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I remember the first time I traveled outside the US, I got a series of vaccine – including a Hepatitis A vaccine.  I do not recall ever seeing a warning about travel within the US – go figure.

Indiana health officials are advising residents to get vaccinated for hepatitis A if their summer plans include visits to Kentucky or Michigan.

The Department of Health says significant outbreaks of the liver-damaging hepatitis A virus have been reported in Kentucky and Michigan.

The agency says Kentucky has seen more than 300 cases of the highly contagious viral infection, including three deaths, most of those in the Louisville area. Michigan has had more than 800 cases, including 25 deaths.

Indiana typically sees less than 20 hepatitis cases each year, but 77 have been confirmed since January.

State Epidemiologist Pam Pontones says getting vaccinated for hepatitis A and thoroughly washing hands when preparing food are “simple, safe and effective ways” to prevent the spread of hepatitis A.

Likely not so good for tourism?

Rose Acre Farms – FDA 483 Investigation Report

Observation 1:
When your monitoring indicated unacceptable rodent activity within a poultry house, appropriate methods were not used to achieve satisfactory rodent control.

Specifically, a review of your pest control records from September 2017 to present indicate an ongoing rodent infestation. The corrective actions taken by your firm have not been effective at reducing the rodent levels within your poultry houses to an acceptable level that is below the threshold established in your SE Prevention Plan.

Observation 2:
There were insanitary conditions and poor employee practices observed in the egg processing facility that create an environment that allows for the harborage, proliferation and spread of filth and pathogens throughout the facility that could cause the contamination of egg processing equipment and eggs.

On 03/28118, during a review of the firm’s cleaning procedures and a walkthrough of the cleaning procedures we observed that the firm did not have in their procedures or use a sanitizing step following the wash step.

Throughout the inspection we observed condensation dripping from the ceiling, pipes, and down walls, onto production equipment (i.e. crack detector, egg grader) and pooling on floors in foot traffic and forklift pathways.

On 03/28/18, we observed maintenance and sanitation employees placing buffers (food contact) and metal covers to the egg packer with buffers (non-food contact) onto floor, pa11ets, and equipment that was visibly dirty with accumulated grime and food debris, before placing the equipment into service. Additionally, throughout the inspection several production and maintenance employees were observed touching non-food contact surfaces (i.e. face, hair, intergluteal cleft, production equipment with accumulated grime and food debris, floor, boxes, trash cans, inedible transport cans) and then touch shell eggs and food contact surfaces (i.e. buffers, rollers, etc.) without changing gloves or washing hands. We also observed maintenance employees dragging non-food contact equipment (i.e. black electrical conduit with accumulated grime and dried food debris) on top of food contact surfaces (i.e. conveyors and rollers).

Throughout the inspection we observed equipment (i.e. conveyor belts, chains, rail guards, buffers, egg transport arms, egg clappers, production computers and exterior of production equipment surfaces) with accumulated food debris (i.e. dried egg and shells) and grime, post sanitation. The same areas of accumulated food debris were observed uncleaned on multiple days during the inspection pre-and post-sanitation.

Rose Acre Farms of Seymour, Indiana is voluntarily recalling 206,749,248 eggs because they have the potential to be contaminated with Salmonella Braenderup, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy individuals infected with Salmonella Braenderup can experience fever, diarrhea, nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella Braenderup can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (i.e., infected aneurysms), endocarditis and arthritis.

The eggs were distributed from the farm in Hyde County, North Carolina and reached consumers in the following states: Colorado, Florida, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia through retail stores and restaurants via direct delivery.

22 illnesses have been reported to date.

