonella outbreak. Please keep in mind that this number does not include cases being reported in other counties or states.

NC Department of Public Health reports 63 cases, which includes cases in NC and other states; however there is a slight delay in reporting.

“We’ve been in contact with Lone Star and we wanted to let people know that they may have been exposed,” Dr. Ray Nicholson, Health Officer for the Health Department said.

Persons who were exposed and unvaccinated can receive a dose of Hepatitis A vaccine to help lessen the effects of the disease or prevent disease if given within 14 days of exposure. Persons who ate or drank at the Lone Star from April 20-April 26, 2012 could have been exposed to Hepatitis A, but should not receive vaccine because it is not effective for exposure past 14 days. Those people should seek medical care if they show symptoms of Hepatitis A.

Persons who ate at the Lone Star from April 27, 2012 to May 3, 2012 may also have been exposed to the Hepatitis A virus. The Vanderburgh County Health Department and Indiana State Department of Health are working to secure vaccine to offer to anyone who ate at the restaurant from April 27 to May 3, 2012. Information on immunization clinics will be released when the health department receives the vaccine. In the meantime, health officials say to remain on the alert.

Oregon investigators have traced an outbreak of norovirus to a reusable grocery bag that members of a Beaverton girls' soccer team passed around when they shared cookies. The soccer team of 13- and 14-year-olds traveled to Seattle for a weekend tournament in October 2010. At the tournament, one girl got sick on Saturday and spent six hours in a chaperone's bathroom. Symptoms of the bug, often called "stomach flu," include vomiting, diarrhea and stomach cramps. The chaperone took the girl back to Oregon. On Sunday, team members had lunch in a hotel room, passing around the bag and eating cookies it held. On Monday, six girls got sick. Oregon scientists determined they had picked up the norovirus from the grocery bag.

Norovirus causes about 21 million illnesses, 70,000 hospitalizations and 800 deaths a year in the United States.

See full artilce in Journal of Infectious Diseases, Volume 205, Issue 11, Pp. 1639-1641 by Kimberly K. Repp and William E. Keene - "A Point-Source Norovirus Outbreak Caused by Exposure to Fomites."

According the Health Officials, the rare type of Salmonella was traced to Asheville made Smiling Hara Tempeh, a fermented soy bean product. Smiling Hara Tempeh made in Candler was pulled from stores and restaurants in April.

That means the disease is now likely spreading person-to-person.

Approximately 500 packages of affected product were distributed from April 12 through April 17, 2012 from this lot and as of the date of this release, 263 of these packages have already been retrieved from retail stores. Product was distributed to health and natural food retail stores located in the following states: AK, AR, AZ, CA, CT, FL, GA, ID, IL, IN, MI, MN, MO, MS, MT, NC, ND, NH, NJ, NM, OH, OK, OR, SC, SC, TN, TX, WA, WI, and WV.

The product comes in a 6 oz pouch with the World Berries™ logo identified as Organic Cacao Nibs with the following UPC code 632474929022, affected lot code 161104 and the use by date for products for the affected lot 04/14, which are laser etched on the vertical edge of the back panel.

No illnesses have been reported to date in connection with this product.

The potential for contamination was identified through the company’s own audit testing of finished product which detected the presence of E. coli 0157:H7. Production and distribution of the product has been suspended while FDA and the company continue their investigation. No other lots of this product and no other FunFresh Foods products are affected by this recall.

- Direct consumption of the tempeh

- Exposure to food items contaminated by uncooked tempeh

- Contact with someone who is ill with Salmonella

The laboratory results today and yesterday offer helpful information to both health officials and the public. Lab tests yesterday confirm that Salmonella Paratyphi B associated with this outbreak causes a non-typhoidal salmonella; which means it causes symptoms that can be severe but not as severe as the other strain of Salmonella Paratyphi B, which lab tests first indicated. 
The test results today help us confirm that the tempeh is associated with this outbreak, however cases are continuing to be reported.

As of May 3, Buncombe County Environmental Health Specialists have contacted all food establishments under the jurisdiction of the Buncombe County Department of Health to verify that the recalled tempeh has been removed. Although a food source has been linked with the outbreak, the outbreak continues because infection is being transmitted person-to-person.

As of 4 pm on 5/4/12 the latest formation about the outbreak is as follows:

46 cases

7 hospitalizations

Age range of those getting ill is 4 – 79 with a median age is 34

60% of cases are female

The CDC reports a total of 14 individuals infected with the outbreak strain of Salmonella Infantis have been reported from 9 states. The number of ill persons identified in each state is as follows: Alabama (1), Connecticut (1), Michigan (1), Missouri (3), North Carolina (3), New Jersey (1), Ohio (2), Pennsylvania (1), and Virginia (1).

Multiple brands of dry pet food produced by Diamond Pet Foods at a single manufacturing facility in South Carolina have been linked to some of the human Salmonella infections. People who think they might have become ill after contact with dry pet food or with an animal that has eaten dry pet food should consult their health care providers.

