11 sick in Connecticut 1, Florida 1, Illinois 1, Massachusetts 2, Minnesota 1, New Jersey 1, Pennsylvania 1, Tennessee 1, Virginia 1, and Washington 1.

As of July 16, 11 people infected with the outbreak strain of Salmonella Anatum have been reported from 10 states. Illnesses started on dates ranging from October 22, 2024, to June 24, 2025. Of 9 people with information available, 4 have been hospitalized. No deaths have been reported.

In May 2025, FDA collected samples of frozen sprouted mat (moth) and moong beans. The product samples tested positive for Salmonella and WGS analysis showed that the Salmonella present in the samples is the strain causing illnesses in this outbreak. This means that people likely got sick from eating sprouted beans.

On July 16, 2025, Chetak LLC Group recalled Deep brand frozen sprouted moong beans and frozen sprouted moth (mat) beans. 

  • Deep brand Sprouted Mat (Moth) in 16-oz. packages with the following codes printed on the back side of the bag:
    • Lot code: IN 24330, 25072, 25108, 24353, 25171, 24297, 25058, 25078, 24291, 25107, 24354 AND 24292
  • Deep brand Sprouted Moong in 16-oz. packages with the following codes printed on the back side of the bag:
    • Lot code: IN 24330, 25072, 25108, 24353, 25171, 24297, 25058, 25078, 24291, 25107, 24354 AND 24292

See recall notice for more information.

Additional Resources:

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $900 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.  

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonella attorneys for a free case evaluation.

Additional Resources:

William “Bill” Marler has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli Outbreak which was chronicled in the book, “Poisoned” and in the recent Emmy Award winning Netflix documentary by the same name. Bill work has been profiled in the New Yorker, “A Bug in the System;” the Seattle Times, “30 years after the deadly E. coli outbreak, A Seattle attorney still fights for food safety;” the Washington Post, “He helped make burgers safer, Now he is fighting food poisoning again;” and several others. 

Dozens of times a year Bill speaks to industry and government throughout the United States, Canada, Europe, Africa, China and Australia on why it is important to prevent foodborne illnesses.  He is also a frequent commentator on food litigation and food safety on Marler Blog. Bill is also the publisher of Food Safety News.

On July 24, 2024, John tested positive for Listeria, while in the ICU. John’s sample was genetically linked, by Whole Genome Sequencing, to a cluster of Listeria associated with potatoes from Mexico.

Figure: SNP-tree of sequences of REP strain uploaded to the public sequence repository at 
NCBI as of July 2025

On July 16, 2024, John was admitted to the hospital with a headache, facial drooping, dizziness, and an abnormal MRI. His family feared he was having an aneurysm. 

A week later, on July 22, 2024, John was intubated and sedated in the ICU, where he remained for five weeks, fighting for his life against bacterial meningitis caused by Listeria. 

When John was first admitted to ICU, he had been hospitalized for a week with symptoms; it took another three days of testing to determine that Listeria was the cause of his illness. John was on a ventilator and multiple IV drips to keep him alive in the ICU. He was comatose and unresponsive for at least a week. At one point, he was so swollen with fluids and meds, he could not even close his eyes. 

After approximately five weeks in the ICU, John was transferred to a rehab hospital for long term acute care (LTAC). He was minimally responsive to his family for the first several months in LTAC. He remained unable to move, speak, swallow, or see without double vision. He developed pressure wounds that required serious care , including a specialized bed. He remained on the IV antibiotic drip for 12 weeks, until blood tested determined that the bacteria had been killed; however, the massive effects of the infection included multiple abscesses in his brainstem and cerebellum, and his brain was left swollen and inflamed. 

John remained on the ventilator until the end of November 2024. He was only able to sit in a wheelchair, propped with pillows for 30 minutes at a time. John started to receive PT, OT, and speech therapy. During this time, John encountered multiple infections including UTIs, bronchitis, and pinkeye. 

John spent eight months at the rehab hospital and continued to improve very slowly and to regain some strength. But the damage was apparent, as his wife details: 

He made gains in communication, but it became apparent that his cognitive perception and personality were affected by the damage from the Listeria infection. It is devastating to see your loved one suffer so much and devastating on a whole different level to try to help and have them hallucinating that you are someone else and there to harm them. To see my husband, my partner in life, have every part of his body and mind affected  is something I will never unsee or unfeel. 

In March 2025, John was transferred to skilled nursing, but it quickly became apparent that this was not the proper level of care for him. In three weeks at the facility, EMS was called for John three times; twice, he had pulled out his own trach tube because it had become clogged with secretions and he could not breathe, and once because he had fallen and none of the nurses could lift him. John’s mental health deteriorated as well, with him saying he felt neglected and like he was left there to die. Subsequently, due to a lack of nursing care, John ended up in the ICU with pneumonia, where he stayed for 10 days and, once again, nearly died. He was discharged back to the rehab hospital, to start the cycle all over again—LTAC, rehab, and then insurance pushing him out the door to skilled nursing. His wife writes: 

I worry and research constantly about where John can be placed and the level of care I can get for him. He requires assistance to  walk, bathe, dress or take care of himself. He is on a feeding tube because he cannot swallow without aspirating. He has tracheostomy that may be permanent as well as the feeding tube. He can speak but is very difficult to understand initially, as half of his face remains paralyzed. He cannot write due to loss of fine motor skills, and he can only read with difficulty due to double vision. He was recently diagnosed with Cerebellar Cognitive Affective Syndrome, for which there is not treatment and no cure. John’s long-term memory remains intact, but his short-term memory, emotional regulation, and impulse control are all affected. 

John has never made it home since being admitted to hospital care last July. He may never make it home, as his medical needs, both physical and mental, remain complex. John is a beloved, successful, vibrant, healthy, intelligent and opinionated man who headed up a family and a business. John is the Chief Creative Officer, CEO, and founding member, of our business. Coming to terms with the changes in our business structure and making sure we are still providing the same levels of thinking and execution has been a nearly full-time job, beyond managing John’s care. Thankfully, John’s thoughtful leadership prior to his sudden disappearance gave us an effective blueprint to keep going and maintaining our level of performance, but to say that this time has been stressful is frankly the understatement of the year.  I only sleep because I’m too mentally exhausted to stay awake at a certain point. 

Essentially, our entire life has been dominated and completely turned upside down by John’s illness since he was admitted. I have struggled to be a parent to our 15-year-old son while my hours (literally and mentally) are dominated by managing John’s care. I worry for my son’s mental health while trying to maintain my own and to be an engaged and involved mom. 

The version of the husband, father, brother, friend, uncle, and boss we all knew, loved and depended on is gone. A shadow version of John remains in place, and because of the complexity of his medical needs, we don’t know for how long. It has been harrowing to watch him suffer for the better part of a year now. He has said he wished he had died last July. What does one even say to that? At the time I was so grateful  that John lived… but seeing how miserable he is now, I don’t feel grateful at all. I feel that my best friend and husband John did die then, and I am a widow to a living person… and that is a truly awful place to exist for both of us.

