www.indonesianfoodmart.com

The recalled " Tempeh Starter Yeast "and “Super Starter Yeast” were distributed nationwide and internationally through direct mail orders. The product was also distributed to the following areas: Australia, Canada, Slovenia, New Zealand, Brunei, Darussalam, Poland and Croatia.

The product comes in sealed, clear plastic packages marked with a small computer printed label. The following sizes were sold: 30gm, 50gm, 250 gm, and 1000 gm

Several illnesses have been reported to date that may be in connection with this problem.

The potential for contamination was noted after testing by the North Carolina Department of Agriculture and Consumer Services revealed the presence of Salmonella in some of the product

Upon being notified of the risk by the FDA, the Indonesianfoodmart.com immediately discontinued their operations. Indonesianfoodmart.com did not manufacture the product which was imported from Indonesia.

The product should not be used. Consumers may securely wrap and return the product to the above address or discard it in a waste receptacle.

Isaak Margolin is living history. Born February 18, 1915, to a Jewish family in Lithuania, Isaak’s family emigrated to Kiev, Ukraine when he was three years old, soon after the Russian Revolution. As did many during this time, Isaak’s family wanted to escape the disintegrating social and cultural structure of his homeland, which had merged with the Soviet Republic after the Revolution. Kiev became Isaak’s home until the late 1970s.

The notion of “home” for a young man in Eastern Europe in the 20s, 30s, and 40s, was different than today. Isaak did what he could to survive in an increasingly turbulent, and ultimately violent society. In the 20s, he went to Moscow, Russia, where he participated in the construction of the city’s underground railway. Later, before World War II, he would travel to Russia’s far east, along the border with China, to build another rail line.

When he returned to Kiev, Ukraine’s formal name had been changed to “Ukrainian Socialist Soviet Republic,” and the country was on a war footing. Isaak ultimately fought for the famous Ukrainian General Sydir Artemovych Kovpak as part of the Soviet partisan forces. As the Nazi Wehrmacht advanced into Soviet territory, Isaak tried to convince his entire family—including his wife Faina and daughter Maya—to escape through the Ural Mountains to the security of the Far East. Some of the family would not leave, believing the Nazis to be incapable of the atrocities that were being reported. But Faina, Maya, and Faina’s mother escaped on the last train carrying refugees out of Kiev, and remained in a village in Eastern Russia throughout the war. They struggled to survive.

Isaak remained in Kiev to fight, and to defend the factory at which he had formerly worked as a mechanic, and other important installations. Nazi forces ultimately surrounded the city, and Isaak escaped into surrounding forests, where he continued to serve under General Kovpak and fought a guerilla war. He was ultimately injured, taken prisoner by the Nazis, and escaped a concentration camp to return to the army and continue the fight.

Though Kiev was liberated earlier, Isaak did not see his family again until after the war ended. After they were reunited, Isaak and his family remained in Kiev until 1979. Isaak and Faina had another child; a son named Yakov. Isaak eventually became disillusioned with the oppressive Soviet communist regime, and finally received political asylum and emigrated to Denver, Colorado around 1979.

In Denver, where Isaak has remained since immigrating, he has enjoyed an extended and growing family. He is pictured below with a great-grandson. In all, Isaak has four grandchildren and nine great grandchildren.

Before Isaak’s Listeriosis illness, he was completely independent, despite being 97 years old. He exercised at a local gym nearly every day. Things changed drastically, however, after he ate a cantaloupe that had been purchased from M&I International Market in Denver in August 2011.

The onset of Isaak’s symptoms began around August 28 with a low-grade fever and diarrhea. The bouts of diarrhea soon became dark and bloody, and increased to the point that by August 31, they were occurring 10 to 12 times daily. Isaak also felt very weak and depleted, having been unable to eat or drink much at all since the illness began.

On August 31, Isaak saw his primary physician, Irina Pines, MD, at Webb Family and Internal Medicine. He described to Dr. Pines a several-day history of fever and bloody diarrhea. Dr. Pines described Isaak as being dehydrated and thought that his illness was a viral syndrome due to food poisoning. She advised that he be seen at the Rose Medical Center emergency department the same day. Transport occurred by ambulance.

At the ER, Isaak saw David Moon, MD, describing a course similar to the one he related to Dr. Pines. Dr. Moon obtained blood, urine and stool samples for study, and began Isaak on intravenous fluids for rehydration, as well as Tylenol for fever and pain. CBC showed that Isaak had an elevated BUN and creatinine, and that he was deficient in potassium and sodium. He also had low platelets, and protein was present in the urine. A portable chest x-ray showed a slightly prominent cardiac silhouette, which was thought to be “likely technically related” to the illness process. Isaak received supplemental oxygen via nasal cannula during his stay in the ER, and was ultimately discharged home after a few hours, stating that he felt much better. Dr. Moon advised that he be seen in follow up with Dr. Pines.

