Time to dust off www.fair-safety.com and www.realrawmilkfacts.com

The Knox County Health Department (KCHD) is investigating a cluster of Escherichia coli (E. coli) O157 cases in children likely associated with consumption of raw milk and contact with farm animals.

Most of the children are known to have consumed raw milk from a local cow-share dairy. Due to possible contamination with E. coli O157 and out of an abundance of caution, KCHD advises the public not to consume raw milk or any other unpasteurized products from French Broad Farm in Mascot, Tenn. at this time. Officials also recommend consumers dispose of all raw milk and unpasteurized products they may have from this farm.

Any further exposure to the farm animals in question has been mitigated as the facility is not currently operating. Therefore, no further directive on that potential source is necessary.

“Bacteria, like E. coli, cannot be seen with the naked eye,” said KCHD Director Dr. Martha Buchanan. “For some perspective, roughly 1,800 can fit on the head of a pen, and it only takes about 10 to make you sick.”

Raw milk and other unpasteurized products can contain harmful bacteria, including E. coli O157. While it is possible to get sick from many other foods, raw milk is one of the riskiest. E. coli can also be found in the feces of cattle, goats, sheep and other ruminant animals. Historically, the major source for human illness is cattle, which can carry E. coli 0157 and show no signs of illness. These bacteria, however, can cause severe diarrhea and even life-threatening complications for humans, especially children, older adults, pregnant women and those with compromised immune systems. Information on preventing E. coli can be found on the CDC’s website.

Symptoms of E. coli infection vary for each person, but often include severe stomach cramps, diarrhea (often bloody), and vomiting. Some may have a low fever (less than 101 ̊F). Some infections are mild, but others can be severe.

As of May 30, 2018, there are 197 cases in 35 states: Alaska (8), Arkansas (1), Arizona (9), California (45), Colorado (3), Connecticut (2), Florida (1), Georgia (5), Idaho (11), Illinois (2), Iowa (1), Kentucky (1), Louisiana (1), Massachusetts (4), Michigan (5), Minnesota (12), Mississippi (1), Missouri (1), Montana (9), Nebraska (1), New Jersey (8), New York (10), North Carolina (1), North Dakota (3), Ohio (7), Oklahoma (1), Oregon (1), Pennsylvania (24), South Dakota (1), Tennessee (3), Texas (3), Utah (1), Virginia (1), Washington (7), and Wisconsin (3).

Illnesses started on dates ranging from March 13, 2018 to May 12, 2018. Ill people range in age from 1 to 88 years, with a median age of 29. Sixty-eight percent of ill people are female. Of 187 people with information available, 89 (48%) have been hospitalized, including 26 people who developed hemolytic uremic syndrome, a type of kidney failure. Five deaths have been reported from Arkansas (1), California (1), Minnesota (2), and New York (1).

As of 1 PM (ET) October 6, 2006, Friday, 199 persons infected with the outbreak strain of E. coli O157:H7 have been reported to CDC from 26 states.

Among the ill persons, 102 (51%) were hospitalized and 31 (16%) developed a type of kidney failure called hemolytic-uremic syndrome (HUS). One hundred forty-one (71%) were female and 22 (11%) were children under 5 years old. The proportion of persons who developed HUS was 29% in children (<18 years old), 8% in persons 18 to 59 years old, and 14% in persons 60 years old or older. Among ill persons who provided the date when their illnesses began, 80% became ill between August 19 and September 5. The peak time when illnesses began was August 30 to September 1- 31% of persons with the outbreak strain became ill on one of those 3 days.

Three deaths in confirmed cases have been associated with the outbreak. One was in an elderly woman from Wisconsin. Yesterday, Idaho confirmed that stool samples from a 2-year-old child with HUS who died on September 20 contained E. coli O157 with a “DNA fingerprint” pattern that matches the outbreak strain. Today, Nebraska reported the death of an elderly woman with an illness compatible with E. coli O157 infection who consumed raw spinach; E. coli O157 with the outbreak strain “DNA fingerprint” was detected in the remaining spinach. Maryland is investigating a suspect case in an elderly woman who died on September 13 and had recently consumed fresh spinach. E. coli O157 was cultured from her stool, but “DNA fingerprinting” has not been possible.

We are in the unique position to know many, but not all (yet), of the “points of sale” – restaurants and grocery stores.  Having over 100 clients allows us to dig deep into their purchase history and consumption history.  We have already determined clusters of illnesses linked to Panera, Texas Roadhouse, Red Lobsters and Papa Murphy’s.  We also have identified a processor – Freshway.  We have reached out to several other retailers, suppliers, processors and growers to ask (first nicely and then with a subpoena) if they will cooperate or not.  We will continue our efforts and share what we find with the FDA and the public.