Nearly one year later we are still searching for the conclusive link between John’s devastating Listeria illness and all the others ill and likely Mexican potatoes.  Question?  Where is our FDA and CDC and the State of Texas in the investigation?

Whole genome sequencing (WGS), which determines the full nucleotide sequence of a bacterium’s genetic makeup, is now the gold standard for laboratory surveillance and investigation of outbreaks of foodborne infections.

With WGS, outbreaks are detected faster when they are smaller, and more outbreaks are being solved and controlled than ever before. WGS has an unsurpassed high resolution by detecting changes at the level of the building stones of the genetic code of the bacteria. The resolution is so high that small differences might be observed within a single bacterial strain and therefore a strain by WGS is not defined by one sequence but rather by a group of highly similar sequences, e.g. differing from each other by up to 10 differences. Biologically, bacteria with similar sequences likely share a recent common ancestor. Along the same lines, it is a basic assumption in outbreak surveillance that bacteria with very similar sequences likely come from the same source even if collected over extended time periods.

Very soon after WGS was introduced in the surveillance, food safety specialists realized that outbreaks with very few cases might occur over long periods, sometimes years. The term “low and slow” was introduced to describe these outbreaks. However, even now the food safety authorities rarely actively look for these outbreaks. They investigate them when they accidently stumble into them when isolates from a food or the food environment match isolates from historical patients, or patient isolates in current outbreak investigations match seemingly sporadic cases from years ago. An example of the latter is the Listeria outbreak linked to Blue Bell ice cream in 2015. 

It is well-known that bacterial strains may persist for years in the food production systems and that such contamination has caused outbreaks. For example, a particular strain of Salmonella Enteritidis caused two outbreaks associated with almonds from California in the 1990s, which lead to the implementation of mandatory fumigation of almonds for human consumption. A strain of Salmonella Newport caused outbreaks every year in the 2000s associated with tomatoes produced in the Delmarva region. A more recent example is a strain of Shiga toxin-producing E. coli causing several outbreaks associated with produce grown in the South Western US. Scientists at the Center for Disease Control and Prevention (CDC) came up with a name, REP-strains (short of Repeating, Emerging or Persistent) for such strains. REP-strains may cause outbreaks with different food vehicles if the ultimate source is outside the food production systems (e.g. the latter E. coli outbreaks) or with just one vehicle if a specific production system has been contaminated (e.g. the Salmonella outbreaks).

After the implementation of WGS it has  been realized that some REP-strains may cause ‘low and slow’ outbreaks that are neither detected nor investigated because the outbreak signals are weak and the illnesses are too spread out in time to be caught by the detection  algorithms used by the public health authorities. This is a shame, because a REP-strain problem that looks small in a one-year time frame may be a big and significant public health issue that needs to be addressed if it persists for years. The wealth of sequence data  in the GenomeTrakr network in the public sequence repository, SRA, at the National Center for Biotechnology information (NCBI) could easily be used to detect such large “low and slow” outbreaks.

Recently, scientists discovered a REP-strain in the SRA, when working on John’s case.  They were checking sequences of Listeria monocytogenes and discovered a group of 130 highly related sequences submitted to the database between 2016 and now (Table and Figure).

These sequences showed up to 23 differences (“SNP-differences”) between them with an average of just 6 SNPs, a difference that is often seen in Listeria outbreaks. 97 sequences were from human clinical isolates in the US submitted by PulseNet USA and 33 were from potatoes (32) and an apple (1) submitted by the Mexican Service for the National Health for Food Safety and Food Quality (SENASICA) with food origin listed as USA. Distribution of sequence submissions by year is seen in the table below.

Table: Listeria isolates of REP strain submitted the public sequence repository at NCBI by year and source.

The distribution by year peaked between 2017 and 2022 from a low start. Since 2022 there has been a few infections every year. Two sequences have so far been submitted in 2025. Unfortunately, the state distribution of the clinical isolates is not provided in the database. CDC or the Food and Drug Administration (FDA) has not mentioned anything about outbreaks or outbreak investigations related to this REP-strain on their web-sites, so it is unclear if they have ever investigated it during one of the peaking years or over the whole time-period. This is odd, since the total number of cases is high and 32 of the sequences originate from a potential food source. This is surely a potential long-lasting outbreak that should be investigated. 

The resources to the CDC and FDA, particularly affecting international activities, have been drastically reduced this year. While the administration suggests these cuts address inefficiencies without compromising core functions, food safety scientists dispute this claim. Investigating the cluster with this REP-strain could provide important clues to settle this dispute testing the agencies’ capabilities in domestic and international outbreak investigation and management, highlighting the importance of maintaining robust food safety programs.

Hello, FDA, CDC and State of Texas.

FDA Encourages Food Industry Leaders to Streamline, Enhance Product Recall Communications With Public and Agency

Stronger, More Transparent Notices Increase Public Safety

July 9, 2025

Dear Industry Leaders:

This letter is directed to manufacturers, packers, distributors, exporters, importers, and retailers involved in the manufacturing and distribution of infant formula, baby foods, and foods intended for children.

As we strive to ensure that food is recognized as a vehicle for wellness, recent incidents involving chemical contaminants in infant and toddler food products have raised public awareness and underscored our shared responsibility in safeguarding our most vulnerable consumers – our children.

At the FDA, we believe that radical transparency in food safety and nutrition actions is key to reducing foodborne illness and chronic disease, setting a strong foundation for lifelong health. It is imperative the food industry and FDA work together to ensure swift, transparent, and effective recall communication, especially for products vital to infant and child nutrition.

Today, we are seeking your assistance in creating a collaborative transformation in how we manage and communicate food recalls, particularly for infant formula, baby foods, and foods intended for children, to provide for greater public awareness of these recalls. We are encouraging our industry partners to enhance communication with the public and continue to work with the FDA when a product is recalled. And we are welcoming industry leaders’ input on how industry and the FDA can communicate recalls faster and in formats that leverage new digital tools.

Industry Call to Action

The FDA’s ability to make informed decisions and disseminate crucial updates to consumers hinges on industry providing prompt notification of recall information to the agency. Recognizing this interdependence, we kindly remind firms to inform the FDA immediately when a decision to initiate a recall is made, as outlined in 21 CFR 7.46(a) and 107.210(a).

Recognizing the public’s desire to have more information about recalled FDA-regulated foods, particularly foods for infants and children, the FDA appreciates the public may want firms to issue public notifications for a broader range of situations than previously experienced. For food safety issues in products for infants and children, firms should consider expanded use of public notification as appropriate to ensure that consumers have access to the most timely and comprehensive information.

