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

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

708 ill, 171 hospitalized and 4 dead

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


Chi Chi’s Green Onion Hepatitis A Outbreak – 2003

565 ill, 130 hospitalized and 3 dead

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


Dole Baby Spinach E. coli Outbreak – 2006

238 ill, 103 hospitalized and 5 dead

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


Peanut Corporation of America Salmonella Outbreak – 2008 – 2009

714 ill, 171 hospitalized and 9 dead

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


Jensen Farms Cantaloupe Listeria Outbreak – 2011

147 ill, 143 hospitalized and 33 dead

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


Bidart Caramel Apple Listeria Outbreak

35 ill, 34 hospitalized and 7 deaths

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


Andrew and Williamson Cucumber Salmonella Outbreak – 2015

907 ill, 204 hospitalized and 6 dead

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

hat-trick_square_400x400‘A hat-trick or hat trick in sports is the achievement of a “positive” feat three times in a game.’

Campylobacter:  Solana Health Department reports that a Mexican restaurant in Fairfield, California has been closed since Wednesday while an investigation continues into 32 confirmed cases of Campylobacter infection.

Alejandro’s Taqueria on Texas Street in downtown Fairfield is to remain shut down until revised operations meet with approval from county health officials. County health officials are not certain what food item might have caused the illnesses. They are still checking samples of cooked foods taken from the restaurant on June 8 and also continuing to investigate the reports of those sickened.

E. coli: The Colorado Department of Public Health and Environment are investigating an outbreak of E. coli O157:H7 in Aurora. The outbreak was reported at Pho 75, an Aurora restaurant located at 2050 South Havana Street.

So far, four ill people have been identified, but as with any outbreak, it is possible that there are more sick than reported, as some might not go to the doctor. One of the four ill was hospitalized.

The Tri-County Health Department is working with the restaurant during the investigation. Pho 75 voluntarily closed yesterday. According to the state, typically when a restaurant closes in this kind of situation, a list of requirements must be met before they are allowed to reopen.

Salmonella:  Ector County Texas Health Department announced the total number of people who have lab-confirmed cases of Salmonella has increased by one, bringing the total number to three.  There are also 24 probable cases. The restaurant where the people got the illness was Ajuua’s Mexican Restaurant.

The restaurant, at the request of the health department, closed their doors Monday after complaints were made by residents who said they got sick after eating at the restaurant on June 1. The investigation started around 4:15 p.m. June 3 after officials with the health department got a call saying 10 people had gotten sick after eating at Ajuua’s.

The CDC announced as of November 19, 2013, a total of 32 persons infected with the outbreak strain of STEC O157:H7 have been reported from four states.

The number of ill persons identified in each state is as follows: Arizona (1), California (27), Texas (1), and Washington (3).

32% of ill persons have been hospitalized. Two ill persons have developed hemolytic uremic syndrome (HUS), and no deaths have been reported.

The STEC O157:H7 PFGE pattern combination in this outbreak is new to the PulseNet database.

Epidemiologic and traceback investigations conducted by local, state, and federal officials indicate that consumption of two ready-to-eat salads, Field Fresh Chopped Salad with Grilled Chicken and Mexicali Salad with Chili Lime Chicken, produced by Glass Onion Catering and sold at Trader Joe’s grocery store locations, are one likely source of this outbreak of STEC O157:H7 infections.

On November 10, 2013, Glass Onion Catering voluntarily recalled numerous ready-to-eat salads and sandwich wrap products that may be contaminated with STEC O157:H7.

Read the list of recalled products regulated by USDA’s Food Safety and Inspection Service (FSIS).

Read the list of recalled products regulated by the U.S. Food and Drug Administration (FDA).

Two long days after word first surfaced about a multi-state outbreak of E. coli tied to raw cookie dough, the CDC has issued information detailing the illnesses.  The outbreak appears to have begun March 1, 2009 and is still ongoing four months later

The CDC reports:

CDC is collaborating with public health officials in many states, the United States Food and Drug Administration (FDA), and the United States Department of Agriculture Food Safety and Inspection Service (FSIS) to investigate an outbreak of E. coli O157:H7 infections.

As of Thursday, June 18, 2009, 65 persons infected with a strain of E. coli O157:H7 with a particular DNA fingerprint have been reported from 29 states. Of these, 23 have been confirmed by an advanced DNA test as having the outbreak strain; these confirmatory test results are pending on the others. The number of ill persons identified in each state is as follows: Arkansas (1), Arizona (2), California (2), Colorado (5), Delaware (1), Hawaii (1), Iowa (2), Illinois (5), Kentucky (1), Massachusetts (4), Maryland (2), Maine (3), Minnesota (5), Missouri (2), Montana (1), North Carolina (1), New Hampshire (2), New Jersey (1), Nevada (2), Ohio (4), Oklahoma (1), Oregon (1), Pennsylvania (2), South Carolina (1), Texas (3), Utah (2), Virginia (2), Washington (5), and Wisconsin (1).