Isaak stayed at home, mostly resting, for the next two days. The pace of his diarrhea had slackened some, but he continued to have difficulty staying hydrated, and continued to feel weak and generally ill. Having endured much worse before, however, he resolved to simply do what he could to make himself comfortable until the illness resolved of its own accord. Isaak did not yet know, of course, that he was suffering from a life-threatening bacterial infection that was actively killing dozens across the United States.

On September 2, the blood sample taken at the ER on August 31 showed gram-positive rods, and then Listeria monocytogenes. A physician at Rose Medical Center called Isaak’s family immediately and requested that he be brought back to the ER for inpatient care and treatment. Isaak arrived shortly thereafter with family members.

On arrival at Rose Medical Center, Isaak saw Laurn Sarnat, MD, who noted an intractable, low grade fever, mild dizziness, a multi-day history of dark-colored diarrhea, a sore throat, and left-sided chest discomfort. He was started on supplemental oxygen and intravenous fluids. Given the positive test for Listeria from the sample on August 31, Dr. Sarnat began ampicillin therapy intravenously. Dr. Sarnat also ordered an echocardiogram to rule out endocarditis, as well as an MRI of the brain. Tylenol was given for control of Isaak’s ongoing pain and fever. Dr. Sarnat’s diagnoses were acute Listeria bacteremia and febrile gastroenteritis.

The echocardiogram was done the next day, September 3, showing (1) mild concentric left ventricular hypertrophy, (2) mild left atrial enlargement, (3) mildly sclerotic aortic valve, (4) moderate mitral and tricuspid regurgitation, (5) severe pulmonary hypertension, and (6) grade 1 diastolic dysfunction. The brain MRI was done on September 2, and showed small vessel ischemic change but no acute disease. After the MRI, Dr. Hammer, who consulted from infectious disease, noted that he anticipated that the ampicillin therapy would continue for 3 weeks, “which is presumptive for meningoencephalitis.”

Over the next several days, Isaak continued to be hypokalemic, and developed hypophosphatemia, though this resolved sooner. After several days’ hospitalization, by September 5, though the hypokalemia continued, Isaak was not having any more diarrhea or fever. Nevertheless, ampicillin therapy continued, as it would for several more weeks.

Ultimately, Isaak’s family decided not to have the physicians at Rose Medical Center perform a lumbar puncture. Isaak’s physicians had told them that the results likely would not dictate any different course of treatment, since Isaak had already tested positive for Listeria. But in order to effectively address that infection, physicians indicated that Isaak would need to have a peripherally inserted central catheter (PICC line) installed to facilitate continuous ampicillin therapy. The procedure occurred, and fortunately was uneventful, on September 6. Afterward, ultrasound showed good placement in the left basilic vein, with the tip lodged securely in the superior vena cava.

Isaak was upset to learn that he could not be discharged home, which is where he badly wanted to go by the end of his hospitalization at Rose Medical Center. Instead, in order to ensure that his Listeria infection resolved with appropriate ampicillin therapy, he was transferred on September 8 to Shalom Park, a convalescent care center for elderly people.

During his stay at Shalom Park, Isaak progressed well, though it was a difficult time for him. He has always been very social and highly independent, despite his old age, and to be reliant on others for his care caused him to become depressed. Jake Berzon, Isaak’s grandson, states:

After spending more than a week at the hospital with Listeria, Isaak had to spend another three plus weeks in rehabilitation at a nursing home, surrounded by people, many of whom he had been acquainted with before, but all of whom are now completely disabled physically, mentally and most often both – a most depressing experience for anybody, but especially for an optimist like Isaak. Isaak persevered yet again, came through the full cycle of rehabilitation at the nursing home and returned to his home.

On September 26, the PICC line was finally removed. Again the procedure was uneventful. Isaak was asking to be discharged home on September 27, and so, after nurses spoke with Mike Todd, MD, who had overseen Isaak’s care at Shalom Park, he was discharged.

In the weeks that followed, Isaak did his best to regain the functionality and independence that he had enjoyed prior to his Listeriosis illness. He never has. Again, Jake Berzon:

He is still not fully recovered from the disease, his two children, who themselves are not in the best of health are also getting up there in age, are not able to help as much as they would like to, the four grandchildren try to help as much as they can, as well, but all live far away and all are raising little kids, under 5 years of age. To sum it all up, Isaak is a fighter and his children and grandchildren never had any doubt that he would live a full 120 years and see his great grandchildren as adults. After Listeria, unfortunately, we just cannot believe that any longer.

A total of 316 individuals infected with the outbreak strains of Salmonella Bareilly or Salmonella Nchanga have been reported from 26 states and the District of Columbia. The 58 new cases are from Alabama (1), California (2), Colorado (1), Georgia (3), Illinois (4), Indiana (1), Louisiana (1), Maryland (3), Massachusetts (6), New Jersey (1), New York (10), North Carolina (6), Pennsylvania (5), Tennessee (2), Texas (3), Virginia (6), and Wisconsin (3).

