As of August 23 2019, there have been seven confirmed cases of Listeria monocytogenes illness in three provinces: British Columbia (1), Manitoba (1) and Ontario (5). Individuals became sick between November 2017 and June 2019. Six individuals have been hospitalized. Individuals who became ill are between 51 and 97 years of age. The majority of cases (86%) are female.

According to Health authorities in Canada, based on the investigation findings to date, Rosemount brand cooked diced chicken has been identified as a likely source of the outbreak. Rosemount cooked diced chicken was supplied to institutions (including cafeterias, hospitals and nursing homes) where many of the individuals who became sick resided, or visited, before becoming ill.  That product has now been recalled.

The CDC, several states, and federal partners (USDA/FSIS) are investigating a multistate outbreak of Listeria monocytogenes infections. This investigation is ongoing and has not identified a specific food item, grocery store, or restaurant chain as the source of infections.  However, The Public Health Agency of Canada is also investigating a Listeria monocytogenes outbreak in several Canadian provinces linked to cooked diced chicken.

Whole genome sequencing (WGS) shows that the type of Listeria making people sick in Canada is closely related genetically to the Listeria making people sick in the United States. WGS gives investigators detailed information about the bacteria causing illness. In this investigation, WGS showed that bacteria isolated from ill people were closely related genetically. This means that people in this outbreak are more likely to share a common source of infection.

As of August 23, 2019, a total of 24 people infected with the outbreak strain of Listeria monocytogenes has been reported from 13 states.  Ill people range in age from 35 to 92 years, with a median age of 72. Sixty-three percent of ill people are female. Of 23 ill people with information available, 22 hospitalizations have been reported. Two deaths have been reported.

In the United States, Tip Top Poultry, Inc., a Rockmart, Ga. establishment, has recalled approximately 135,810 pounds of fully cooked poultry products that may be adulterated with Listeria monocytogenes, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced.

The frozen, diced, and mechanically separated ready to eat chicken was produced on January 21, 2019 and display “PACK DATE 01/21/19” on the labels. The products subject to recall bear establishment number “P-17453” inside the USDA mark of inspection or on the case. These items were shipped to hotels, restaurants, and institutions nationwide.

The problem was discovered on August 17, 2019, when the Canadian Food Inspection Agency (CFIA) notified FSIS that a sample of product produced by Tip Top Poultry, Inc. confirmed positive for the presence of Listeria monocytogenes.

By warning you not to wash chicken (or other poultry), FSIS correctly recognizes the risk of cross-contamination in your kitchen and the risk that it poses to you and your family – especially children and the elderly.  But, why does it continue to allow companies to knowingly sell us Salmonella-tainted poultry?

Personally, as I said to the Los Angeles Times some time ago, “I think that anything that can poison or kill a person should be listed as an adulterant [in food].”

Ignoring Salmonella in meat makes little, if any, sense. Even after the Court’s twisted opinion in Supreme Beef v. USDA, where it found Salmonella “not an adulterant per se, meaning its presence does not require the USDA to refuse to stamp such meat ‘inspected and passed’, ” our government’s failure to confront the reality of Salmonella, especially antibiotic-resistant Salmonella, is inexcusable.

The Wisconsin Supreme Court in Kriefall v Excel called it as it saw it:

The E. coli strain that killed Brianna and made the others sick is a “deleterious substance which may render [meat] injurious to health.” There is no dispute about this. Thus, under the first part of 21 U.S.C. § 601(m)(1), meat that either “bears or contains” E. coli O157:H7 (the “deleterious substance”) is “adulterated.” That E. coli O157:H7 contamination can be rendered non-“injurious to health” by cooking thoroughly, as discussed below, does not negate this; Congress used the phrase “may render,” not “in every circumstance renders.” Moreover, if the E. coli bacteria is not considered to be “an added substance,” because it comes from some of the animals themselves and is not either applied or supplied during the slaughtering process (although we do not decide this), it cannot be said that the E. coli strain “does not ordinarily render [the meat on or in which it appears] injurious to health.” Accordingly, meat contaminated by E. coli O157:H7 is also “adulterated” under the second part of § 601(m)(1).