FDA Actions to Improve Transparency

Industry and government recall systems must evolve to meet the public’s need for timely information. We are proposing a strategic overhaul, leveraging communications best practices as well as cutting-edge technologies to revolutionize how we work together to collect, analyze, and disseminate crucial recall information. Our vision includes:

Short term goals

  • Enhancing public access to critical recall information by creating a centralized, consumer-focused webpage for streamlined access to recall information, with an emphasis on infant formula, baby foods, and foods intended for children.
  • Evaluating internal and external recall communication protocols on public communications for certain recall situations, ensuring alignment with current best practices and public health priorities.
  • Improving recall data granularity and accessibility by upgrading the FDA Enforcement Report system to allow for more refined and targeted filtering of recall information by the public, particularly for sensitive food categories.
  • Improving the reach and clarity of our recall communications by leveraging focus group research and other stakeholder feedback on risk communication strategies.
  • Further increasing the speed of recall classification through process improvements.

Long term goals

  • Optimizing recall information collection by redesigning and digitizing key recall documentation to support automated data extraction and AI-assisted analysis, improving overall recall process efficiency.
  • Modernizing data submission infrastructure through implementation of an advanced digital platform for industry partners to submit standardized data, enhancing efficiency in recall information processing, dissemination, and recall classification.

These enhancements, which require increased public-private partnerships, and sufficient resources and time, are aimed at achieving radical transparency, and empowering parents and caregivers to monitor the products they purchase or have in their home and safeguard their children’s immediate safety and long-term health outcomes.

This initiative reflects our commitment to increased collaboration with industry leaders, focused on placing the public’s needs first, empowering parents, protecting our children, and fostering a healthier future for generations to come.


Sincerely,

/S/

Marty

Martin A. Makary, M.D., M.P.H.

Commissioner of Food and Drugs

/S/

Kyle

Kyle A. Diamantas, J.D.

Deputy Commissioner for Human Foods

I mailed this letter to Secretary Kennedy and Commissioner Makary – two weeks ago – still no response.

Full letter: https://www.marlerblog.com/files/2025/06/Draft-FOIA-Exemption-4-Letter-6.17.25-FINAL.pdf 

Dear Secretary Kennedy and Commissioner Makary:

Re:      2024 Multi-state E. coli O157:H7 Outbreak Linked to Romaine Lettuce

On behalf of my injured clients and in the public’s interests in radical transparency, I am writing for your help.  We ask the FDA to disclose the names of the grower, processor, broker, distributors, and points of service identified in its investigation of this E. coli O157:H7 outbreak.

My firm represents ten individuals who were seriously sickened in the 2024 multistate E. coli O157:H7 outbreak linked to romaine lettuce. Each of them—Austin Carnaghi, Tina Graham, Alaina Mujkanovic, Sawyer Swearingen, Kimberly Everding, Colton George, Lilly Hasenour, Cynthia Hefling and Alec Schielke —suffered severe illness after consuming contaminated romaine lettuce served at schools, restaurants, catered events, or purchased at retail. 

These illnesses were not minor. They were severe, prolonged, and in many cases, life-threatening, requiring lengthy hospitalizations, intensive medical interventions, and ongoing recovery. Multiple individuals developed hemolytic uremic syndrome (HUS), a serious and potentially fatal complication that can result in kidney failure, neurological injury, and death.

Austin Carnaghi, a 15-year-old boy from St. Louis, Missouri, became ill after eating a salad served at a school event on November 6, 2024. The meal had been prepared and catered by Andre’s Banquets & Catering. Shortly after eating the salad, Austin experienced severe abdominal cramping, persistent vomiting, and continuous diarrhea, which progressed to bloody diarrhea. He sought medical attention at an urgent care facility, where a stool sample tested positive for E. coli O157:H7. 

Lilly Hasenour, a 15-year-old girl from Greenwood, Indiana, also became seriously ill after consuming romaine lettuce served at her school in late October 2024. Her condition rapidly deteriorated, and she was hospitalized for 26 days—from November 11, 2024, to December 7, 2024—and diagnosed with HUS. During her hospitalization, Lilly endured 17 days of hemodialysis and received nine blood transfusions. She also developed pancreatitis and neurological complications as a result of her illness. 

Tina Graham, like Austin Carnaghi, became ill after consuming food, including salad, catered by Andre’s Banquets on November 7, 2024. Four days later, on November 11, she began experiencing excruciating abdominal pain, vomiting, and frequent episodes of bloody diarrhea. Her symptoms were so intense that she was unable to sleep and required a bedside commode every 10 to 15 minutes during her hospitalization. A stool sample collected at the hospital subsequently tested positive for E. coli O157:H7.  

Alaina Mujkanovic, a 16-year-old girl, became ill after eating food served by Andre’s Banquets at her high school on November 8, 2024. Within two days later, she developed intense abdominal cramping, dizziness, malaise and severe diarrhea that progressed to bloody diarrhea. She sought emergency medical care, where testing confirmed an infection with E. coli O157:H7.

Sawyer Swearingen, also 16 years old, fell ill after eating food catered by Andre’s Banquets on November 7, 2024. His symptoms mirrored those of others: persistent vomiting, diarrhea, and abdominal pain. He was hospitalized for five days due to dehydration and decreased fluid intake exacerbated by the vomiting and diarrhea and was later confirmed to have E. coli O157:H7.

Kimberly Everding attended a funeral reception at Andre’s South Banquets & Catering in St. Louis on November 8, 2024, where she ate salad. Three days later, on November 11, she developed severe symptoms consistent with E. coliinfection. Her condition deteriorated rapidly, requiring hospitalization for nine days.

Colton George, just nine years old at the time, became seriously ill after eating romaine lettuce purchased by his parents at Kroger’s. His symptoms escalated quickly, and he was hospitalized for 18 days—from November 17, 2024, to December 5, 2024. He was diagnosed with HUS and confirmed to be a whole genome sequence (WGS) match to the outbreak strain. During his hospitalization, Colton underwent nine days of continuous renal replacement therapy (hemodialysis) followed by five more days of intermittent hemodialysis. He also received five blood transfusions. He spent his 10th birthday in the hospital.

Cynthia Hefling also consumed romaine lettuce in November 2024 and developed nausea, vomiting, diarrhea, bloody diarrhea, stomach cramps, muscle aches, fatigue, headache, and a urinary tract infection. She was hospitalized for 25 days. As her condition worsened, she was transferred to an Intensive Care Unit (ICU) on November 29 for hemodialysis, where she remained until December 7. She underwent nine days of hemodialysis, received one blood transfusion, and was diagnosed with life-threatening HUS. She also developed acute encephalopathy in the ICU, requiring medication.

Alec Schielke, like Alaina Mujkanovic and Sawyer Swearingen, is 16 years of age. He became ill after consuming romaine lettuce purchased at Kroger’s in November 2024. He was hospitalized for 21 days with symptoms that were later confirmed to be caused by an E. coli infection. Alec endured a prolonged gastrointestinal illness, requiring extensive medical care.