Ill persons range in age from 2 to 57 years; however, more than 70% are less than 19 years old and none are over 60 years old; 75% are female. Twenty-five persons have been hospitalized, 7 developed hemolytic uremic syndrome (HUS); none have died. Reports of these infections increased above the expected baseline in May and continue into June.
Investigation of the Outbreak

In an epidemiologic study, ill persons answered questions about foods consumed during the days before becoming ill and investigators compared their responses to those of persons of similar age and gender previously reported to State Health Departments with other illnesses. Preliminary results of this investigation indicate a strong association with eating raw prepackaged cookie dough. Most patients reported eating refrigerated prepackaged Nestle Toll House cookie dough products raw.

E. coli O157:H7 has not been previously associated with eating raw cookie dough. CDC, the state health departments, and federal regulatory partners are working together in this ongoing investigation.
Clinical Features

Most people infected with E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps 2-8 days (average of 3-4 days) after swallowing the organism, but some illnesses last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. Most people recover within a week, but some develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur in people of any age but is most common in children under 5 years old and the elderly.
Advice to Consumers

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention are warning consumers not to eat any varieties of prepackaged Nestle Toll House refrigerated cookie dough due to the risk of contamination with E. coli O157:H7. If consumers have any prepackaged, refrigerated Nestle Toll House cookie dough products in their home they should throw them away. Cooking the dough is not recommended because consumers might get the bacteria on their hands and on other cooking surfaces. The recall does not include Nestle Toll House morsels, which are used as an ingredient in many home-made baked goods, or other already baked cookie products.

Individuals who have recently eaten prepackaged, refrigerated Toll House cookie dough and have experienced any of these symptoms should contact their doctor or health care provider immediately. Any such illnesses should be reported to state or local health authorities.

Consumers should be reminded they should not eat raw food products that are intended for cooking or baking before consumption. Consumers should use safe food-handling practices when preparing such products, including following package directions for cooking at proper temperatures; washing hands, surfaces, and utensils after contact with these types of products; avoiding cross contamination; and refrigerating products properly.

As much as any other victim of the 2006 Dole Spinach Outbreak, Suzanne Bandy’s case is about the staggering contrast between past and present.  When asked for her thoughts, Suzanne wrote of her first 57 years: “very simply, my life embodied the American Dream.”  Suzanne’s former life is, however, gone for good.  Now, she states, “I pray to God every day that I may wake up from this horrible nightmare and return to the life that I loved.”

Sadly, Suzanne’s prayers will never be answered.   The E. coli O157:H7 infection, along with the resulting hemolytic uremic syndrome (HUS), that she suffered in September 2006 devastated her kidneys.  Consequently, her current renal function—measured roughly a year after her acute illness—is nearing a level where either a kidney transplant or lifelong dialysis will be necessary for survival.  It is forecast that Suzanne will reach end stage renal disease in as little as five years.

Mr. President, this could have happened to you too.  E. coli O157:H7, as you will see from this video, is a very nasty bug.

Official word of the bagged spinach outbreak broke with the FDA’s announcement, on September 14, 2006, that a number of E. coli O157:H7 illnesses across the country “may be associated with the consumption of produce.”

Meanwhile, the FDA and CDC, in conjunction with local and state health agencies from across the country, worked feverishly to figure out the brand names associated with illness. Early statistical analysis suggested that many brands were implicated, but the spinach sold under the several brand names had all come from the Natural Selection Foods processing center in San Juan Batista, California. Accordingly, Natural Selection recalled all of its spinach products with “use by” dates from August 17 to October 1, 2006. The recall, of course, included Dole brand spinach. But further data and study ultimately narrowed the possible sources of the outbreak down to one brand of packaged greens: Dole.

Ultimately, the FDA confirmed 205 outbreak-related cases, with 102 hospitalizations, thirty-one cases of HUS, and five deaths, though the actual number of people affected by the outbreak was certainly much larger. This is the story of one of those cases.

E. coli O157:h7 Infection Leaves Concert Pianist Unable to Play from Marlerclark on Vimeo.

The Ladies Tea, an annual tradition at Bethany Free Will Baptist Church, was catered by the Country Cottage in Locust Grove, which is at the center of the state and local health department investigation.  One attendee has been sickened, more than 20 others "probable" says health department, after church tea attendees ate food served by Locust Grove’s Country Cottage catering service.

Country Cottage catered the event Saturday, August 16.  Approximately 160 of the 200 to 250 people attending the event have been contacted. Because there was no sign-in sheet, the number of attendees is an estimation.  Because the catered event had a limited menu, it may help narrow down what food is the source of the E. coli.

Oklahoma State health investigators have confirmed that at least 248 people have become ill as a result of the E. coli O111 outbreak in Northeastern Oklahoma.  Of that number, 202 were adults and 46 were children.  A Pryor man, Chad Ingle, died.  At least 64 people were hospitalized, including 16 who received kidney dialysis treatment.  Of that number, nine were children and seven were adults.  Investigators said the number of reported cases and hospitalizations may change as state investigators continue their investigation into the source of the outbreak.  The common denominator is the Cottage Grove restaurant in Locust Grove, Oklahoma.

To date the water in the well used at the restaurant has tested negative for E. coli O111, as has both the surfaces of the restaurant and left over food – REMEMBER – all were tested at least a week or more after people dined at the restaurant.