Now, why would Salmonella be different? According to the CDC, it is estimated that 1.4 million cases of salmonellosis occur each year in the United States. Of those cases, 95 percent are related to foodborne causes. Approximately 220 of each 1,000 cases result in hospitalization, and 8 of every 1,000 cases result in death. About 500 to 1,000 deaths – 31 percent of all food-related deaths – are caused by Salmonella infections each year.

So, where do we stand with the existing USDA/FSIS law on adulteration?  Here is the law:

21 U.S.C. § 601(m)(4) – SUBCHAPTER I – INSPECTION REQUIREMENTS; ADULTERATION AND MISBRANDING – CHAPTER 12 – MEAT INSPECTION – TITLE 21—FOOD AND DRUGS

(m) The term “adulterated” shall apply to any carcass, part thereof, meat or meat food product under one or more of the following circumstances:

(1) if it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in case the substance is not an added substance, such article shall not be considered adulterated under this clause if the quantity of such substance in or on such article does not ordinarily render it injurious to health; …

(3) if it consists in whole or in part of any filthy, putrid, or decomposed substance or is for any other reason unsound, unhealthful, unwholesome, or otherwise unfit for human food;

(4) if it has been prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health; …

Hmmm. It is hard to read the above and not think that the words in bold equate to all E. coli and Salmonella — frankly, all pathogens in food. I know, I am just a lawyer, but don’t ya think that when food with animal feces (and a dash of E. coli O157:H7) in it is considered an adulterant, that other animal feces (with dashes of other pathogens, like Salmonella) in them, should be considered adulterated too?  But, hey, that is just me. Another odd governmental fact is that the FDA does not seem to make a distinction between pathogens it considers adulterants or not. FDA’s enabling legislation – Sec. 402. [21 USC §342] of the Food, Drug & Cosmetic Act also defines “Adulterated Food” as food that is: 

(a) Poisonous, insanitary, or deleterious ingredients.

(1) If it bears or contains any poisonous or deleterious substance which may render it injurious to health; but in case the substance is not an added substance such food shall not be considered adulterated under this clause if the quantity of such substance in such food does not ordinarily render it injurious to health;

(2) If it bears or contains any added poisonous or added deleterious substance … that is unsafe within the meaning of section 406;

(3) if it consists in whole or in part of any filthy, putrid, or decomposed substance, or if it is otherwise unfit for food;

(4) if it has been prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health …

It would be interesting, and perhaps entertaining, to have House and Senate hearings focusing on what should and should not be considered adulterants in our food. I can see panels of scientists from various fields, FDA, USDA and FSIS officials, beef and produce industry representatives, and consumers discussing this. I would pay to watch it.

A study from the U.S. Department of Agriculture (USDA) reveals that individuals are putting themselves at risk of illness when they wash or rinse raw poultry.

“Cooking and mealtime is a special occasion for all of us as we come together with our families and friends,” said Dr. Mindy Brashears, the USDA’s Deputy Under Secretary for Food Safety. “However, the public health implications of these findings should be of concern to everyone. Even when consumers think they are effectively cleaning after washing poultry, this study shows that bacteria can easily spread to other surfaces and foods. The best practice is not to wash poultry.”

The results of the observational study showed how easy bacteria can be spread when surfaces are not effectively cleaned and sanitized. The USDA is recommending three easy options to help prevent illness when preparing poultry, or meat, in your home.