Brenda Lippert, a 70-year-old woman from Franklin, Indiana, became ill after eating a side salad with her lunch at Jockamo’s Pizza. The following day, she developed diarrhea, vomiting, and overall weakness. As her condition worsened, she required hospitalization for five days. 

Given the severity of this outbreak, we respectfully urge the FDA to disclose the identities of all entities involved—including the lettuce grower and processor identified as the source of contamination through its internal investigation. This information does not constitute “commercial or financial” data “obtained from a person” under FOIA Exemption 4 and therefore does not qualify as confidential. 

The public interest in “radical transparency” is overwhelming and far outweighs any claimed interest in nondisclosure. This outbreak sickened the ten individuals described above, along with 79 others across 15 states. Seven developed hemolytic uremic syndrome (HUS), and one tragically died. Moreover, this outbreak has been linked to six prior historical clusters, strongly suggesting the presence of a persistent, resident strain of E. coli at or near the source.

Continued withholding of this information impedes accountability, undermines consumer protection, and obstructs vital public health efforts aimed at preventing future outbreaks. The public has a right to know which entities were responsible for these illnesses so that appropriate safeguards can be implemented, monitored, and enforced.

An(other) Outbreak of E. coli O157:H7 Linked to Romaine Lettuce

As detailed in the FDA’s CORE Report, on November 25, 2024, PulseNet coded an outbreak of E. coli O157:H7 2411MOEXH-2. At the time of closing, this investigation included 89 cases across 15 states: AR (2), CO (1), IL (7), IN (8), KS (1), KY (1), MO (50), MT (1), ND (2), NE (3), OH (8), PA (1), SD (1), TN (1), WI (2), all related within 0-4 alleles by cgMLST. 

Isolation dates ranged from November 7, 2024, to December 1, 2024. Reported onset dates (n=83) ranged from November 4, 2024, to November 30, 2024. Ages ranged from 4 to 90 years with a median age of 24. Sixty of 88 cases (68%) female. Outcome information was available for 74 cases, of which 36 (49%) were hospitalized. There were 7 reported cases of HUS, and 1 death attributed to this outbreak.

A case in this investigation was defined as infection with E. coli O157:H7 with an isolate related to the outbreak strain within 0-4 alleles by cgMLST and isolation date ranging from November 7 to December 1, 2024. This outbreak was related to six historical investigations: 2302MLEXH-1, 2210MLEXH-3, 2210MLEXH-2, 2209MLEXH-1, 2112MLEXH-1, and 2106CAEXH-1. The only vehicle identified was for 2112MLEXH-1, which was closed with a confirmed vehicle of organic power greens. The NCBI tree (pictured below) for this strain included numerous nonclinical beef isolates.

NCBI tree

This outbreak was coded following notification from FDA colleagues in Missouri after they identified and investigated multiple illnesses linked to events catered by the same Missouri-based caterer. These events occurred between November 6 and November 8. All events included the same menu items with a few modifications. Missouri colleagues conducted a retrospective cohort study at two of the events and found that salads were the only statistically significant menu item across both events. Salads contained an iceberg/romaine lettuce blend, carrots, purple cabbage, onions, canned pimento, canned artichokes, parmesan cheese, and a house made salad dressing.

In total, 7 subclusters were identified across the multistate outbreak. These included 3 Missouri catered events, an Ohio secondary school, an Indiana restaurant, an Illinois restaurant, and an Illinois event catered by a different Missouri-based caterer. Salads were the common link across all 7 subclusters, and cases in all subclusters ate an iceberg/romaine lettuce blend. CDC deployed a focused questionnaire on November 26, 2024; 27 questionnaires were returned. Epi information was available for 65 cases, of which 60 (95%) reported consuming any type of leafy green prior to illness. Of 57 cases who could remember the exact type of leafy green consumed, 50 (88%) consumed romaine lettuce. This is statistically significantly higher than the background rate of 49% from the FoodNet Population survey. A traceback investigation was initiated in response to an E. coli O157 outbreak with leafy greens as the suspected vehicle. 

The investigation consisted of three traceback legs representing twenty-eight cases and five points of service (POS). The three traceback legs identified four distribution centers, one broker, two processors, one grower, and one ranch. The traceback investigation determined that a sole processer sourced romaine lettuce from a single grower that would have been available at all points of service during the timeframe of interest. Additionally, romaine lettuce supplied to four of the five POS were traced back to a common ranch and lot. Through analysis of records, four lots of romaine lettuce were implicated, resulting in confirmation of romaine lettuce as the vehicle. Epidemiologic and traceback data supported the conclusion that romaine lettuce was the source of illnesses in this outbreak. 

On February 11, 2025, the FDA published its findings in a Coordinated Outbreak Response & Evaluation (CORE) report titled “E. coli O157:H7/Romaine Lettuce/Nov 2024 Executive Incident Summary CARA #1280.”[1] The report includes a redacted traceback diagram (pictured below) that identifies five POS, four distributors, one broker, one processor, and one grower that the FDA linked to the outbreak through its internal investigation. But FDA officials never issued public communications following the investigation, nor did it disclose the identities of the entities that grew, processed, brokered, distributed, or served the contaminated lettuce. Agency officials claimed that this information is protected under Exemption 4 of the Freedom of Information Act (“FOIA”), which shields confidential commercial information from public release. In fact, such information is not protected under Exemption 4, as it does not meet the legal standard for confidential treatment and directly concerns public health and safety.

FDA’s redacted traceback diagram

The Identities Withheld by the FDA Are Not Protected Under FOIA Exemption 4

            The FDA’s decision to withhold the names of the grower, processor, broker, distributors and points of service linked to the 2024 E. coli O157:H7 outbreak involving romaine lettuce is legally unsound and contrary to the core principles of transparency embedded in the Freedom of Information Act (FOIA). Under Exemption 4 of FOIA, an agency must demonstrate that the withheld information is: (1) “commercial or financial” in nature; (2) “obtained from a person”; and (3) “privileged or confidential”. 5 U.S.C. § 552 (b)(4). None of these conditions are satisfied here. 

The Withheld Information Is Not “Commercial or Financial” in and of Itself

To qualify for withholding under FOIA Exemption 4, the information must be commercial or financial “in and of itself”—meaning it must serve a commercial function or be of a commercial nature. Citizens for Resp. & Ethics in Wash. v. United States DOJ, 58 F.4th 1255, 1263 (D.C. Cir. 2023). The D.C. Circuit has made clear that Exemption 4 protects only information that private entities typically keep confidential because it reveals “basic commercial operations, such as sales statistics, profits and losses, and inventories, or relate[s] to the income-producing aspects of a business.” Id. (quoting Pub. Citizen Rsch. Grp. v. FDA, 704 F.2d 1280, 1290, 227 U.S. App. D.C. 151 (D.C. Cir. 1983)). 

