Vaccinating food service workers will not solve the entire problem – we need a nation-wide focus on homelessness and drug use as well.

According to a recent health warning, the CDC, multiple states across the country have reported outbreaks of hepatitis A (HAV), primarily among people who use drugs and people experiencing homelessness. Since the hepatitis A outbreaks were first identified in 2016, more than 15,000 cases, 8,500 hospitalizations, and 140 deaths as a result of HAV infection have been reported.

However, if state data is reviewed about 65% of the individuals sickened have been linked to drug use and homelessness, the remaining 35% have been Epi-Linked (people infected who are not drug users or homeless) or the cause of their infection is unknown.

In 2000, I said this:

“In the last six months Hepatitis A exposures have been linked to two Seattle-area Subways, a Carl’s Jr. in Spokane, WA, Hoggsbreath, a Minnesota restaurant, and three restaurants in Northwest Arkansas, IHOP, U.S. Pizza, and Belvedeers. Restaurants and food manufacturers must take action and voluntarily vaccinate all of their employees.”

Since then – especially recently – hardly a day goes by that the press does not report another food service worker possibly exposing thousands of patrons to HAV. Yet, neither the CDC nor any restaurant association has recommended HAV vaccination for such workers – until after the exposure.  This is not an acceptable public health response.

What is Hepatitis A?

Hepatitis A is one of the five Hepatitis viruses that are known to cause inflammation of the liver. The Centers for Disease Control and Prevention estimate that 150,000 people in the U.S. are infected each year by hepatitis. The illness is characterized by sudden onset of fever, malaise, nausea, anorexia, and abdominal pain, followed by jaundice. The incubation period for Hepatitis A, which varies from 10 to 50 days, is dependent upon the number of infectious particles consumed.

Where does Hepatitis A come from?

Hepatitis A spreads from the feces of infected people and can produce disease when individuals consume contaminated water or foods. Cold cuts, sandwiches, fruits, fruit juices, milk, milk products, vegetables, salads, shellfish, and iced drinks are also implicated in outbreaks. Water, shellfish, and salads are common sources. Contamination of foods by infected workers in food processing plants and restaurants is increasingly common.

How can a Hepatitis A infection be prevented?

Get vaccinated

If exposed, the illness can be prevented by a shot immune globulin within 2 weeks of exposure

Wash hands thoroughly with soap and warm water after using the bathroom, changing diapers, and before preparing/eating food.

Clean and disinfect bathrooms and diaper-changing surfaces frequently.

Never change diapers on eating or food preparing surfaces.

Cook shellfish before eating.

Drink water from approved source only.

For additional information see the Marler Clark sponsored Web sites about hepatitis A and about hepatitis A litigation.

Mondelēz Global LLC announced today a limited voluntary recall in the United States of certain Chewy Chips Ahoy 13oz cookies. This voluntary recall is being conducted because of the potential for certain product to contain an unexpected solidified ingredient. Some reports of potential adverse health effects have been received.

Mondelez spokesman Tom Armitage later clarified in an emailed statement: “In some instances, the cornstarch in our Chewy Chips Ahoy recipe did not fully incorporate in the mixing procedure and solidified in the baking process. The vast majority of consumers have not reported adverse events with respect to the product in the four code dates recalled. However, a small number of consumers have reported gagging, choking or dental injury, but none of these reports have been confirmed at this time. We issued this voluntary recall as a precaution, as the safety of our consumers is our top priority.”

This recall is limited exclusively to the products listed in the table below, available at retail stores nationwide.

Description Retail UPC Best When Used
By Dates		 Package Image
CHIPS AHOY CHEWY COOKIE (13
OZ)		 0 44000 03223 4 07SEP2019
08SEP2019
14SEP2019
15SEP2019
(Located on left top side of package by lift tab)		 See Image Above

The CDC and several states are investigating a multistate outbreak of Listeria infections linked to deli-sliced meats and cheeses. The U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) and the U.S. Food and Drug Administration (FDA) are monitoring the outbreak.

As of April 15, 2019, 8 people infected with the outbreak strain of Listeria monocytogenes have been reported from 4 states. A list of the states and the number of cases in each can be found on the Map of Reported Cases page.

Listeria specimens from ill people were collected from November 13, 2016 to March 4, 2019. Ill people range in age from 40 to 88 years, with a median age of 57. Thirty-eight percent are female. All 8 people (100%) have been hospitalized. One death has been reported from Michigan.

Epidemiologic and laboratory evidence indicates that deli-sliced meats and cheeses might be contaminated with Listeria monocytogenes and could make people sick.