According to the FDA Diamond has been recalling pet food over the last few weeks:

Diamond Pet Foods Voluntarily Recalls Limited Number of Dry Dog Food Bags Due to a Potential Health Risk Recall is limited to one formula of Diamond Naturals distributed to 12 states

Diamond Pet Foods Expands Voluntary Recall to Include Diamond Puppy Formula due to Possible Salmonella Contamination

And, its not like this has not happened before:

Multistate Outbreak of Human Salmonella Infections Caused by Contaminated Dry Dog Food --- United States, 2006--2007

Update: Recall of Dry Dog and Cat Food Products Associated with Human Salmonella Schwarzengrund Infections --- United States, 2008

Human Salmonellosis Associated with Animal-Derived Pet Treats --- United States and Canada, 2005

RECALL INFROMATION:

Diamond Pet Foods has voluntarily recalled some brands of dry pet food that it manufactured in Gaston, S.C., between December 9, 2011 and April 7, 2012 due to potential Salmonella contamination. The brands that were recalled on May 4 have not tested positive for Salmonella.  The company is recalling multiple brands, however, as a precautionary measure to ensure the safety and well-being of customers and their pets. Consumers should check this website for the production codes and best-before dates on the bags of recalled food, and discontinue feeding it. To learn whether or not the brand of pet food you use is included in the recall, please select it from the list below.  Please note: we have issued CORRECTED production codes for all the brands below except for Apex.  Each brand's page will have the CORRECTED production codes.

38 cases of Salmonella paratyhpi B have been reported. On Monday, a Smiling Hara voluntarily recalled 12-ounce packages of unpasteurized soybean Tempeh because of possible contamination with Salmonella.

Chad Oliphant, of Smiling Hara Tempeh announced that the company initiated a voluntary recall of all Smiling Hara products out of an abundance of caution.  The products in question were manufactured between January 11, and April 11, 2012. This includes all varieties and sizes of tempeh with a Best Buy date of 7/11/12 through 10/25/12.

Tempeh is made from cooked and slightly fermented soybeans and formed into a patty, similar to a very firm veggie burger. Many commercially prepared brands add other grains and spices.

Buncombe County Health (BCHD) officials said that the disease transmission is linked to the outbreak in one of three ways: those who have eaten tempeh, those who have connections to others who have been ill with Salmonella paratyphi B (person-to-person) and others that are under further investigation to determine if there are other sources of contamination associated with the outbreak. Cases have surfaced in North and South Carolina, Tennessee and New York.  See May 1 BCHD statement.  The BCHD also warned people with Salmonella paratyphi B to avoid preparing food for others and to follow proper hand washing procedures.  Sick people who work with food, in childcare settings, or in healthcare facilities should stay home from work until lab tests show they are no longer contagious.  See May 2 BCHD statement.  Picture of recalled Tempeh:

The U.S. Department of Agriculture today will announce a series of policy measures that will better protect consumers from foodborne illness in meat and poultry products. These measures will significantly improve the ability of both plants and USDA to trace contaminated food materials in the supply chain, to act against contaminated products sooner, and to establish the effectiveness of food safety systems.

“The additional safeguards we are announcing today will improve our ability to prevent foodborne illness by strengthening our food safety infrastructure,” said USDA Under Secretary for Food Safety Dr. Elisabeth Hagen “Together, these measures will provide us with more tools to protect our food supply, resulting in stronger public health protections for consumers.”

The policy measures include the following:

USDA’s Food Safety and Inspection Service (FSIS) intends to implement new traceback measures in order to control pathogens earlier and prevent them from triggering foodborne illnesses and outbreaks. FSIS is proposing to launch traceback investigations earlier and identify additional potentially contaminated product when the Agency finds E. coli O157:H7 through its routine sampling program. When FSIS receives an indication of contamination through presumptive positive test results for E. coli, it will aim to link products, companies, and the pathogen to a sole source supplier and to any other processors that received the contaminated product from the supplier, instead of waiting for confirmation.

FSIS is implementing three provisions included in the Food, Conservation and Energy Act of 2008 (the 2008 Farm Bill). The new regulations, published as a Final Rule and directed by Congress, require establishments to prepare and maintain recall procedures, to notify FSIS within 24 hours that a meat or poultry product that could harm consumers has been shipped into commerce, and to document each reassessment of their hazard control and critical control point (HACCP) system food safety plans.

FSIS is announcing the availability of guidance to plants on the steps that are necessary to establish that their HACCP food safety systems will work as designed to control the food safety hazards that they confront. This process, called “validation,” enables companies to ensure that their food safety systems are effective for preventing foodborne illness. This notice announces that the draft guidance document is available for comment.

In the past two years, FSIS has announced several measures to safeguard the food supply, prevent foodborne illness, and improve consumers' knowledge about the food they eat. These initiatives support the three core principles developed by the President’s Food Safety Working Group: prioritizing prevention; strengthening surveillance and enforcement; and improving response and recovery. Some of these actions include:

• Zero tolerance policy for six Shiga toxin-producing E. coli (STEC) serogroups. Raw ground beef, its components, and tenderized steaks found to contain E. coli O26, O103, O45, O111, O121 or O145 will be prohibited from sale to consumers. USDA will launch a testing program to detect these dangerous pathogens and prevent them from reaching consumers.

• Test and hold policy that will significantly reduce consumer exposure to unsafe meat products, should the policy become final, because products cannot be released into commerce until Agency test results for dangerous contaminants are known.

• Labeling requirements that provide better information to consumers about their food by requiring nutrition information for single-ingredient raw meat and poultry products and ground or chopped products.

• Public Health Information System, a modernized, comprehensive database about public health trends and food safety violations at the nearly 6,100 plants FSIS regulates.