The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug AdministrationExternal are investigating a multistate outbreak of Salmonella Carrau infections.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS showed that isolates from ill people were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

The multistate investigation began on April 2, 2019, when PulseNet identified the outbreak. As of April 24, 2019, 117 people infected with the outbreak strain of Salmonella Carrau have been reported from 10 states – Minnesota, Iowa, Missouri, Michigan, Illinois, Wisconsin, Indiana, Ohio, Kentucky and Alabama.

Illnesses started on dates ranging from March 4, 2019, to April 8, 2019. Ill people range in age from less than one to 98 years, with a median age of 53. Fifty-eight percent are female. Of 88 people with information available, 32 (36%) have been hospitalized. No deaths 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 weeks.

Epidemiologic and traceback evidence indicate that pre-cut melon supplied by Caito Foods LLC of Indianapolis, Ind. 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. Forty-six (73%) of 63 people interviewed reported eating pre-cut melons purchased at grocery stores, including pre-cut cantaloupe, watermelon, honeydew, or a fruit salad mix or fruit tray with melon. Five 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, Ind.

  • FDA inspectors found Listeria in 19 of the plants (21 percent) and Salmonella in one
  • More than half of the facilities (45) had 39 objectionable and 39 insanitary practices
  • Six facilities were selected for extremely unsanitary practices
  • The findings prompted three voluntary recalls,

According to an FDA Press Release today:

 

“Inspecting food facilities and collecting and testing samples from the environment where foods are produced are two of the many ways the FDA works to better understand microbial hazards and to help prevent contaminated products from reaching consumers. These activities help the FDA gather data and information necessary to develop prevention-based systems and, when contamination does occur, to respond swiftly to these hazards. Following a string of safety issues related to a number of U.S. ice cream distributors, the FDA engaged a team to inspect and obtain environmental samples from 89 ice cream production facilities in 32 states to test for Listeria monocytogenes and Salmonella. Although many of these facilities were adhering to good manufacturing practices, we did find that some were in violation of the law,” said Frank Yiannas, FDA Deputy Commissioner for Food Policy and Response. “Findings from our inspections resulted in three voluntary recalls that were conducted in 2017 and 2018 to protect public health. We also collaborated with inspected companies to help them make needed corrections and implement food safety plans designed to keep harmful bacteria out of their products and protect American consumers. These results serve as an important reminder to all food facilities distributing products in the U.S. of the importance of complying with rules set forth to mitigate safety issues. Ultimately, we must work together to ensure all necessary protective steps are taken so that Americans can continue having confidence that the foods available for purchase in the U.S. are safe and wholesome.”

 

The U.S. Food and Drug Administration today released a report on its findings from inspections and environmental sampling for Listeria monocytogenes and Salmonella at 89 ice cream production facilities in 32 states from Sept. 12, 2016 to Aug. 30, 2017. The agency began the sampling assignment following 16 recalls of ice cream products that occurred from 2013 to 2015 due to the presence of pathogens, and an outbreak of listeriosis linked to an ice cream maker in 2015 that involved three deaths. The sampling was designed to gain insights into the extent to which Listeria monocytogenes and Salmonella may be in the manufacturing environment, and to evaluate each establishment’s ability to identify, prevent, reduce, and/or eliminate microbial hazards of public health concern. No objectionable conditions or practices were observed in nearly half of the ice cream production facilities inspected. The FDA did detect Listeria monocytogenes in 19 of the facilities; however, only one of them was found to have the pathogen on a food-contact surface. The FDA also detected Salmonella in one facility.

As a result of these findings, three voluntary recalls were conducted in 2017 and 2018. These include two voluntary recalls of Working Cow Homemade Inc. ice creams due to potential contamination with Listeria monocytogenes, and a Nelson’s Creamery LLC recall due to undeclared soy lecithin in one of their products. The FDA also suspended Working Cow Homemade Inc.’s food facility registration in 2018. The FDA lifted the suspension earlier this year after the firm changed its business model to cease making ice cream and only distribute product made by other manufacturers.

The findings affirm the need for commercial ice cream makers to ensure that they are controlling hazards in accordance with the Preventive Controls for Human Food rule established by the FDA Food Safety Modernization Act. Companies that follow the rule and employ robust environmental monitoring programs will likely occasionally detect environmental pathogens, but how an establishment responds to a pathogen finding is critical.

For some reason it reminded me of a song my dad used to sing me.

FSIS reported moments ago, K2D Foods, doing business as (DBA) Colorado Premium Foods, a Carrolton, Ga. establishment, is recalling approximately 113,424 pounds of raw ground beef products that may be contaminated with E. coli O103, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.  This is a Class I Recall.

