This is another it what will be a long – too long – series of outbreak investigations where we have represented consumers in what I hope will be a cautionary tale, and a learning experience, for manufacturers of food.
Veggie Booty is a puffed rice and corn snack food, coated with vegetable spices. This snack has become tremendously popular with young children, and many parents view Veggie Booty as a healthy alternative to chips and other processed foods commonly marketed to toddlers.
In early spring 2007, public health officials at local and state health departments noticed an increase in reported cases of Salmonella serotype Wandsworth, a rare strain of Salmonella. Communicating through OutbreakNet, a CDC-facilitated network of epidemiologists responsible for investigating disease outbreaks of foodborne and waterborne origin, investigators determined that ill cases tended to be 3 years old or younger. Interviews conducted with parents of case-patients revealed that they often shopped predominately at upscale grocery stores selling organic products. Still, data obtained from preliminary interviews did not reveal any strong evidence of a particular food or type of food. As the number of cases of S. Wandsworth climbed to 46 cases by late June, investigators decided a more targeted interview approach was needed.
CDC and state investigators agreed that a single interviewer would re-contact parents of case-patients to collect information about food consumption using an open-ended questionnaire. Responses to the open-ended questionnaire provided the first inkling that the outbreak might be linked to consumption of Veggie Booty snack food. To confirm investigators’ suspicions, a nationwide case control-study using age-matched friend controls was implemented. Case-patients ten months of age and older were enrolled in the study. Control cases were selected from non-ill friends of an enrolled patient. Three controls were interviewed for each case. Completed questionnaire forms were sent to the CDC for data analysis. On June 27, 2007, the CDC had gathered enough data to implicate Robert’s American Gourmet Veggie Booty as the source of the outbreak. The agency advised the US Food and Drug Administration (FDA) that a recall was needed.
On June 28, 2007, Robert’s American Gourmet of Sea Cliff, New York, manufacturer of Veggie Booty, issued a voluntary recall of Veggie Booty. All bag sizes, lots and codes were affected by the recall. That same day the FDA issued an alert to warn consumers not to eat Veggie Booty Snack Food and to discard any Robert’s American Gourmet brand Veggie Booty. The recall was expanded on July 2, 2007 to include Super Veggie Tings Crunch Corn Sticks.
The CDC asked local and state investigators to contact parents of case-patients to determine if leftover product was available for testing at public health laboratories. On July 2, 2007, the Minnesota Department of Health (MDH) posted a message on OutbreakNet informing participants that the state’s Department of Agriculture (MDA) had isolated Salmonella serogroup Q in a bag of Veggie Booty with a Sell-By-Date of September. By July 3, MDH and MDA microbiologists had found Salmonella in five bags of Veggie Booty with different production codes. Pulsed field gel electrophoresis (PFGE) analysis matched the outbreak strain of S. Wandsworth (pattern number WWSX01.0013) found in product to the strain found in case patients. Minnesota microbiologists would subsequently identify a second strain of S. Wandsworth (WWSX01.0012) in Veggie Booty.
On July 12, 2007, the CDC reported that an uncommon strain of Salmonella serotype Typhimurium had been isolated from Veggie Booty product and that the strain (JPXX01.1037/JPXA26.0333) matched case-patients in Washington and Oregon who had a history of consuming Veggie Booty in the week prior to symptom onset. The New York State Department of Health isolated a third serotype, Salmonella Kentucky (JGPX01.0111) in a sealed bag of Veggie Booty. In total 61 bags of Veggie Booty were tested in 12 states. Salmonella sp. was found in 13 bags. Eleven of the 13 bags were positive for the outbreak strain of S. Wandsworth, and one bag was positive for S. Typhimurium and Enterobacter sakazakii. Furthermore, the CDC isolated S. Haifa (EPCX01.0008) and S. Saintpaul (JN6X01.0169/JN6A26.0027) in separate bags of Veggie Booty.
The FDA inspected Van de Vries’ Edison, New Jersey location from June 28, 2007 to August 21, 2007. The FDA determined a spice utilized in making Veggie Booty was the contamination source. A sample tested from a mixed batch of Veggie Booty spice blend tested positive for the outbreak strain of Salmonella Wandsworth. A sample from a lot of parsley powder, an ingredient in the Veggie Booty spice mix supplied by World Spice, Inc., also tested positive for Salmonella Wandsworth. The FDA also found isolates in seasoning positive for Salmonella Mbandaka (TDRX01.0153/TDRA26.0019). The FDA inspection determined that Van de Vries failed to inspect and handle raw materials to ascertain that they were clean and suitable for processing into food.
Between 2/26/2007 and 9/6/2007, 70 cases of Salmonella Wandsworth were identified in 23 states and 14 Salmonella Typhimuirum cases were identified in six states. All of the isolates were indistinguishable from the outbreak strains by PFGE. Ninety-three percent of the cases with S. Wandsworth occurred in children aged ten months to three years. Six patients were hospitalized. Just over one-half (n=8) of the S. Typhimurium cases were in children aged ten months to three years; two were hospitalized. There were no deaths associated with the outbreak. Ninety-eight percent of the cases reported eating Veggie Booty snack food in the week before illness onset.