The names of the grower, processor, distributors, brokers, and retail or food service outlets linked to this outbreak do not qualify as “commercial or financial” information under any reasonable reading of the statute. They do not reveal confidential business strategies, proprietary processes, financial data, or any other competitively sensitive material. Rather, they are factual identifiers of entities involved in the supply chain of a contaminated food product that caused a deadly public health outbreak. 

The D.C. Circuit directly addressed this issue in Citizens for Resp. & Ethics in Wash. v. United States DOJ, rejecting the argument that a contractor’s names could be withheld merely because disclosure might result in reputational damages or economic consequences. The Court explained:

The Bureau does not explain in any detail how a contractors’ name is commercial “in and of itself”—that is, how the name “serves a ‘commercial function’ or is of a ‘commercial nature.’” Instead, the Bureau rests its claim of exemption exclusively on the potential commercial consequences of disclosure, asserting that the contractors could face public hostility and resulting economic harm if their names were disclosed. […] But the commercial consequences of disclosure are not on their own sufficient to bring confidential information within the protection of Exemption 4 as “commercial.” 58 F.4th 1255, 1267-1268 (internal citations omitted).

 The Court warned that allowing government agencies to withhold information based solely on the prospect of public scrutiny would invert FOIA’s purpose: 

Under the Bureau’s approach, whenever public scrutiny might have reputational repercussions with potential knock-on commercial effects, the government and a contractor could shield information from public view simply by agreeing to keep it secret. That is not what Congress had in mind when it protected “citizens’ right to be informed about ‘what their government is up to.’” 

Id. at 1267-1268.

The same logic applies here. Merely identifying the entities involved in the distribution of contaminated food does not transform their names into “commercial” information. Exemption 4 does not—and cannot—stretch that far, particularly given that FOIA exemptions “must be narrowly construed.” Id. at. 1261.

The Withheld Information Was Not “Obtained from a Person”

Exemption 4 applies only to information “obtained from a person.” 5 U.S.C. § 552 (b)(4).  FOIA broadly defines “person” to include “an individual, partnership, corporation, association, or public or private organization other than an agency.” 5 U.S.C. § 551(2). Courts have consistently held that information is “obtained from a person” only if it originates outside the federal government. Ctr. for Biological Diversity v. United States Forest Serv., 2025 U.S. Dist. LEXIS 59288 at *19 (D.D.C. 2025); see also Elec. Priv. Info. Ctr. v. DHS, 117 F. Supp. 3d 46, 63 (D.D.C. 2015) (“Information is considered ‘obtained from a person’ … so long as the information did not originate within the federal government.”) 

Although this standard can encompass agency documents that directly summarize or restate third-party data, it does not extend to information that has been independently generated or substantively reformulated by the government. “[W]hen an agency analyzes, rather than just summarizes, third-party information, such information will not be considered ‘obtained from a person.’” 2025 U.S. Dist. LEXIS 59288 at *19 (quoting Philadelphia Newspapers, Inc. v. HHS, 69 F. Supp. 2d 63, 66-67 (D.D.C. 1999).

That distinction is dispositive here. The identities of the grower, processor, distributors, broker, and retail or food service outlets were not supplied to the FDA by any external party. Rather, the FDA independently uncovered these entities through its own traceback investigation, conducted in coordination with other federal agencies. The agency did not merely compile or summarize date submitted by third party—it generated new information through its investigative efforts. Accordingly, the redacted identities reflect the FDA’s own analysis and do not qualify as information “obtained from a person” under Exemption 4. 

The Withheld Information Is Not “Privileged or Confidential”

To qualify as “confidential” under Exemption 4, information must meet at least one of the two conditions described by the Supreme Court in Food Mktg. Inst. v. Argus Leader Media, 588 U.S. 427, 434, 139 S. Ct. 2356, 204 L. Ed. 2d 742 (2019). First, the information must be “customarily kept private, or at least closely held, by the person imparting it.” Id. Second, the government must provide “some assurance that it will remain secret.” Id. Neither condition is satisfied here. 

First, the identities of growers, processors, brokers, distributors, and retail or food service outlets involved in this outbreak are not the type of information that is customarily kept private. These entities operate in public-facing, highly regulated sectors—agriculture, food distribution, and retail sales—where their roles in the supply chain are widely known or readily discoverable through public sources. Farms, processors, and distributors routinely disclose their customers, partners, and supply chains for marketing, compliance, and logistics purposes. Unlike trade secrets, pricing models, or proprietary formulas, the basic fact of who grew or sold a food product is not “known only to a limited few” or “intended to be held in confidence or kept secret.” Id. at 434. Indeed, many of these entities advertise their participation in national supply chains and their relationships with retailers or food service companies. Moreover, as detailed above, the FDA did not receive this information from any external party; it uncovered and synthesized it through its own independent investigation. This further undercuts any claim that the information was “imparted” by a “person” in confidence, as required under Food Mktg. Inst. v. Argus.

Second, there is no indication that the FDA gave any assurance—formal or informal—that the identities of these entities would be kept confidential. On the contrary, disclosure is standard practice in many foodborne illness outbreaks, where identifying implicated parties is critical for public health response and consumer protection. The FDA’s own policies emphasize transparency, particularly in matters involving acute risk to human health. Without any assurance of confidentiality and no consistent, established practice of secrecy by the entities themselves, the withheld information simply does not meet the definition of “confidential” under Exemption 4.

The Public Interest Demands Disclosure

FOIA exists “to pierce the veil of administrative secrecy and to open agency action to the light of public scrutiny.” Citizens, 58 F.4th at 1261 (internal citations omitted). Disclosure—not secrecy—is the dominant objective of the Act. Id.Accordingly, the exemptions to FOIA must be “narrowly construed,” and the burden of justifying any withholding rests with the agency. Id. at 1261-1262.

            Exemption 4 does not—and cannot—shield information from public scrutiny simply because its release may cause discomfort to private entities or government agencies. The statute protects confidential commercial information, not reputational interests or the government’s desire to avoid controversy. Id. at 1268. 

            Here, the public interest in disclosure is overwhelming. The FDA has withheld the identities of entities linked to a deadly E. coli O157:H7 outbreak that sickened at least 89 people across 15 states, caused seven cases of hemolytic uremic syndrome (HUS), and led to one death. Traceback analysis revealed that the outbreak strain matched six prior E. coliclusters—strong evidence of a persistent, resident strain at or near the source. Disclosure is essential to public accountability and future prevention. 

            Even though the outbreak investigation is closed, the health risks remain. Without transparency about where the contamination occurred and who was responsible, the public, regulators, and industry cannot take informed steps to prevent recurrence. This is precisely the kind of secrecy FOIA was enacted to prevent: where withholding information compromises public health and conceals systemic failures from the scrutiny necessary to correct them. 

            Accordingly, we respectfully request that the FDA disclose the names of the grower, processor, broker, distributors, and points of service identified in its investigation. The law does not support secrecy here—and neither does public interest.