Three hundred and four persons infected with the outbreak strain of Salmonella Bareilly have been reported from 26 states and the District of Columbia. The number of ill persons with the outbreak strain of Salmonella Bareilly identified in each state is as follows: Alabama (3), Arkansas (1), California (4), Colorado (1), Connecticut (9), District of Columbia (2), Florida (1), Georgia (13), Illinois (27), Indiana (1), Louisiana (4), Maryland (27), Massachusetts (33), Mississippi (2), Missouri (4), Nebraska (1), New Jersey (26), New York (48), North Carolina (10), Pennsylvania (25), Rhode Island (6), South Carolina (3), Tennessee (4), Texas (7), Virginia (22), Vermont (1), and Wisconsin (19).

Twelve persons infected with the outbreak strain of Salmonella Nchanga have been reported from 5 states. The number of ill persons with the outbreak strain of Salmonella Nchanga identified in each state is as follows: Georgia (2), New Jersey (2), New York (6), Virginia (1), and Wisconsin (1).

Among 316 persons for whom information is available, illness onset dates range from January 28 to May 3, 2012. Ill persons range in age from <1 to 86 years, with a median age of 30. Fifty-nine percent of patients are female. Among 217 persons with available information, 37 (17%) reported being hospitalized. No deaths have been reported.

The FDA Inspection at Moon Marine found that tanks used for storage of process waters have apparent visible debris, filth and microbiological contamination. Sand and activated carbon filter units used in manufacturing of water are not sanitized, and ventilation for tanks is not filtered to protect against contamination. There is no laboratory analysis for water used in ice manufacturing at the REDACTED facility to show the water used to make ice is potable. Ice manufacturing lacks sanitary controls: ice manufacturing equipment at the Moon Fishery facility is located outside and is susceptible to adulteration from pests and the environment. Apparent bird feces were observed on the ice manufacturing equipment at Moon Fishery; insects and filth were observed in and on the equipment. Ice manufacturing equipment at your REDACTED facility is rusty and situated so that the ice cannot be protected against adulteration, as the ice manufacturing process is constructed into the flooring of the ice facility. Tuna processed at your facility, which is consumed raw or cooked, comes in direct contact with water and ice.

Some of the floor and wall tiles in the tuna processing area are broken and cracked, not allowing for proper cleaning.  After cleaning, the ceiling directly above the in-process tuna line was observed to have visible product residue. After cleaning, product residues and rust were observed on knives and utensil storage boxes. These knives are used to cut raw tuna.  Peeling paint was observed directly above the in-process tuna line.  There was no hand drying devices available in the employee rest rooms on the first floor.

As disturbing as the above were the pictures posted on the FDA website that clearly should on the exterior of the boxes that Tuna Scape was supposed to be cooked, not served raw as a “sushi-like” product.

The Form 483 report, posted by the FDA late Tuesday afternoon, was the result of a week-long inspection that began April 12 after an outbreak of human Salmonella Infantis infection was traced to contaminated pet food manufactured at the Diamond Pet Foods plant in Gaston, S.C.

The report states that Diamond was using cardboard and duct tape on some of its equipment and that there were damaged paddles on the conveyor. The inspectors also noted that some surfaces at the facility were encrusted with food residues.

FDA inspectors specifically listed these four observations:

OBSERVATION 1

All reasonable precautions are not taken to ensure that production procedures do not contribute contamination from any source.

Specifically, no microbiological analysis is conducted or there is no assurance that incoming animal fat will not introduce pathogens into their production and cause contamination of finished product. Also, the firm's current sampling procedure for animal digest does (sic) preclude potential for adulteration after sampling and during storage in warehouse. On 4/13/12, an employee was observed touching in-line fat filter and oil with bare hands.

OBSERVATION 2

Failure to provide hand washing and hand sanitizing facilities at each location in the plant where needed.

Specifically, there are no facilities for hand washing or hand sanitizing in the production areas where there is direct contact with exposed finished feed/food.

OBSERVATION 3

Failure to maintain equipment, containers and utensils used to convey, hold, and store food in a manner that protects against contamination.

Specifically, paddles in conveyor (South or Middle conveyor leading to the screeners going to packaging) were observed to have gouges and cuts, which exhibited feed residues. The damage to the paddles may allow for harborage areas for microorganisms and are difficult to clean and sanitize.

OBSERVATION 4

Failure to maintain equipment so as to facilitate cleaning of the equipment.

Specifically, firm utilizes cardboard, duct tape, and other non cleanable surfaces on equipment. These materials were observed to have residues adhering. The foam gaskets around access doors to the bucket elevators were observed in deteriorating condition and exhibited an accumulation of feed residues and dust.