  1. Significantly decrease your risk by preparing foods that will not be cooked, such as vegetables and salads, BEFORE handling and preparing raw meat and poultry.
    • Of the participants who washed their raw poultry, 60 percent had bacteria in their sink after washing or rinsing the poultry. Even more concerning is that 14 percent still had bacteria in their sinks after they attempted to clean the sink.
    • 26 percent of participants that washed raw poultry transferred bacteria from that raw poultry to their ready to eat salad lettuce.
  2. Thoroughly clean and sanitize ANY surface that has potentially touched or been contaminated from raw meat and poultry, or their juices.
    • Of the participants that did not wash their raw poultry, 31 percent still managed to get bacteria from the raw poultry onto their salad lettuce.
    • This high rate of cross-contamination was likely due to a lack of effective handwashing and contamination of the sink and utensils.
      • Clean sinks and countertops with hot soapy water and then apply a sanitizer.
      • Wash hands immediately after handling raw meat and poultry. Wet your hands with water, lather with soap and then scrub your hands for 20 seconds.
  3. Destroy any illness causing bacteria by cooking meat and poultry to a safe internal temperature as measured by a food thermometer.
    • Beef, pork, lamb and veal (steaks, roasts and chops) are safe to eat at 145°F.
    • Ground meats (burgers) are safe to eat at 160°F.
    • Poultry (whole or ground) are safe to eat at 165°F.
      • Washing, rinsing, or brining meat and poultry in salt water, vinegar or lemon juice does not destroy bacteria. If there is anything on your raw poultry that you want to remove, pat the area with a damp paper towel and immediately wash your hands.

“Everyone has a role to play in preventing illness from food,” said Administrator Carmen Rottenberg of USDA’s Food Safety and Inspection Service (FSIS). “Please keep in mind that children, older adults, and those with compromised immune systems are especially at risk. Washing or rinsing raw meat and poultry can increase your risk as bacteria spreads around your kitchen, but not washing your hands for 20 seconds immediately after handling those raw foods is just as dangerous.”

I am working on yet another E. coli HUS case linked to a food product that should never had been tainted in the first place.  I had asked a parent of a client to give me a sense of the worst of the many bad times.  I deleted information that could identify the case.

On Christmas Eve, I went home to try to make something of the holiday for our _____ year old _____, _____.

_____ stayed with _____ and called me shortly after I got home.

_____ said that _____ was having seizures and I should come back to the hospital right away.

Driving on the _____ on the way to the hospital, I got another call from _____. They were doing chest compressions on _____…

… I have never driven so fast in my life. I pulled up to the hospital and left my car right at the door with the keys in it, and ran to the PICU.

The doors were locked at the entrance and the receptionist had stepped away.

I was desperately pounding on the doors to be let in.

I thought _____ had died.

As a father of three daughters, I honestly cannot imagine the horror of this situation.  E. coli and HUS already leaves you helpless – I am not sure how someone recovers from this.

CDC and FDA are now advising people not to buy or feed any pig ear dog treats to pets, including any that may already be in homes.

People can get sick after handling the treats or caring for dogs who ate the treats. Dogs might get sick after eating them.

Since the last update on July 17, 2019, a total of 34 ill people have been added to this investigation.

A total of 127 people infected with the outbreak strains of Salmonella have been reported from 33 states.

  • 26 ill people (30%) have been hospitalized. No deaths have been reported.
  • 24 illnesses (21%) are among children younger than 5 years.

State health and regulatory officials in several states and the FDA have tested pig ear dog treats at various suppliers and identified many different strains of Salmonella. No single supplier, distributor or common brand of pig ear treats has been identified that could account for all the illnesses. This is why CDC and FDA are now advising people to not buy or feed any pig ear dog treats to pets.

From the FDA:

Pet foods and treats contaminated with Salmonella and L. mono are of particular public health importance because they can affect both human and animal health. Pets can get sick from these pathogens and may also be carriers of the bacteria and pass it on to their human companions without appearing to be ill. People can get sick from handling contaminated pet foods and treats or touching surfaces that have had contact with the contaminated pet foods and treats. Additionally, if a person gets Salmonella or L. mono on their hands, they can spread the bacteria to other people, objects, and surfaces. The FDA is aware of recent cases in which humans and/or animals have gotten sick from exposure to Salmonella-contaminated pet foods (Salmonella-human cases, Salmonella-kitten, Salmonella-kitten and dog).  Although FDA is not aware of a documented case of a person acquiring L. mono infection from a pet food, once Salmonella or L. mono get established in the pet’s gastrointestinal tract, the animal can shed the bacteria in the feces when it has a bowel movement, and the contamination may continue to spread. Because animals can shed the bacteria in the feces when they have bowel movements, it’s particularly important to clean up the animal’s feces in yards or parks where people or other animals may become exposed, in addition to cleaning items in the home.