Very truly yours, 

William D. Marler

[1] https://www.marlerblog.com/files/2025/04/2411MOEXH-2-Romaine-E.-coli-FDA-Records.pdf

On June 27, 2025 the Lexington-Fayette County Health Department (LFCHD) was made aware of an outbreak of Salmonella infection. To date, ten (10) confirmed cases of Salmonella infection have been reported. The cases include four (4) Fayette County residents, two (2) Jessamine County residents, two (2) Mercer County residents, one (1) Fleming County resident, and one (1) out of state resident.

Cases were interviewed to see what food items they consumed prior to their illness. It was discovered that each case had eaten at least one meal at different Ramsey’s Diner locations between June 17-20. While the entrée items differed, each case consumed a custard-based pie topped with meringue or a cheesecake dessert. If you have recently purchased a pie from Missy’s or Ramsey’s and still have leftovers, you are advised to discard the remainder.

The time between exposure to Salmonella and experiencing symptoms can range from 6 hours to 6 days but most commonly occurs in 6-48 hours. Symptoms of Salmonella infection can include diarrhea, fever, abdominal cramps and pain, nausea, vomiting, chills, headache and blood in the stool. Symptoms usually resolve within a few days but could last over a week. If symptoms persist, please seek advice from your healthcare provider. Those who are immunocompromised are at a higher risk for developing more severe illness. If you have experienced these symptoms after consuming food or pies from Ramsey’s Diner or Missy’s Pies since June 15, please complete the following questionnaire to report your symptoms to assist in quantifying the outbreak: https://redcap.link/salmonella_investigation

LFCHD has worked with Ramsey’s and Missy’s Pies to discard any pies that were onsite. Samples of pies and eggs were collected for testing to be completed by the state public health laboratory. Thorough cleaning of the common kitchen where pies were prepared was completed and the establishment was allowed to return to operations to prepare lower risk items such as shelf stable fruit pies and other pies which do not have eggs as ingredients for fillings. At this time, there has been no positive identification of an implicated source for the Salmonella exposure; however, eggs are a raw agricultural commodity (RAC) and as such have the potential to be contaminated. Therefore, it is important to observe proper storage, handling, and cooking temperatures. Please visit the following U.S. Food and Drug Administration site for more information about egg safety: https://tiny.lfchd.org/2p96mv7x

I spoke to a woman today whose kid is in ICU because of E.coli.

The City of Chico is advising residents to avoid swimming in Sycamore Pool at One Mile Recreation Area in Bidwell Park until further notice. Elevated levels of bacteria are present in the water, which presents an increased risk of illness to children, the elderly, and individuals with compromised immune systems.

  • Avoid swimming in Sycamore Pool
  • Wash hands thoroughly if in contact with creek water
  • Keep pets out of the water

Dear ACIP Secretariat:

The Advisory Committee on Immunization Practices (ACIP) provides advice and guidance to the Director of the CDC regarding use of vaccines and related agents for control of vaccine-preventable diseases in the civilian population of the United States. Recommendations made by the ACIP are reviewed by the CDC Director and, if adopted, are published as official CDC/HHS recommendations in the Morbidity and Mortality Weekly Report (MMWR).

Presently, approximately 5% of all hepatitis A outbreaks are linked to infected food-handlers.

Here is what the CDC continues to say about vaccinating food-handlers:

Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?

CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using or injecting drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare because standard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who participate in risk behaviors previously described are at greater risk for hepatitis A infection.

The CDC misses the point; granted, food service workers are not more at risk of getting hepatitis A because of their occupation, but they are a risk for spreading it to customers. Food service positions are typically low paying and certainly have the likelihood of being filled by people who are immigrants from countries where hepatitis A might be endemic or by people who have been recently experienced homelessness.

Over the past several years, there has been an ongoing outbreak of hepatitis A in the United States. As of February 2, 2023, there have been a total of 44,779 cases with a 61% hospitalization rate (approximately 27,342 hospitalizations). The death toll stands at 421. Since the outbreak started in 2016, 37 states have reported cases to the CDC.

The CDC recommends to the public that the best way to prevent hepatitis A is through vaccination, but the CDC has not explicitly stated that food service workers should be administered the vaccination. While food service workers are not traditionally designated as having an increased risk of hepatitis A transmission, they are not free from risk. 

24% of hepatitis A cases are asymptomatic, which means a food-handler carrying the virus can unknowingly transmit the disease to consumers. Historically, when an outbreak occurs, local health departments start administering the vaccine for free or at a reduced cost. The funding from these vaccinations is through taxpayer dollars. 

A mandatory vaccination policy for all food service workers was shown to be effective at reducing infections and economic burden in St. Louis County, Missouri.

From 1996 to 2003, Clark Country, Nevada had 1,523 confirmed cases of hepatitis A, which was higher than the national average. Due to these alarming rates, Clark County implemented a mandatory vaccination policy for food service workers. As a result, in 2000, the hepatitis A rates significantly dropped and reached historic lows in 2010. The county removed the mandatory vaccine rule in 2012 and are now part of the ongoing hepatitis A outbreak. 

According to the CDC, the vaccinations cost anywhere from $30 to $120 to administer, compared to thousands of dollars in hospital bills, and offer a 95% efficacy rate after the first dose and a 99% efficacy after the second dose. Furthermore, the vaccine retains its efficacy for 15-20 years.  

During an outbreak, if a food service worker is found to be hepatitis A positive, a local health department will initiate post-exposure treatment plans that must be administered within a two-week period to be effective. The economic burden also affects the health department in terms of personnel and other limited resources. Sometimes, the interventions implemented by the local health department may be ineffective. 

Though there are many examples of point-source outbreaks of hepatitis A that have occurred within the past few years around the country, a particularly egregious outbreak occurred in the early fall of 2021 in Roanoke, Virginia. The health department was notified about the outbreak on September 21, 2021, after the first case was reported by a local hospital. The Roanoke Health Department, along with the Virginia Department of Health, investigated this outbreak.

Three different locations of a local restaurant, Famous Anthony’s, were ultimately determined to be associated with this outbreak. The Virginia Department of Health published a community announcement on September 24, 2021, about the outbreak and the potential exposure risk. 

For purposes of the investigation, a case was defined as a “[p]erson with (a) discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels and (c) [who] tested positive for hepatitis A (IgM anti-HAV-positive), and frequented any of three Famous Anthony’s locations, or was a close contact to the index case patient, during the dates of August 10 through August 27, 2021.”

As of November 2021, a total of 49 primary cases (40 confirmed and 9 probable) were identified in this outbreak. Two secondary cases were also identified. Cases ranged from 30 to 82 years of age (median age of 63). In all, 57 percent of cases were male. Thirty-one cases included hospitalizations, and at least 4 case patients died. Illness onsets occurred between August 25 and October 15, 2021.