Diamond Pet Foods recalled nine brands of dry pet foods manufactured at its Gaston plant between Dec. 9, 2011 and April 7, 2012. Several other companies whose food was also produced in the facility have joined the recall. See eFoodAlert for the most up-to-date information on the recall and product distribution.

Hat tip to Dr. Marion Nestle of New York University and Alan Reilly of Food Safety Authority of Ireland for noticing what was right before our eyes:

Who would have known that you were supposed to cook Tuna Scape before you ate it?  Perhaps the grocery stores and restaurants who sold it?

My guess is that the 258 persons infected with the outbreak strains of Salmonella Bareilly (247 persons) or Salmonella Nchanga (11 persons) reported from 24 states and the District of Columbia and the 32 ill hospitalized where not told.

See all the pictures and full FDA Report.

FDA 483 Inspection Report (download PDF):

Mr. Dominic Sebastian, Managing Director, Moon Fishery (India) Pvt. Ltd., 11/722/D, Chemical Industrial Estate, Aroor, Alleppy 688534 Kerala India

Observation No. 1

Your HACCP plan does not list one or more critical control points that are necessary for each of the identified food safety hazards.

Specifically, your HACCP plan for raw tuna does not list critical control points at the following process step to control the hazards of Clostridium botulinum, histamine and allergens.

A. There is no Critical Control Point listed on your HACCP plan for the process of cutting, scraping, and vacuum packaging performed in your processing room, kept at a temperature of REDACTED C to control the hazard of pathogen growth and histamine formation.

B. There is no Critical Control Point listed on your HACCP plan for Clostridium botulinum and allergen labeling applied to the primary packaging.

C. There is no Critic al Control Point listed on your HACCP plan for metal detection.

D. In your HACCP plan for receiving tuna, the only critical limit listed is temperature, with no critical limit listed for vessel monitoring and histamine testing records to show that tuna was not temperature abused on the harvesting vessel.

Observation No. 2:

You are not monitoring the sanitation conditions and practices with sufficient frequency to assure conformance with Current Good Manufacturing Practices including safety of water that comes into contact with food or food contact surfaces, including water used to manufacture ice condition and cleanliness of food contact surfaces maintenance of hand washing, hand sanitizing and toilet facilities, and protection of food, food packaging material, and food contact surfaces from adulteration.

A. You are not monitoring the safety of water as evidenced by:

1. Tanks used for storage of process waters have apparent visible debris, filth and microbiological contamination. Sand and activated carbon filter units used in manufacturing of water are not sanitized, and ventilation for tanks is not filtered to protect against contamination. There is no laboratory analysis for water used in ice manufacturing at the REDACTED facility to show the water used to make ice is potable. Ice manufacturing lacks sanitary controls: ice manufacturing equipment at the Moon Fishery facility is located outside and is susceptible to adulteration from pests and the environment. Apparent bird feces were observed on the ice manufacturing equipment at Moon Fishery; insects and filth were observed in and on the equipment. Ice manufacturing equipment at your REDACTED facility is rusty and situated so that the ice cannot be protected against adulteration, as the ice manufacturing process is constructed into the flooring of the ice facility. Tuna processed at your facility, which is consumed raw or cooked, comes in direct contact with water and ice.

B. You are not monitoring the condition or cleanliness of food contact surfaces as evidenced by:

1. Some of the floor and wall tiles in the tuna processing area are broken and cracked, not allowing for proper cleaning.

2. After cleaning, the ceiling directly above the in-process tuna line was observed to have visible product residue.

3. After cleaning, product residues and rust were observed on knives and utensil storage boxes. These knives are used to cut raw tuna.

C. You are not monitoring protection from adulterants as evidenced:

1. Peeling paint was observed directly above the in-process tuna line.

D. You are not monitoring hand washing, hand sanitizing and toilet facilities as evidenced by:

1. There was no hand drying devices available in the employee rest rooms on the first floor.

For those readers of my blog (thanks mom), I have taken up much space – even more than raw milk – on these pages in an effort to get certain additional E. coli’s deemed adulterants in the eyes of the USDA/FSIS.  If you type in the word “Petition” into the search bar above you can track my history on the issue or read – “It is past time for the USDA/FSIS to deem "the Big Six" E. coli as adulterants” and all the attached links.  So, it likely comes as no surprise that I found myself in the Washington Post this morning:

Bill Marler, a Seattle lawyer who had represented victims of the Jack in the Box outbreak, was not satisfied. He petitioned the USDA to ban dozens of E. coli strains from the food supply. In support, he detailed the case of Maryland woman who died after eating bagged baby spinach, a Utah woman who suffered permanent kidney damage after eating a fast-food meal, and an Oklahoma woman who also suffered kidney failure. Marler said each victim had been infected by a different E. coli strain.