The raw ground beef items were produced on March 26, March 29, April 2, April 5, April 10, and April 12, 2019.  The following products are subject to recall:

  • Two 24-lb. vacuum-packed packages in cardboard boxes containing raw “GROUND BEEF PUCK” with “Use Thru” dates of 4/14/19, 4/17/19, 4/20/19, 4/23/19, 4/28/19, and 4/30/19.

The products subject to recall bear establishment number “EST. 51308” inside the USDA mark of inspection on the boxes. These items were shipped to distributors in Ft. Orange, Fla. and Norcross, Ga. for further distribution to restaurants.

FSIS and its public health partners, including the Centers for Disease Control and Prevention (CDC) and the Tennessee Department of Health, have been investigating an outbreak of E. coli O103. Unopened, intact ground beef collected as part of the ongoing investigation from a restaurant location, where multiple case-patients reported dining, tested positive for E. coli O103. At this time, there is no definitive link between this positive product and the ongoing E. coli O103 outbreak. Further traceback and product analysis continues to determine if the recalled products are related to the E. coli O103 outbreak.

According to the CDC, a total of 156 people infected with the outbreak strain of E. coli O103 have been reported from 10 states – Minnesota, Illinois, Indiana, Ohio, Kentucky, Tennessee, Virginia, Mississippi, Georgia and Florida.

Many clinical laboratories do not test for non-O157 STEC, such as O103 because it is harder to identify than STEC O157:H7. People can become ill from STECs 2–8 days (average of 3–4 days) after exposure to the organism.

Most people infected with STEC O103 develop diarrhea (often bloody) and vomiting. Some illnesses last longer and can be more severe. Infection is usually diagnosed by testing of a stool sample. Vigorous rehydration and other supportive care is the usual treatment; antibiotic treatment is generally not recommended. Most people recover within a week, but, rarely, some develop a more severe infection. Hemolytic uremic syndrome (HUS), a type of kidney failure, is uncommon with STEC O103 infection. HUS can occur in people of any age but is most common in children under 5 years old, older adults and persons with weakened immune systems. It is marked by easy bruising, pallor and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

FSIS is concerned that some product may be in refrigerators or freezers of restaurants. Restaurants that have purchased these products are urged not to serve them.

Now available for purchase from Amazon.com and the University of Chicago Press (receive a 20% discount with the following promo code: UCPNEW)

Foodborne illness is a big problem. Wash those chicken breasts, and you’re likely to spread Salmonella to your countertops, kitchen towels, and other foods nearby. Even salad greens can become biohazards when toxic strains of E. coli inhabit the water used to irrigate crops. All told, contaminated food causes 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year in the United States.

With Outbreak, Timothy D. Lytton provides an up-to-date history and analysis of the US food safety system.

He pays particular attention to important but frequently overlooked elements of the system, including private audits and liability insurance.Lytton chronicles efforts dating back to the 1800s to combat widespread contamination by pathogens such as E. coli and salmonella that have become frighteningly familiar to consumers. Over time, deadly foodborne illness outbreaks caused by infected milk, poison hamburgers, and tainted spinach have spurred steady scientific and technological advances in food safety. Nevertheless, problems persist. Inadequate agency budgets restrict the reach of government regulation. Pressure from consumers to keep prices down constrains industry investments in safety. The limits of scientific knowledge leave experts unable to assess policies’ effectiveness and whether measures designed to reduce contamination have actually improved public health. Outbreak offers practical reforms that will strengthen the food safety system’s capacity to learn from its mistakes and identify cost-effective food safety efforts capable of producing measurable public health benefits.

Marion Nestle

“In Outbreak, Lytton gives us a legal scholar’s superb analysis of how government, lawyers, and civil society are struggling to prevent the tragic and unnecessary illnesses, hospitalizations, and deaths caused by microbial food contaminants. Foodborne illness may seem like an intractable problem, but Lytton’s suggestions for dealing with it are well worth attention, as is everything else in this beautifully written, thoughtful, and readable account. I couldn’t put it down.”

Stephen Sugarman, UC Berkeley School of Law

“A remarkable sweeping overview and evaluation of food safety practices that well serves both experts working in the field and members of the general public interested in the problem of food safety. Lytton shows how major outbreaks have prompted a variety of changes to reduce the risk of foodborne illness. Yet, as he argues persuasively, we don’t have firm scientific knowledge as to the degree to which—if at all—most of these measures have actually achieved their goal.”

William D. Marler, Esq., The Food Safety Law Firm

“From swill milk to HACCP to FSMA to Blockchain, Lytton weaves a compelling biological story of how we feed ourselves and the interplay between the supply chain, regulation, media, and civil litigation.”

Members of the California Leafy Greens Marketing Agreement have adopted new rules requiring them to sanitize “open source” used water for overhead irrigation following recent E. coli outbreaks that led investigators to suspect water as a cause.

The new rules, which passed in an April 19 vote, cover 99% of the leafy greens grown in California, according the California LGMA.

Arizona?

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.