Ultimately, the outbreak investigation revealed that a cook, who also had risk factors associated with hepatitis A, had been infected with hepatitis A while working at multiple Famous Anthony’s restaurant locations. This index case’s mother and adult son also tested positive for hepatitis A. Following an inspection, the outbreak inspector noted, “due to the etiology of hepatitis A transmission, it is assumed the infectious food handler did not perform proper hand washing or follow glove use policy.” It was determined that person-to-person spread was the most likely mode of transmission in this outbreak. Environmental contamination was also considered a possible mode of transmission. 

Overwhelmed by the number of victims who pursued legal action for their injuries, Famous Anthony’s filed for bankruptcy and several of its locations have been closed.

The tragedy of this preventable hepatitis A outbreak cannot be overstated. Four people died. In one family, two of its members lost their lives. Most of the victims were hospitalized. Many risked acute liver failures. At least one person required both a liver and kidney transplants. Medical bills for the victims totaled over $6,000,000 in acute costs with millions of dollars in future expenses. And, this all because one employee did not receive a $30-$120 hepatitis A vaccine.

Affordable prevention of future tragedies like the Famous Anthony’s outbreak is possible and necessary. The time has come to at least recommend vaccinations to food service workers to reduce the spread of hepatitis A.

I would urge you to review this recently published article.

“Determining the burden of foodborne hepatitis a spread by food handlers: suggestions for a targeted vaccination?”

Studies highlighted critical challenges, including underreporting, asymptomatic cases, and delayed interventions. Control measures largely relied on immunoglobulin administration, while vaccination was rarely implemented and showed poor adherence among food service staff. Although economic analyses were limited and sometimes inconclusive, some evidence suggested potential healthcare savings from prevention efforts. Considering HAV’s high transmissibility and the difficulty of timely outbreak detection, targeted vaccination of food handlers—especially those in high-risk settings or seasonal employment—emerges as a promising method of biological risk management in food industries. These considerations could support food industries in considering vaccination as a tool to prevent foodborne HAV transmission.

Trucchi C, Del Puente F, Piccinini C, Roveta M, Sartini M and Cristina ML (2025) Determining the burden of foodborne hepatitis a spread by food handlers: suggestions for a targeted vaccination? Front. Public Health 13:1617004. doi: 10.3389/fpubh.2025.1617004

Sincerely,

William Marler

On behalf of 31 hepatitis A victims and families

On July 24, 2024, John tested positive for Listeria, while in the ICU. John’s sample was genetically linked, by Whole Genome Sequencing, to a cluster of Listeria associated with potatoes from Mexico.

Figure: SNP-tree of sequences of REP strain uploaded to the public sequence repository at 
NCBI.

On July 16, 2024, John was admitted to the hospital with a headache, facial drooping, dizziness, and an abnormal MRI. His family feared he was having an aneurysm. 

A week later, on July 22, 2024, John was intubated and sedated in the ICU, where he remained for five weeks, fighting for his life against bacterial meningitis caused by Listeria. 

When John was first admitted to ICU, he had been hospitalized for a week with symptoms; it took another three days of testing to determine that Listeria was the cause of his illness. John was on a ventilator and multiple IV drips to keep him alive in the ICU. He was comatose and unresponsive for at least a week. At one point, he was so swollen with fluids and meds, he could not even close his eyes. 

After approximately five weeks in the ICU, John was transferred to a rehab hospital for long term acute care (LTAC). He was minimally responsive to his family for the first several months in LTAC. He remained unable to move, speak, swallow, or see without double vision. He developed pressure wounds that required serious care , including a specialized bed. He remained on the IV antibiotic drip for 12 weeks, until blood tested determined that the bacteria had been killed; however, the massive effects of the infection included multiple abscesses in his brainstem and cerebellum, and his brain was left swollen and inflamed. 

John remained on the ventilator until the end of November 2024. He was only able to sit in a wheelchair, propped with pillows for 30 minutes at a time. John started to receive PT, OT, and speech therapy. During this time, John encountered multiple infections including UTIs, bronchitis, and pinkeye. 

John spent eight months at the rehab hospital and continued to improve very slowly and to regain some strength. But the damage was apparent, as his wife details: 

He made gains in communication, but it became apparent that his cognitive perception and personality were affected by the damage from the Listeria infection. It is devastating to see your loved one suffer so much and devastating on a whole different level to try to help and have them hallucinating that you are someone else and there to harm them. To see my husband, my partner in life, have every part of his body and mind affected  is something I will never unsee or unfeel. 

In March 2025, John was transferred to skilled nursing, but it quickly became apparent that this was not the proper level of care for him. In three weeks at the facility, EMS was called for John three times; twice, he had pulled out his own trach tube because it had become clogged with secretions and he could not breathe, and once because he had fallen and none of the nurses could lift him. John’s mental health deteriorated as well, with him saying he felt neglected and like he was left there to die. Subsequently, due to a lack of nursing care, John ended up in the ICU with pneumonia, where he stayed for 10 days and, once again, nearly died. He was discharged back to the rehab hospital, to start the cycle all over again—LTAC, rehab, and then insurance pushing him out the door to skilled nursing. His wife writes: 

I worry and research constantly about where John can be placed and the level of care I can get for him. He requires assistance to  walk, bathe, dress or take care of himself. He is on a feeding tube because he cannot swallow without aspirating. He has tracheostomy that may be permanent as well as the feeding tube. He can speak but is very difficult to understand initially, as half of his face remains paralyzed. He cannot write due to loss of fine motor skills, and he can only read with difficulty due to double vision. He was recently diagnosed with Cerebellar Cognitive Affective Syndrome, for which there is not treatment and no cure. John’s long-term memory remains intact, but his short-term memory, emotional regulation, and impulse control are all affected. 

John has never made it home since being admitted to hospital care last July. He may never make it home, as his medical needs, both physical and mental, remain complex. John is a beloved, successful, vibrant, healthy, intelligent and opinionated man who headed up a family and a business. John is the Chief Creative Officer, CEO, and founding member, of our business. Coming to terms with the changes in our business structure and making sure we are still providing the same levels of thinking and execution has been a nearly full-time job, beyond managing John’s care. Thankfully, John’s thoughtful leadership prior to his sudden disappearance gave us an effective blueprint to keep going and maintaining our level of performance, but to say that this time has been stressful is frankly the understatement of the year.  I only sleep because I’m too mentally exhausted to stay awake at a certain point. 

Essentially, our entire life has been dominated and completely turned upside down by John’s illness since he was admitted. I have struggled to be a parent to our 15-year-old son while my hours (literally and mentally) are dominated by managing John’s care. I worry for my son’s mental health while trying to maintain my own and to be an engaged and involved mom. 

The version of the husband, father, brother, friend, uncle, and boss we all knew, loved and depended on is gone. A shadow version of John remains in place, and because of the complexity of his medical needs, we don’t know for how long. It has been harrowing to watch him suffer for the better part of a year now. He has said he wished he had died last July. What does one even say to that? At the time I was so grateful  that John lived… but seeing how miserable he is now, I don’t feel grateful at all. I feel that my best friend and husband John did die then, and I am a widow to a living person… and that is a truly awful place to exist for both of us.