The Petition came after I spent $500,000 to see what the incidence of non-O157 E. coli was in the retail hamburger supply.

However, where this issue is did not come about because of my petition.  There were good scientists at the CDC and at FSIS - Dr. Hagen and Dr. Raymond - consumer groups like CSPI, STOP, CFI, Consumer Federation, PEW, and yes, industry leaders like BPI (of “pink slime” fame), Costco - and many unnamed – who stepped up and said the time had come.

Now, let’s make sure that the June 4, 2012 start date stays.  OMB, we are watching.

As the mother of one child said. “If these tests save just one life, isn’t it worth it?”

There has been coverage on this before too.

Moon India became aware of the problem after the FDA sampled tuna strips from a lot not yet in distribution. However as a cautionary measure Moon India agreed to recall tuna strips that were already distributed, none of which is from the suspect lot sampled by FDA. Distribution of these AA or AAA Grade Tuna Strips Product of India is limited to 4 wholesalers: one in Georgia, one in Massachusetts, one in New Jersey and one in New York.

The wholesalers may have broken the shipments into smaller lots for further distribution. The frozen raw yellow fin tuna product was originally packaged in white boxes with black writing naming the importer as Moon Marine USA Corporation, a separate and independent company, and identifying the contents as Tuna Strips AA or AAA, Product of India. The boxes contain several vacuum-wrapped packages with no further labeling.

Distribution of the product has been suspended while FDA and the company continue their investigation as to the scope of the problem.

Product sellers, including distributors and restaurants, should consult their suppliers to determine whether the Tuna Strips from India in their possession originated from Moon India. The product may not be accompanied by lot numbers or labeling information.

Solid Gold is voluntarily recalling the products below, distributed in the United States and Canada from between January and May 2012. The products are:

Solid Gold WolfCub Large Breed Puppy Food, 4 lb, 15 lb, and 33 lb, with a best before date of December 30, 2012 and batch code starting with SGB1201

4 lb identifying UPC 093766750005

15 lb identifying UPC 093766750012

33 lb identifying UPC 093766750029

Solid Gold WolfKing Large Breed Adult Dog Food, 4 lb, 15 lb, and 28.5 lb, with a best before date of December 30, 2012 and batch code starting with SGL1201

4 lb identifying UPC 093766750050

15 lb identifying UPC 093766750067

28.5 lb identifying UPC 093766750081

Best by dates (lot codes) can be found on the back of the bag in the bottom right-hand corner of 33 lb, 28.5 lb and 15 lb bags and the bottom of the 4 lb bags.

Pets with Salmonella infections may have decreased appetite, fever and abdominal pain. If left untreated, pets may be lethargic and have diarrhea or bloody diarrhea, fever and vomiting. Infected but otherwise healthy pets can be carriers and infect other animals or humans. If your pet has consumed the recalled product and has these symptoms, please contact your veterinarian.

Individuals handling dry pet food can become infected with Salmonella, especially if they have not thoroughly washed their hands after having contact with surfaces exposed to this product. People who believe they may have been exposed to Salmonella should monitor themselves for some or all of the following symptoms: nausea, vomiting, diarrhea or bloody diarrhea, abdominal cramping and fever.

A widely distributed contaminated food product might cause illnesses in a specific region and across the United States. As of January 19, 2012, a total of 68 individuals infected with the outbreak strain of Salmonella Enteritidis have been reported from 10 states. The number of ill persons identified in each state with the outbreak strain was as follows: Texas (43), Oklahoma (16), Kansas (2), Iowa (1), Michigan (1), Missouri (1), Nebraska (1), New Mexico (1), Ohio (1), and Tennessee (1).

In last few weeks as many as 21 cases of food-borne illnesses have been traced to raw milk from a farm outside of Willsonville, Oregon.

Health officials are repeating advice that raw milk is dangerous.

Producers and drinkers say the outbreak is an anomaly and that the benefits of raw milk outweigh the risks.

A woman, who asked not to be identified on the air, told OPB's Think Out Loud that her two-year-old suffered terribly after drinking raw milk.

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

Please see www.realrawmilkfactcs.com.

Recall information from Diamond Pet Foods:

• Chicken Soup for the Pet Lover’s Soul
• Country Value
• Diamond
• Diamond Naturals
• Premium Edge
• Professional
• 4Health
• Taste of the Wild
• Apex
• Kirkland Signature/Kirkland Signature Nature’s Domain
• Canidae

Addition brands recall courtesy of efoodalert:

Natural Balance recalls several products manufactured on its behalf by Diamond Pet Foods, because the products may be contaminated with Salmonella. Please see the Diamond Pet Foods, Etc. Recalls – 2012 page for details on the recalled products.

WellPet LLC recalls Wellness Complete Health® Super5Mix® Large Breed Puppy dry dog food (15-lb and 30-lb bags and 5-oz sample bags; Best by dates of JAN 9 2013 through JAN 11 2013), because the product, which was manufactured by Diamond Pet Foods, may be contaminated with Salmonella.