In interviews, ill people answered questions about the foods they ate and other exposures in the four weeks before they became ill. Of 6 people interviewed, 5 (83%) reported eating products sliced at a deli counter, including meats and cheeses. Delis where ill people shopped served many different brands of products and there is limited information about the brands ill people bought.

USDA-FSIS and FDA evaluated records state inspectors collected from delis where ill people ate to determine whether a common meat or cheese product was served at the delis. The analysis of the available documentation could not identify a common product. USDA-FSIS and FDA will continue to assist with the investigation should additional information become available.

The outbreak strain of Listeria monocytogenes has been identified in samples from meat sliced at a deli, and from deli counters in multiple retail locations in New York and Rhode Island. WGS showed that the Listeria strain from these samples is closely related genetically to the Listeria strain from ill people. This result provides more evidence that people in this outbreak got sick from eating deli-sliced products. At this time, the investigation has not identified a common product that was sliced or prepared in the delis.

Additional Resources:

Jensen Tuna of Louisiana is recalling frozen ground raw tuna sourced from JK Fish of Vietnam due to possible Salmonella contamination. The recalled tuna was individually packaged in one-pound bags and sold in 20-pound boxes under lot numbers z266, z271, and z272

No other tuna products are impacted or part of this recall.

The product was sold to wholesalers in Connecticut, Iowa, Illinois, Minnesota, North Dakota, New York, and Washington. These wholesalers further distribute the product to restaurants and retail locations. The product was distributed from November 30, 2018 to March 15, 2019.

Restaurants and retailers should check with their suppliers and not sell or serve recalled frozen ground tuna and should wash and sanitize locations where recalled ground tuna was stored. Consumers with concerns should ask their restaurants and retailers whether the tuna dish they are purchasing contained the recalled ground tuna.

The voluntary recall is in response to the CDC and FDA’s investigation of 13 illnesses caused by Salmonella, confirmed to date. As of today, the ground tuna samples were found negative for Salmonella.  The illnesses are reported in Connecticut, Iowa, Illinois, Minnesota, New York, North Dakota and Washington.

Salmonella is an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Most people infected with Salmonella develop symptoms within 12 to 72 hours after infections, according to the FDA. The illness, marked by diarrhea, fever and abdominal cramps, usually lasts 4 to 7 days.

Symptoms of Salmonella infection include diarrhea, abdominal pain and fever. Symptoms usually begin within 12 to 96 hours after exposure, but they can begin up to 2 weeks after exposure. Infections usually clear in five to seven days, but about 28 percent of laboratory-confirmed cases require hospitalization. More serious invasive infections occasionally occur. Many Salmonella infections in otherwise healthy people do not require medical treatment. For those who seek health care, most do not require antibiotics. However, antibiotic treatment may be warranted in some cases. If you’ve consumed these products, become ill and are concerned about your health, consult your health care provider.

The 2019 Salmonella Carrau Outbreak

The CDC reported this evening, a multistate investigation which began on April 2, 2019, when PulseNet identified the outbreak. As of April 12, 2019, 93 people infected with the outbreak strain of Salmonella Carrau have been reported from nine states – Alabama 1, Illinois 5, Indiana 18, Kentucky 16, Michigan 19, Minnesota 3, Missouri 3, Ohio 27, Wisconsin 1.

Illnesses started on dates ranging from March 4, 2019, to March 31, 2019. Ill people range in age from less than one to 98 years, with a median age of 53. Fifty-seven percent are female. Of 53 people with information available, 23 (43%) have been hospitalized. No deaths have been reported.

Epidemiologic and traceback evidence indicate that pre-cut melon supplied by Caito Foods LLC of Indianapolis, Indiana is the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty (77%) of 39 people interviewed reported eating pre-cut melons purchased from grocery stores, including pre-cut cantaloupe, watermelon, honeydew, or a fruit salad mix or fruit tray with melon. Four additional people reported eating pre-cut melon outside the home.

Information collected from stores where ill people shopped indicates that Caito Foods LLC supplied pre-cut melon to these stores. On April 12, 2019, Caito Foods, Inc. recalledExternal pre-cut watermelon, honeydew melon, cantaloupe, and pre-cut fruit medley products containing one of these melons produced at the Caito Foods LLC facility in Indianapolis, Indiana.

The 2018 Salmonella Adelaide Outbreak

As of July 24, 2018, 77 people infected with the outbreak strain of Salmonella Adelaide were reported from nine states – Arkansas 1, Florida 1, Illinois 7, Indiana 14, Kentucky 1, Michigan 39, Missouri 11, Ohio 2, Tennessee 1.