The Federal Food, Drug, and Cosmetic Act requires that all animal food, like human food, be safe to eat, produced under sanitary conditions, contain no harmful substances, and be truthfully labeled. Without an effective control for pathogens, such as cooking, animal food is more likely to contain pathogens such as Salmonella and L. mono. Refrigeration or freezing does not kill the bacteria.

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Cyclospora infections linked to consumption of fresh basil exported by Siga Logistics de RL de CV of Morelos, Mexico.

As of August 15, 2019, a total of 205 people with laboratory-confirmed Cyclospora infections associated with this outbreak have been reported from 11 states:  CT (1), FL (50), GA (2), IA (2), MA (1), MN (33), NY (107), OH (3), RI (1), SC (1), and WI (4).  Exposures were reported in 5 states (Florida, Minnesota, New York, Ohio, and Wisconsin).

Illnesses started on dates ranging from June 10, 2019 to July 18, 2019. Ill people ranged in age from 15 to 98 years with a median age of 51 and 70% were female. Five (2%) people have been hospitalized. No deaths attributed to Cyclospora have been reported.

Illnesses might not yet be reported due to the time it takes between when a person becomes ill and when the illness is reported. This takes an average of 4 to 6 weeks.

There are typically multiple clusters of Cyclospora infections that occur during a given season. It is unknown at this time if other reported cases of Cyclospora infection in the United States this season are linked to fresh basil. This investigation is ongoing.

Epidemiologic evidence and early product distribution information indicate that fresh basil exported by Siga Logistics de RL de CV of Morelos, Mexico, is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. An illness cluster is defined as two or more people who do not live in the same household who report eating at the same restaurant location, attending a common event, or shopping at the same location of a grocery store in the week before becoming ill. Investigating illness clusters provides critical clues about the source of an outbreak. If several unrelated ill people ate or shopped at the same location of a restaurant or store within several days of each other, it suggests that the contaminated food item was served or sold there. In this fresh basil-associated cluster, there were several situations in which people reported eating at the same restaurants.

The FDA and regulatory officials in several states are collecting records to determine the source of the fresh basil that ill people ate in the five affected states. Product distribution information available at this time indicates that the fresh basil that made people sick was exported by Siga Logistics de RL de CV of Morelos, Mexico. This traceback investigation is ongoing to determine the source of contamination. Additional illness clusters are currently under investigation to determine if they are linked to fresh basil exported by Siga Logistics de RL de CV of Morelos, Mexico.

Consumers should not eat fresh basil exported by Siga Logistics de RL de CV of Morelos, Mexico, until we learn more about this outbreak. This investigation is ongoing, and CDC will provide updates when more information is available.

What is Cyclospora?

Cyclospora is a parasite composed of one cell, too small to be seen without a microscope. The organism was previously thought to be a blue-green alga or a large form of cryptosporidium. Cyclospora cayetanensis is the only species of this organism found in humans. The first known human cases of illness caused by cyclospora infection (that is, cyclosporiasis) were first discovered in 1977. An increase in the number of cases being reported began in the mid-1980s, in part due to the availability of better diagnostic techniques. Over 15,000 cases are estimated to occur in the United States each year. The first recorded cyclospora outbreak in North America occurred in 1990 and was linked to contaminated water. Since then, several cyclosporiasis outbreaks have been reported in the U.S. and Canada, many associated with eating fresh fruits or vegetables. In some developing countries, cyclosporiasis is common among the population and travelers to those areas have become infected as well.

Where does Cyclospora come from?