I will not complain here – again – why the FDA refuses to name those involved – from farms, distributors, processors and  retailers (stores and restaurants).  But you can read my thoughts here.

Directly from the FDA:

What does this traceback diagram (Redacted) tell us?

It says that there isn’t a simple or obvious explanation for how this outbreak occurred within the supply chain. If the explanation was as simple as a single farm, or a single processor or distributor, we would have already figured that out. The traceback diagram does show us that the contamination with E. coli O157:H7 was unlikely to have happened near the end of the supply chain (such as at a distributor) because there are no common distributors among the places that received and sold or served contaminated lettuce. The contamination likely happened at, or close to, the Yuma growing area.

Our task now is to investigate what happened. We are actively evaluating a number of theories about how romaine lettuce grown on multiple farms in the same growing region could have become contaminated around the same time. It’s possible that contamination occurred on multiple farms at once, through some sort of environmental contamination (e.g., irrigation water, air/dust, water used for pesticide application, animal encroachment). Another possibility is that it happened just after the lettuce left the farm. We are examining all possibilities and as we investigate we learn more about a potential common source we will communicate this information with growers and consumers. But the source and mode of contamination may remain difficult to identify.

Our efforts are complicated by the fact that romaine lettuce is a perishable commodity with a short shelf life of a couple of weeks. None of the lettuce that likely made people sick was available for testing because of the time between the incubation period of E. coli O157:H7 (the time between exposure to the lettuce and the onset of illness) and the time it takes to seek health care and collect specimens from ill people, test those specimens, report the illnesses to public health officials, fingerprint the pathogen to make sure it is part of the outbreak, and interview the ill people to identify where and when they were exposed.  By that time, the lettuce they ate which could have made them ill is long gone.

King 5 News reports that Seattle and King County public health officials are investigating an E.coli outbreak at several Homegrown restaurants in the Seattle area.

Officials say four people have tested positive for Shiga-producing E. coli (STEC) after eating food at three different Homegrown restaurants in King County: Redmond, Kirkland, and Seattle at the Westlake Avenue location.

All four people – three adults and one child – ate the chicken pesto chicken sandwich during April 24-26, 2018. Victims suffered abdominal cramps and diarrhea, with one person reporting they had bloody diarrhea.

Health investigators inspected the three Homegrown locations and identified potential risk factors, such as handwashing facilities violations at two of three locations and a cold holding temperature violation at one of them. All three restaurants were required to complete a thorough cleaning and disinfection.

Investigators were also looking into the various ingredients of the chicken pesto sandwich. Since then, all Homegrown locations in King County have stopped selling the chicken pesto sandwich during the investigation.

According to the CDC, as of May 15, 2018, 172 people infected with the outbreak strain of E. coli O157:H7 have been reported from 32 states.  Alaska (8), Arizona (8), California (39), Colorado (3), Connecticut (2), Florida (1), Georgia (4), Idaho (11), Illinois (2), Iowa (1), Kentucky (1), Louisiana (1), Massachusetts (3), Michigan (5), Minnesota (12), Mississippi (1), Missouri (1), Montana (8), Nebraska (1), New Jersey (8), New York (5), North Dakota (2), Ohio (6), Oregon (1), Pennsylvania (21), South Dakota (1), Tennessee (3), Texas (1), Utah (1), Virginia (1), Washington (7), and Wisconsin (3).

Illnesses started on dates ranging from March 13, 2018 to May 2, 2018.

Ill people range in age from 1 to 88 years, with a median age of 29. Sixty-five percent of ill people are female. Of 157 people with information available, 75 (48%) have been hospitalized, including 20 people who developed hemolytic uremic syndrome, a type of kidney failure.

One death was reported from California.

Illnesses that occurred after April 21, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli and when the illness is reported. This takes an average of two to three weeks.

According to the FDA, the last shipments of romaine lettuce from the Yuma growing region were harvested on April 16, 2018, and the harvest season is over. It is unlikely that any romaine lettuce from the Yuma growing region is still available in people’s homes, stores, or restaurants due to its 21-day shelf life. The most recent illnesses reported to CDC started when romaine lettuce from the Yuma growing region was likely still available in stores, restaurants, and in peoples’ homes.