Illnesses started on dates ranging from April 30, 2018, to July 2, 2018. Ill people ranged in age from less than 1 year to 97, with a median age of 67. Among ill people, 67% were female. Out of 70 people with information available, 36 (51%) were hospitalized. No deaths were reported.

Epidemiologic and traceback evidence indicated that pre-cut melon supplied by the Caito Foods, LLC of Indianapolis, Indiana was the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Thirty-six (64%) of 56 people interviewed reported eating pre-cut melon purchased from grocery stores, including cantaloupe, watermelon, or a fruit salad mix with melon. Twelve other people reported eating melon but did not specify whether it was pre-cut.

Information collected from stores where ill people shopped indicated that Caito Foods, LLC supplied pre-cut melon to these stores. On June 8, 2018, Caito Foods, LLC recalled fresh-cut watermelon, honeydew melon, cantaloupe, and fresh-cut fruit medley products containing one of these melons that were produced at the Caito Foods facility in Indianapolis, Indiana.

Indiana 1
Georgia 17
Kentucky 54
Ohio 7
Tennessee 28
Virginia 2

As of April 12, 2019, 109 people infected with the outbreak strain of E. coli O103 have been reported from six states. CDC is reporting the 109 illnesses that the PulseNet laboratory network has confirmed are part of this outbreak. States are investigating additional illnesses that might be a part of this outbreak. A list of the states and the number of confirmed cases in each can be found on the Map of Reported Cases page.

Illnesses started on dates from March 2, 2019, to March 26, 2019. Ill people range in age from less than 1 year to 83 years, with a median age of 18. Fifty-three percent are female. Of 81 people with information available, 17 (21%) have been hospitalized. No deaths and no cases of hemolytic uremic syndrome have been reported.

Illnesses that occurred after March 20, 2019, might not yet be reported due to the time it takes between when a person becomes ill with E. coli and when the illness is reported. This takes an average of two to three weeks.

This multistate investigation began on March 28, 2019, when officials in Kentucky and Georgia notified CDC of this outbreak. Preliminary epidemiologic information suggests that ground beef is the 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. Sixty-three (84%) of 75 people interviewed reported eating ground beef. This percentage is significantly higher than results from a survey Cdc-pdf[PDF – 787 KB] of healthy people. Ill people bought or ate ground beef from several different grocery stores and restaurants. Many ill people bought large trays or chubs of ground beef from grocery stores and used the meat to make dishes like spaghetti sauce and sloppy joe.

Traceback investigations are ongoing to determine the source of ground beef supplied to grocery stores and restaurants where ill people ate. At this time, no common supplier, distributor, or brand of ground beef has been identified

CDC collaborated with public health and regulatory officials in several states and the U.S. Department of Agriculture’s Food Safety and Inspection Service to investigate a multistate outbreak of Salmonella Typhimurium infections. Public health investigators used the PulseNet system to identify illnesses that were part of this outbreak. DNA fingerprinting was performed on Salmonella bacteria isolated from ill people by using PFGE and WGS.

A total of 265 people infected with the outbreak strains of Salmonella Typhimurium were reported from 8 states. WGS performed on bacteria isolated from ill people showed that they were closely related genetically. This means that people in this outbreak were more likely to share a common source of infection.

Illnesses started on dates ranging from January 8, 2018, to March 20, 2018. Ill people ranged in age from less than 1 year to 89 years, with a median age of 57. Sixty-seven percent of people were female. Ninety-four hospitalizations were reported, including one person from Iowa who died.

Epidemiologic, laboratory, and traceback evidence indicated that chicken salad produced by Triple T Specialty Meats, Inc. and sold at Fareway grocery stores was the likely source of this multistate outbreak.

Public health officials in Iowa first detected this outbreak and linked the illnesses to chicken salad sold at Fareway grocery stores. CDC searched the PulseNet database and identified illnesses in other states, and those illnesses were added to this outbreak. In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 222 people interviewed, 194 (87%) reported eating chicken salad purchased from Fareway grocery stores. Triple T Specialty Meats, Inc. produced the chicken salad that ill people reported eating.

On February 9, 2018, Fareway stopped selling chicken salad in all of its stores after the Iowa Department of Inspections and Appeals contacted the company about the illnesses. The Iowa Department of Public Health and the Iowa Department of Inspections and Appeals issued a consumer advisory on February 13, 2018 warning that chicken salad sold at Fareway may be contaminated with Salmonella.

Investigators in Iowa collected chicken salad from two Fareway grocery store locations in Iowa for laboratory testing. An outbreak strain of Salmonella Typhimurium was identified in both samples.