Cyclospora is spread when people ingest water or food contaminated with infected stool. For example, exposure to contaminated water among farm workers may have been the original source of the parasite in raspberry-associated outbreaks in North America. Cyclospora needs time (one to several weeks) after being passed in a bowel movement to become infectious. Therefore, it is unlikely that cyclospora is passed directly from one person to another. It is not known whether or not animals can be infected and pass infection to people.

What are the typical symptoms of Cyclospora infection?

Cyclospora infects the small intestine (bowel) and usually causes watery diarrhea, bloating, increased gas, stomach cramps, loss of appetite, nausea, low-grade fever, and fatigue. In some cases, vomiting, explosive diarrhea, muscle aches, and substantial weight loss can occur. Some people who are infected with cyclospora do not have any symptoms. Symptoms generally appear about a week after infection. If not treated, the illness may last from a few days up to six weeks. Symptoms may also recur one or more times. In addition, people who have previously been infected with cyclospora can become infected again.

What are the serious and long-term risks of Cyclospora infection?

Cyclospora has been associated with a variety of chronic complications such as Guillain-Barre syndrome, reactive arthritis or Reiter’s syndrome, biliary disease, and acalculous cholecystitis. Since cyclospora infections tend to respond to the appropriate treatment, complications are more likely to occur in individuals who are not treated or not treated promptly. Extraintestinal infection also appears to occur more commonly in individuals with a compromised immune system.

How is Cyclospora infection detected?

Your health care provider may ask you to submit stool specimen for analysis. Because testing for cyclospora infection can be difficult, you may be asked to submit several stool specimens over several days. Identification of this parasite in stool requires special laboratory tests that are not routinely done. Therefore, your health care provider should specifically request testing for cyclospora if it is suspected. Your health care provider might have your stool checked for other organisms that can cause similar symptoms.

How is Cyclospora infection treated?

The recommended treatment for infection with cyclospora is a combination of two antibiotics, trimethoprim-sulfamethoxazole, also known as Bactrim, Septra, or Cotrim. People who have diarrhea should rest and drink plenty of fluids. No alternative drugs have been identified yet for people with cyclospora infection who are unable to take sulfa drugs. Some experimental studies, however, have suggested that ciprofloxacin or nitazoxanide may be effective, although to a lesser degree than trimethoprim-sulfamethoxazole. See your health care provider to discuss alternative treatment options.

How can Cyclospora infection be prevented?

Avoiding water or food that may be contaminated is advisable when traveling. Drinking bottled or boiled water and avoiding fresh ready-to-eat produce should help to reduce the risk of infection in regions with high rates of infection. Improving sanitary conditions in developing regions with poor environmental and economic conditions is likely to help to reduce exposure. Washing fresh fruits and vegetables at home may help to remove some of the organisms, but cyclospora may remain on produce even after washing.

The Snohomish Health District required the immediate closure of Ashiya Teriyaki located at 1233 164th St SW in Lynnwood following a confirmed case of hepatitis A in a foodworker. People who ate at this restaurant between August 2 and August 15 may be at risk for developing hepatitis A, and should contact their healthcare provider to get a hepatitis A vaccine or see if other treatment is needed.

This case does not appear to linked to the previously reported outbreak in Washington state.

Hepatitis A is a highly contagious liver infection caused by the hepatitis A virus. It can vary in severity, with mild cases lasting two weeks or less and more severe cases lasting 4-6 weeks or longer. Some individuals, especially children, may not develop jaundice, and may have an illness so mild that it can go unnoticed. However, even mildly ill people can still be highly infectious.

The early signs and symptoms of hepatitis A are:
• Fever
• Fatigue
• Loss of appetite
• Nausea,
• Vomiting
• Diarrhea
• Dark urine
• Jaundice (yellowing of eyes or skin).

Hepatitis A virus is spread as a result of fecal contamination, and may be spread from person to person through close contact or through food handling. The virus can be spread by contaminated food and beverages.