According to the complaint (#cv-00794) filed in Oregon Federal District Court today, Chris Fronzak, lead singer for the heavy metal band Attila, consumed a spicy tuna roll containing Nakaochi Scrape at a Metairie, Louisiana restaurant while his band was on tour. Within two days, Mr. Fronzak began to experience severe gastrointestinal symptoms including nausea, vomiting, diarrhea, stomach cramps, fever, headache, and muscle aches. After six days of attempting self-care without any improvement, Mr. Fronzak, who was without health insurance, was taken to the emergency room for treatment. While in the ER, a sample was taken that would ultimately test positive for Salmonella. The complaint alleges Mr. Fronzak suffered physically, emotionally, and economically.

And, yes, Marler Clark filed the suit.

"Listeria is a really a nasty bug," said Marler. "Listeria gets into the bloodstream and it causes enormous problems. Most of these people who died, died very, very painful deaths. They had neurological symptoms, physiological symptoms, they suffered lots of pain, and in some cases it was like losing their minds. That just that shouldn't happen from eating fresh cantaloupe. It shouldn't happen."

Programming note: For more on CNN's investigation of September's historic and deadly Listeria outbreak watch "CNN Presents" this Sunday at 8 p.m. and 11 p.m. ET on CNN.  Here is part of the video:

The Missouri State Department of Health and Senior Services said Wednesday it now has 14 confirmed cases of E. coli O157:H7. The two new E. coli cases are from Boone and Marion counties. The 14 cases have similar lab results, geographic proximity and/or case history - drank raw milk or are family memembers of those who drank raw milk. A 2-year-old Boone County child sickened with E. coli remained hospitalized Wednesday with hemolytic uremic syndrome (HUS), a complication of E. coli infection that causes kidney failure. Five cases have been reported in Boone County, three in Cooper, three in Howard, and one each in Jackson, Marion and Callaway counties. The illnesses have been linked to a farm owned by Sam Stroupe of Armstrong, Missouri.

In Oregon a total of twenty-one people have been linked to tainted raw milk. According to the Oregon State Department of Health, the Oregon farm whose raw milk is the suspected source of an E. coli O157:H7 outbreak that has sickened 19 has now been associated with two more foodborne illness victims. Health officials reported Monday that two adults who had consumed raw milk from Foundation Farm had contracted infections from two different pathogens - Campylobacter and Cryptosporidium.  Four children ages 1, 3, 14 and 14 were hospitalized with hemolytic uremic syndrome (HUS).  According to the most recent information, all four are still in the hospital.

For more information on the real risks of raw milk, visit, www.realrawmilkfacts.com.  And, for more information on the complications of HUS, see, E. coli Outbreaks and HUS: The acute and long-term consequences.

As many as 32 Hospitalized

The FDA’s Office in New Delhi, India has initiated a seafood HACCP (Hazard Analysis Critical Control Point) inspection at the Nakaochi scrape yellowfin tuna manufacturer, Moon Fishery Pvt Ltd. in Aroor, India. A report on the inspection will be posted to the www.fda.gov website when finalized by FDA. The FDA was informed that April 12, 2012 was the last day of tuna processing at the firm due to the seasonal nationwide ban on tuna harvest from the Indian Ocean.  There is now evidence as yet where in prodcution the tuna became tainted with Salmonella.

Records obtained by FDA and traceback efforts indicated that Moon Marine USA Corporation of Cupertino, California imported the product. Moon Marine recalled all their frozen raw yellowfin tuna product imported from India, labeled as Nakaochi Scrape AA or AAA, totaling approximately 58,000 pounds. Link to photos of recalled product.  Link to photos of recalled product.

Nakaochi Scrape is tuna meat, which is specifically scraped off from the backbone/ribs, and resembles a ground product. This particular product is designed for retail distribution only to restaurants and grocery stores and is used to make sushi, sashimi, ceviche and similar dishes.

The FDA collected and tested samples of unopened packages of recalled Nakaochi Scrape from Moon Marine USA Corporation. FDA laboratories have identified Salmonella in two samples of Nakaochi scrape yellowfin tuna with a PFGE pattern indistinguishable from the Salmonella Bareilly strain associated with this outbreak. One of the samples also yielded another type of Salmonella with a PFGE pattern indistinguishable from the cluster of Salmonella Nchanga infections.

A total of 7 clusters at restaurants or grocery stores have been identified where 2 or more unrelated ill persons reported eating in the week before illness. In each cluster, at least one ill person reported eating sushi purchased at the restaurant or grocery store. These clusters are located in 5 states: Connecticut, Maryland, Rhode Island, Texas, and Wisconsin.