The FDA has identified Harrison Farms of Yuma, Arizona, as the grower and sole source of the whole-head romaine lettuce that sickened several people in an Alaskan correctional facility, but has not determined where in the supply chain the contamination occurred.

The traceback investigation indicates that the illnesses associated with this outbreak cannot be explained by a single grower, harvester, processor, or distributor. While traceback continues, the FDA will focus on trying to identify factors that contributed to contamination of romaine across multiple supply chains.  The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching consumers.

The Public Health Agency of Canada says six Canadians have been stricken by a strain of E. coli that has a similar genetic fingerprint to romaine lettuce from Yuma Arizona that has already sickened 149 people in 29 states. At least 64 people have been hospitalized in the United States, including 17 with hemolytic uremic syndrome. One death occurred in California.

The six Canadian illnesses were reported between late March and mid-April in four provinces — one each in British Columbia and Alberta and two each in Saskatchewan and Ontario. One Canadian was hospitalized.  No deaths have been reported in Canada.

Of the six, two Canadians reported travelling to the U.S. before getting sick and eating romaine lettuce while they were there. The others ate romaine lettuce at home, or in prepared salads purchased at grocery stores, restaurants and fast food chains, before their illnesses occurred.

The U.S. Food and Drug Administration says romaine lettuce from the Yuma is no longer being produced and distributed, so the potential for exposure to contaminated lettuce is reduced.

The romaine lettuce E. coli outbreak is  on the minds of many at the 10th VTEC Conference in Florence.

122 sick from 26 states.

At least 52 hospitalized.

At least 14 with HUS.

1 death has been reported.

Ill people range in age from 1 to 88 years, with a median age of 29.

63% are female.

The North Dakota Department of Health (NDDoH) reports North Dakota’s first case of E. coli infection associated with romaine lettuce originating from the Yuma, Arizona growing region. The NDDoH has been working with the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and other state and local health officials in this national investigation. A second case in ND possibly associated with the outbreak is still under investigation.

As of May 2, 121 cases from 25 states, Alaska (8), Arizona (8), California (24), Colorado (2), Connecticut (2), Georgia (4), Idaho (11), Illinois (1), Kentucky (1), Louisiana (1), Massachusetts (2), Michigan (4), Mississippi (1), Missouri (1), Montana (8), New Jersey (7), New York (2), Ohio (3), Pennsylvania (20), South Dakota (1), Tennessee (1), Utah (1), Virginia (1), Washington (6), and Wisconsin (1), have been reported to the CDC, not including the case from North Dakota, which will be added to the outbreak summary in the next update. Fifty-two cases have been hospitalized and there has been one death. Cases range in age from 1 to 88 years, with a median age of 29.  At least 52 people have been hospitalized with 14 with HUS.  There has been one death.

The CDC reports as of May 1, 2018, 121 people infected with the outbreak strain of E. coli O157:H7 have been reported from 25 states. A list of the states and the number of cases in each can be found on the Case Count Map page. Illnesses started on dates ranging from March 13, 2018 to April 21, 2018. Ill people range in age from 1 to 88 years, with a median age of 29. Sixty-three percent of ill people are female. Of 102 people with information available, 52 (51%) have been hospitalized, including 14 people who developed hemolytic uremic syndrome, a type of kidney failure. One death was reported from California.

Illnesses that occurred after April 11, 2018, might not yet be reported due to the time it takes between when a person becomes ill with E. coli and when the illness is reported. This takes an average of two to three weeks.

There are 98 cases in 22 states: Alaska (8), Arizona (5), California (16), Colorado (2), Connecticut (2), Georgia (1), Idaho (10), Illinois (1), Louisiana (1), Michigan (3), Mississippi (1), Missouri (1), Montana (8), New Jersey (7), New York (2), Ohio (3), Pennsylvania (18), South Dakota (1), Tennessee (1), Virginia (1), Washington (5), and Wisconsin (1). The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to leafy greens. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.

The most recent information collected by the FDA, in conjunction with federal, state, and local partners, indicates that the romaine lettuce that ill people ate was likely grown or originated from the winter growing areas in or around the Yuma region. This region generally supplies romaine lettuce to the U.S. during November-March each year.

The FDA has identified Harrison Farms as the source of the whole-head romaine lettuce that made several people ill at a correctional facility in Alaska. However, the agency has not determined where in the supply chain the contamination occurred. The FDA is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching the Alaska correctional facility where it was served.

It is likely that Harrison Farms is the source or one of the sources – we continue to dig and will get to the bottom of this.