The District is working closely with Ashiya Teriyaki to ensure all food is discarded and the establishment is properly cleaned. Upon completion, and after passing an inspection, the restaurant will be allowed to reopen.

As a reminder, if you think you got sick after eating in any restaurant, please contact the Communicable Disease Surveillance line at 425.339.5278.

To prevent the spread of disease, thorough handwashing after using the bathroom and prior to food preparation is key. Handwashing should include vigorous soaping of the hands. All surfaces should be washed including the back of the hands, wrists, between fingers and under fingernails. Hands should be thoroughly rinsed with running water and dried completely.

Sound familiar?

All preventable by a hepatitis A vaccination – the only foodborne illness that is vaccine preventable.  Here are a few examples of cases involving ill workers and the impact on customers and restaurants.

In 2017 Bartaco in New York at least 5 people sickened with Hepatitis A many of who were hospitalized with hundreds of thousands in medical bills and wage loss.

McDonalds in Skagit County in 1998 was implicated in a cluster of Hepatitis A illnesses linked to an exposure by a Hepatitis A positive assistant manager.

In 1999 nearly 40 became ill after being exposed to a Hepatitis A positive working at two Subway locations in the Seattle area.  Several of the patrons were hospitalized with one young boy suffering acute liver failure requiring a liver transplant.

A Carls Jr. was hit in Spokane in 2000 with a Hepatitis A cluster that sickened over a dozen after being exposed to an ill worker.

In 2001 a Massachusetts D’Angelo’s Hepatitis A ill employee was linked to several customers who became ill after being exposed to contaminated food served at the restaurant.

A Hepatitis A positive employee at Maple Lawn Dairy in New York exposed at least six customers in 2004, including one patron who suffered acute liver failure and died.

In July and August of 2009, public health officials in the Quad-City region of Illinois identified at least 32 confirmed cases of hepatitis A among residents of Rock Island, Henry, Mercer, Warren, and Woodford Counties. People became ill after eating food purchased from the Milan McDonald’s restaurant and then developing a Hepatitis A infection.

According to press reports, Franklin County health officials are planning mass hepatitis A vaccinations as the county grapples with an ongoing outbreak of the highly contagious liver infection.

The Missouri Department of Health and Senior Services said Tuesday an employee at the Bob Evans restaurant in Washington, 3151 Phoenix Center Drive, was infected while working shifts from Aug. 3 through Aug. 10.

The DHSS said it was “uncommon” for restaurant patrons to catch hepatitis A from a sick food handler but said anyone who dined at Bob Evans between Aug. 3 and 12 should get vaccinated as a precaution.

The county health department is administering a mass vaccination from 9 a.m. to 4 p.m. on Friday at 414 East Main Street, Union; and from 8 a.m. to 12 p.m. on Saturday at the same location.

The state has since September 2017 seen an increase in hepatitis A cases, and has linked 400 cases “to an ongoing outbreak in Missouri.”

Franklin County has seen 63 cases, or nearly 16% of all cases. The only other county reporting more cases is Butler, in southeast Missouri, with 109 cases.

An estimated 103,000 people live in Franklin County, southwest of St. Louis County in the region’s exurbs.

The Franklin County Commission on July 30 issued an order requiring all restaurant workers to get vaccinated within 90 days of the order. The employees need another dose six months later, according to the order.

The health department advised Bob Evans patrons to monitor their health for 50 days after exposure, wash hands frequently and thoroughly, and to stay home if symptoms of hepatitis A develop.

The disease is spread when someone unknowingly consumes the virus from “objects, food, or drinks contaminated by small, undetected amounts of stool from an infected person,” according to the state. Symptoms may include the yellowing of the skin or whites of the eyes, abdominal pain, nausea or diarrhea.

“Transmission appears to be through direct person-to-person spread,” the state said. “Based on current information, persons who use injection and non-injection illicit drugs are at increased risk for hepatitis A during this outbreak.”

The Bob Evans employee was the third Franklin County food worker diagnosis since June to draw a public warning from the DHSS.