Two hundred forty-seven persons infected with the outbreak strain of Salmonella Bareilly have been reported from 24 states and the District of Columbia. The number of ill persons with the outbreak strain of Salmonella Bareilly identified in each state is as follows: Alabama (2), Arkansas (1), California (2), Connecticut (9), District of Columbia (2), Florida (1), Georgia (10), Illinois (23), Louisiana (3), Maryland (24), Massachusetts (27), Mississippi (2), Missouri (4), Nebraska (1), New Jersey (25), New York (39), North Carolina (4), Pennsylvania (20), Rhode Island (6), South Carolina (3), Tennessee (2), Texas (4), Virginia (16), Vermont (1), and Wisconsin (16). Eleven persons infected with the outbreak strain of Salmonella Nchanga have been reported from 5 states. The number of ill persons with the outbreak strain of Salmonella Nchanga identified in each state is as follows: Georgia (2), New Jersey (2), New York (5), Virginia (1), and Wisconsin (1). 32 ill persons have been hospitalized, and no deaths have been reported.

See complications following Salmonella infection - Irritable Bowel Syndrome (IBS) and Reactive Arthritis or “Reiter’s Syndrome."

Update from the CDC on May 2:

A total of 258 individuals infected with the outbreak strains of Salmonella Bareilly or Salmonella Nchanga have been reported from 24 states and the District of Columbia. The 58 new cases are from California (2), Connecticut (1), Georgia (1), Illinois (8), Maryland (4), Massachusetts (3), Nebraska (1), New Jersey (8), New York (6), North Carolina (1), Pennsylvania (13), Tennessee (2), Virginia (7), and Wisconsin (1).

Two-hundred forty-seven persons infected with the outbreak strain of Salmonella Bareilly have been reported from 24 states and the District of Columbia. The number of ill persons with the outbreak strain of Salmonella Bareilly identified in each state is as follows: Alabama (2), Arkansas (1), California (2), Connecticut (9), District of Columbia (2), Florida (1), Georgia (10), Illinois (23), Louisiana (3), Maryland (24), Massachusetts (27), Mississippi (2), Missouri (4), Nebraska (1), New Jersey (25), New York (39), North Carolina (4), Pennsylvania (20), Rhode Island (6), South Carolina (3), Tennessee (2), Texas (4), Virginia (16), Vermont (1), and Wisconsin (16).

Eleven persons infected with the outbreak strain of Salmonella Nchanga have been reported from 5 states. The number of ill persons with the outbreak strain of Salmonella Nchanga identified in each state is as follows: Georgia (2), New Jersey (2), New York (5), Virginia (1), and Wisconsin (1).

• 32 ill persons have been hospitalized, and no deaths have been reported.

Sushi Salmonella Outbreak - Food Safety Attorney Bill Marler from Marlerclark on Vimeo.

190 Persons infected with the outbreak strain of Salmonella Bareilly have been reported from 21 states and the District of Columbia. The number of ill persons with the outbreak strain of Salmonella Bareilly identified in each state is as follows: Alabama (2), Arkansas (1), Connecticut (8), District of Columbia (2), Florida (1), Georgia (9), Illinois (15), Louisiana (3), Maryland (20), Massachusetts (24), Mississippi (2), Missouri (4), New Jersey (18), New York (33), North Carolina (3), Pennsylvania (7), Rhode Island (6), South Carolina (3), Texas (4), Virginia (9), Vermont (1), and Wisconsin (15).

10 persons infected with the outbreak strain of Salmonella Nchanga have been reported from 5 states. The number of ill persons with the outbreak strain of Salmonella Nchanga identified in each state is as follows: Georgia (2), New Jersey (1), New York (5), Virginia (1), and Wisconsin (1).

28 ill persons have been hospitalized, and no deaths have been reported.

Past Tuna Salmonella Outbreaks in United States

Twenty-three were sickened in 2010 with Salmonella Paratyphi B linked to the consumption of imported, raw, ahi tuna at various locations on the island of Oahu, Hawaii. The product was said to have originated from Asia, and was previously frozen. Concurrent cases of Salmonella Paratyphi B were reported in five other U.S. states, California, Maryland, Pennsylvania, Massachusetts, and New York. It was not stated whether these cases were also linked to the consumption of raw ahi tuna.

Four were sickened in 2008 linked to an outbreak of Salmonella Barranquilla among people who had eaten raw tuna or bass fish at a restaurant in Massachusetts.

Forty-four were sickened in 2007 with Salmonella Paratyphi B after the consumption of previously frozen, raw, ahi tuna on the island of Oahu, Hawaii. Additional cases were identified in Colorado and California. The tuna had been sent from Indonesia to a U.S. mainland importer.