Nearly one year later we are still searching for the conclusive link between John’s devastating Listeria illness and all the others ill and likely Mexican potatoes.  Question?  Where is our FDA and CDC and the State of Texas in the investigation?

Whole genome sequencing (WGS), which determines the full nucleotide sequence of a bacterium’s genetic makeup, is now the gold standard for laboratory surveillance and investigation of outbreaks of foodborne infections.

With WGS, outbreaks are detected faster when they are smaller, and more outbreaks are being solved and controlled than ever before. WGS has an unsurpassed high resolution by detecting changes at the level of the building stones of the genetic code of the bacteria. The resolution is so high that small differences might be observed within a single bacterial strain and therefore a strain by WGS is not defined by one sequence but rather by a group of highly similar sequences, e.g. differing from each other by up to 10 differences. Biologically, bacteria with similar sequences likely share a recent common ancestor. Along the same lines, it is a basic assumption in outbreak surveillance that bacteria with very similar sequences likely come from the same source even if collected over extended time periods.

Very soon after WGS was introduced in the surveillance, food safety specialists realized that outbreaks with very few cases might occur over long periods, sometimes years. The term “low and slow” was introduced to describe these outbreaks. However, even now the food safety authorities rarely actively look for these outbreaks. They investigate them when they accidently stumble into them when isolates from a food or the food environment match isolates from historical patients, or patient isolates in current outbreak investigations match seemingly sporadic cases from years ago. An example of the latter is the Listeria outbreak linked to Blue Bell ice cream in 2015. 

It is well-known that bacterial strains may persist for years in the food production systems and that such contamination has caused outbreaks. For example, a particular strain of Salmonella Enteritidis caused two outbreaks associated with almonds from California in the 1990s, which lead to the implementation of mandatory fumigation of almonds for human consumption. A strain of Salmonella Newport caused outbreaks every year in the 2000s associated with tomatoes produced in the Delmarva region. A more recent example is a strain of Shiga toxin-producing E. coli causing several outbreaks associated with produce grown in the South Western US. Scientists at the Center for Disease Control and Prevention (CDC) came up with a name, REP-strains (short of Repeating, Emerging or Persistent) for such strains. REP-strains may cause outbreaks with different food vehicles if the ultimate source is outside the food production systems (e.g. the latter E. coli outbreaks) or with just one vehicle if a specific production system has been contaminated (e.g. the Salmonella outbreaks).

After the implementation of WGS it has  been realized that some REP-strains may cause ‘low and slow’ outbreaks that are neither detected nor investigated because the outbreak signals are weak and the illnesses are too spread out in time to be caught by the detection  algorithms used by the public health authorities. This is a shame, because a REP-strain problem that looks small in a one-year time frame may be a big and significant public health issue that needs to be addressed if it persists for years. The wealth of sequence data  in the GenomeTrakr network in the public sequence repository, SRA, at the National Center for Biotechnology information (NCBI) could easily be used to detect such large “low and slow” outbreaks.

Recently, scientists discovered a REP-strain in the SRA, when working on John’s case.  They were checking sequences of Listeria monocytogenes and discovered a group of 130 highly related sequences submitted to the database between 2016 and now (Table and Figure).

These sequences showed up to 23 differences (“SNP-differences”) between them with an average of just 6 SNPs, a difference that is often seen in Listeria outbreaks. 97 sequences were from human clinical isolates in the US submitted by PulseNet USA and 33 were from potatoes (32) and an apple (1) submitted by the Mexican Service for the National Health for Food Safety and Food Quality (SENASICA) with food origin listed as USA. Distribution of sequence submissions by year is seen in the table below.

Table: Listeria isolates of REP strain submitted the public sequence repository at NCBI by year and source.

The distribution by year peaked between 2017 and 2022 from a low start. Since 2022 there has been a few infections every year. Two sequences have so far been submitted in 2025. Unfortunately, the state distribution of the clinical isolates is not provided in the database. CDC or the Food and Drug Administration (FDA) has not mentioned anything about outbreaks or outbreak investigations related to this REP-strain on their web-sites, so it is unclear if they have ever investigated it during one of the peaking years or over the whole time-period. This is odd, since the total number of cases is high and 32 of the sequences originate from a potential food source. This is surely a potential long-lasting outbreak that should be investigated. 

The resources to the CDC and FDA, particularly affecting international activities, have been drastically reduced this year. While the administration suggests these cuts address inefficiencies without compromising core functions, food safety scientists dispute this claim. Investigating the cluster with this REP-strain could provide important clues to settle this dispute testing the agencies’ capabilities in domestic and international outbreak investigation and management, highlighting the importance of maintaining robust food safety programs.

Hello, FDA, CDC and State of Texas.

The Pennsylvania Department of Agriculture is warning consumers to immediately discard Meadow View Jerseys brand raw milk purchased since April 1 with sell-by dates between April 15 and July 8. 

Milk samples from the dairy were tested and confirmed to be contaminated with Campylobacter after patients reported symptoms of campylobacteriosis after having consumed the products.

The implicated milk was sold in glass half-gallon, and plastic half-gallon and gallon containers. The milk was sold at the farm’s store in Leola and a number of retail stores in south-central Pennsylvania.

The farm contacted wholesalers that distributed the milk, but the state agriculture department could not obtain a list of customers who purchased it.

A current list of Meadow View Jerseys Dairy distributors was not available, but milk with the farm’s label was available in the following locations in 2024:

Berks County: Weaver Orchard, 40 Fruit Lane, Morgantown, PA 19543

Dauphin County: Soil & Soul Farm, 2405 Colebrook Road, Middletown, PA 17057

Lancaster County: 

  • Meadow View Jerseys Retail Farm Store, 172 South Farmersville Road, Leola, PA 17540
  • Bird in Hand Farm Supply, 2805 Old Philadelphia Pike, Bird in Hand, PA 17505
  • Ebenezer Groceries, 465 North Reading Road, Ephrata, PA 17522
  • Everest Indian Grocery Store, 1621 Columbia Ave., Lancaster, PA 17603
  • Forry’s Country Store, 820 Ivy Drive Lancaster, PA 17601
  • Hilltop Acres, 347 Rife Run Road, Manheim, PA 17545
  • Meck’s Produce, 1955 Beaver Valley Pike, Strasburg, PA 17579
  • Sensenig Poultry, 843 Furnace Hill Road, Lititz, PA 17543
  • The Country Store 3140, Mount Joy Road, Mount Joy PA 17552
  • Union Mill Acres, 7557 Elizabethtown, Road Elizabethtown, PA 17022
  • Willow Creek Grocery, 30 Willow Street, Reinholds, PA 17569