On February 21, 2018, Triple T Specialty Meats, Inc. recalled all chicken salad produced from January 2, 2018 to February 7, 2018. The recalled chicken salad was sold in containers of various weights from the deli at Fareway grocery stores in Iowa, Illinois, Minnesota, Nebraska, and South Dakota from January 4, 2018 to February 9, 2018.

Although legal to sell at retail in the state of Washington, you must ask why a retailer would take such a risk?

Dungeness Valley Creamery is again recalling retail raw whole milk, skim milk and cream because it might be contaminated with Escherichia coli bacteria (E. coli), the dairy announced Tuesday.

Dungeness Valley Creamery retail raw whole milk, skim milk and cream displaying Best By dates of April 6-20 have been recalled.

Those who bought the products are urged not to drink the product and return it to the place of purchase for a full refund, the dairy said.

The recall was initiated after routine sampling conducted by the state Department of Agriculture revealed the presence of toxin-producing E. coli in retail raw whole milk dated April 6.

In September 2018, the dairy was linked to another recall because of at least two illnesses.  Laboratory tests confirmed E. coli infections in a young child and an elderly person in Washington state who drank unpasteurized, raw milk from the same dairy.

The implicated dairy was linked to an E. coli outbreak in 2009 and recalled some of its raw milk in 2013 after state tests found E. coli.

Shiga toxin-producing E. coli infections may cause severe diarrhea, stomach cramps and bloody stool.

Symptoms generally appear three to four days after exposure but can take as long as nine days to appear.

In some cases, the infection causes hemolytic uremic syndrome (HUS) in which red blood cells are destroyed resulting in kidney failure.

Infants, children, pregnant women, the elderly and those with compromised immune systems are especially at risk.

Anyone experiencing these symptoms should immediately contact a health care provider. At this time, there are no known illnesses associated with the recalled product.

Today the CDC reported that 96 people have been infected with the outbreak strain of E. coli O103 in Ohio, Kentucky, Tennessee, Virginia and Georgia. Illnesses started on dates from March 2, 2019, to March 26, 2019. Ill people range in age from 1 to 81 years, with a median age of 17. Fifty-one percent are female. Of 67 people with information available, 11 (16%) have been hospitalized.  Thus far no common food item has been determined, leaving the consuming public with less than full knowledge on how to protect themselves and their families.  Here are a few tips: Things to Avoid during a food outbreak

As of April 8, 2019, 96 people infected with the outbreak strain of E. coli O103 have been reported from five states. CDC is reporting the 96 illnesses that the PulseNet laboratory network has confirmed are part of this outbreak. States are investigating additional illnesses that might be a part of this outbreak.

Illnesses started on dates from March 2, 2019, to March 26, 2019. Ill people range in age from 1 to 81 years, with a median age of 17. Fifty-one percent are female. Of 67 people with information available, 11 (16%) have been hospitalized. No deaths and no cases of hemolytic uremic syndrome have been reported.

This investigation is still ongoing and a specific food item, grocery store, or restaurant chain has not been identified as the source of infections. State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started. Federal and state regulatory officials use that information to guide efforts to identify a contaminated food and trace it to its source. Learn more about how public health and regulatory agencies investigate a foodborne disease outbreak.

Outbreaks of E. coli O103 are rare.  From the CDC NORS dataset:

https://wwwn.cdc.gov/norsdashboard/

Year State Transmission Serotype Setting Illnesses
2000 Washington Food O103 Caterer (food prepared off-site from where served); Other 18
2010 Minnesota Food O103:H2; O145:NM School/college/university 29
2011 Wisconsin Animal Contact O103; O157:H7 6
2013 Minnesota Person-to-person O103 Child day care 3
2013 Pennsylvania Indeterminate O103:H2 Private home/residence 2
2014 Ohio Indeterminate O103 Child day care 3
2014 Multistate Food O103:H2 Restaurant – other or unknown type 12
2014 Ohio Indeterminate O103; O157:H7; O146:H21 Private home/residence 4
2015 Multistate Food O103 Restaurant – other or unknown type 4
2015 Ohio Person-to-person O103 School/college/university 6
2015 Multistate Food O103 Restaurant – other or unknown type 6
2015 Kansas Person-to-person O103 Child day care 12
2015 North Carolina Person-to-person O103 Child day care 20
2015 Virginia Person-to-person O103:H2 Prison/jail 4
2015 Ohio Indeterminate O103 Child day care 5
2016 Ohio Indeterminate O103 Other, specify 7
2017 Ohio Person-to-person O103 Child day care 4
2017 Oregon Food O103 Other 13

Additional Resources