According to the Oregon Department of Health, nineteen people in Oregon are ill with E. coli in an outbreak traced to raw milk from Foundation Farm near Wilsonville, Oregon. Of the 19 people, 11 have culture-confirmed E. coli O157 infections. Fifteen of the 19 cases are children 19 or younger. Four of the children have been hospitalized with kidney failure. On April 19, a Portland hospital confirmed that one of the hospitalized children - a 13-year-old girl - was in critical condition. According to a member of the cowshare implicated in the outbreak, as many as four of the farmer's children are also sickened, including one with hemolytic uremic syndrome (HUS).

The Missouri Department of Health and Senior Services on Wednesday named Stroupe Farm in Howard County as the possible source of an ongoing E. coli O157:H7 outbreak in central Missouri. The health department has also narrowed their outbreak down to 12. A 2-year-old who consumed raw milk products has been hospitalized for more than two weeks after developing symptoms of hemolytic uremic syndrome (HUS). Eight of the 12 individuals reported consuming raw milk or raw milk products from Stroupe Farm. Of the other four, two are related to people who consumed raw milk, while the remaining two have infections that genetically match the others despite the individuals reporting no connection to raw dairy.

Since 1998, 118 total outbreaks
with 2,123 total illnesses, 2 deaths have been linked to raw milk or raw milk cheese:

- 85 fluid milk: 17 cow, 4 goat, 64 unspecified milk type;

- 27 cheese: 2 aged, 3 homemade, 17 Mexican-style queso fresco, 1 goat chevre, 1 curds, 3 unspecified;

- multiple raw dairy products (fluid milk, cheese, and/or colostrum);

- 2,123 total illnesses, 2 deaths;

- 1,490 fluid milk-related illnesses, no deaths: 225 cow, 63 goat, 1,202 unspecified;

- 576 cheese-related illnesses: 46 aged, 80 homemade, 324 Mexican-style queso fresco (2 deaths), 5 goat chevre, 63 curds, 58 unspecified cheese type;

- 57 multiple raw dairy products related illnesses (fluid milk, cheese, and/or colostrum).

Adolescents and young adults with chronic kidney disease face a number of complications from their chronic kidney disease (Andreoli SP, Acute and Chronic Renal Failure in Children, 2009) including alterations in calcium and phosphate balance and renal osteodystrophy (softening of the bones, weak bones and bone pain), anemia (low blood count and lack of energy), hypertension (high blood pressure) as well as other complications.

Renal osteodystrophy (softening of the bones) is an important complication of chronic renal failure. Bone disease is nearly universal in patients with chronic renal failure; in some patients symptoms are minor to absent while others may 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 phosphorus 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.

Anemia (low blood cell count that leads to a lack of energy) is a very common complication of chronic renal failure. The kidneys make a hormone that tells the bone marrow to make red blood cells and this hormone is not produced in sufficient amounts in children with chronic renal failure. Thus, children with chronic renal failure gradually become anemic while their chronic renal failure is slowly progressing. The anemia of chronic renal failure is 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).

Renal replacement therapy can be in the form of dialysis (peritoneal dialysis or hemodialysis) or renal transplantation. The average waiting time for a deceased donor kidney for children age 0-17 years is approximately 275-300 days while the average waiting time for patient’s age 18-44 years is approximately 700 days (United States Renal Data Systems, Table 7.8, 2005).

Following transplantation, a patient will need to take immunosuppressive medications for the remainder of his/her life 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 liability, cataracts, decreased growth, osteomalacia and osteonecrosis (softening of the bones and bone pain), hypertension, acne and difficulty in controlling glucose levels.

Cyclosporine and/or tacrolimus are also commonly used as immunosuppressive medications following transplantation. 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 is also commonly used after transplantation (sometimes imuran is used); each of these drugs 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 postoperative period.

Lifelong immunosuppression as used in patients with kidney transplants is associated with several complications including an increased susceptibility to infection, accelerated atherosclerosis (hardening of the arteries) and increased incidence of malignancy (cancer) and chronic rejection of the kidney.

A patient may need more than one kidney transplant during his/her life. United States Renal Data Systems (USRDS) report that the half-life (time at which 50% of the kidneys are still functioning and 50% have stopped functioning) is 10.5 years for a deceased transplant in children age 0-17 years and 15.5 years for a living related transplant in children 0-17 years. 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. Thus, depending upon age when the patient receives his/her first transplant he/she may need 1-2 transplants. The life expectancy of a person with a kidney transplant is significantly less than the general population and the life expectancy of person on dialysis a markedly less than the general population.

If and when a child needs a second kidney transplant after loss of his/her first transplant, he/she will need dialysis until a subsequent transplant can be performed. He/She 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. 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 major complication of peritoneal dialysis.

E. coli O157:H7 and other shiga-toxin producing E. coli are very dangerous bacteria – especially to children. The acute phase – even for those who do not progress to hemolytic uremic syndrome (HUS) – can be a painful and frightening experience. For those who progress to HUS, the risk of death is real. And, even if the child survives, it may well be left with chronic health problems for the remainder of its life.