The affected eggs, from plant number P-1065 with the Julian date range of 011 through date of 102 printed on either the side portion or the principal side of the carton or package, as follows:

Lot Codes 011 – 102

Item Description Carton UPC
COUNTRY DAYBREAK A LARGE X 30 DOZEN 077236000302
COUNTRY DAYBREAK A LARGE X15 DOZEN 077236000302
COUNTRY DAYBREAK A JUMBO X24 DOZEN 077236000500
COUNTRY DAYBREAK A MEDIUM X30 DOZEN 077236000203
COUNTRY DAYBREAK A XLARGE X30 DOZEN 077236000401
COUNTRY DAYBREAK A JUMBO X12 DOZEN 077236000500
FOOD LION A JUMBO X 12 DOZEN 035826089618
FOOD LION A MEDIUM X15 DOZEN 035826089649
FOOD LION A XLARGE X 15 DOZEN 035826089625
FOOD LION A 18PK LARGE X15 DOZEN 035826089601
FOOD LION A LARGE X15 DOZEN 035826089588
FOOD LION A 6PK LARGE X 15 DOZEN 035826089632
LOOSE A USDA SMALL X 30 DOZEN N/A
LOOSE A USDA MEDIUM X 30 DOZEN N/A
LOOSE A XLARGE X15 DOZEN N/A
LOOSE A XLARGE X30 DOZEN N/A
LOOSE A MEDIUM X 15 DOZEN N/A
LOOSE A MEDIUM X30 DOZEN N/A
LOOSE USDA AA XLARGE X30 DOZEN N/A
LOOSE USDA AA XLARGE X15 DOZEN N/A
LOOSE USDA AA LARGE X30 DOZEN N/A
LOOSE USDA AA LARGE X15 DOZEN N/A
LOOSE USDA AA MEDIUM X30 DOZEN N/A
LOOSE AA XLARGE X30 DOZEN N/A
LOOSE USDA AA LARGE PFG X 30 DOZEN N/A
LOOSE USDA AA LARGE PFG X 15 DOZEN N/A
LOOSE USDA A XLARGE X30 DOZEN N/A
NELMS A JUMBO X24 634181000018
WAFFLE HOUSE LOOSE USDA A LARGE X 30 DOZEN N/A
CRYSTAL FARMS A MEDIUM X30 077236000203
CRYSTAL FARMS A 18PK MEDIUM X 30 077236000258
CRYSTAL FARMS A 2.5 DOZ MEDIUM X 25 077236000124
COUNTRY DAYBREAK A XLARGE X15 DOZEN 077236000401
COUNTRY DAYBREAK USDA GRADE A XLARGE X 240 DOZEN PULP 077236700400
COUNTRY DAYBREAK USDA GRADE A LARGE RACK X 240 DOZEN PULP 077236700301
COBURN FARMS A MEDIUM MP X 30 DOZEN 051933182608
COBURN FARMS A LARGE X 30 DOZEN 051933190801
COBURN FARMS A 18PK LARGE X 30 DOZEN 051933182509
SUNSHINE FARMS A JUMBO X 12 DOZEN 804879457336
GLENVIEW USDA AA LOOSE LARGE (6-2.5 FLATS) X 15 DOZEN N/A
GLENVIEW USDA AA LOOSE LARGE (12-2.5 FLATS) X 30 DOZEN N/A
GLENVIEW USDA AA LOOSE MEDIUM (6-2.5 FLATS) X 15 DOZEN N/A
GLENVIEW USDA AA LOOSE XLARGE (6-2.5 FLATS) X 15 DOZEN N/A
GLENVIEW USDA AA LOOSE MEDIUM (12-2.5 FLATS) X 30 DOZEN N/A
GLENVIEW USDA AA LOOSE XLARGE (12-2.5 FLATS) X 30 DOZEN N/A
GREAT VALUE GRADE A USDA 18PK XLARGE X 24 DOZEN RPC 078742127132
GREAT VALUE GRADE A USDA 12PK XLARGE X 24 DOZEN RPC 078742127128
GREAT VALUE GRADE A USDA TWIN 18PK LARGE X 24 DOZEN RPC 078742127101
GREAT VALUE GRADE A USDA 6PK LARGE X 15 DOZEN 078742127095
GREAT VALUE GRADE A USDA 12PK MEDIUM X 15 DOZEN 078742127224
GREAT VALUE GRADE A USDA 12PK LARGE X 24 DOZEN RPC 078742127071
GREAT VALUE GRADE A USDA 18PK LARGE X 24 DOZEN RPC 078742127088
GREAT VALUE GRADE A 12PK JUMBO X 22 DOZEN RPC 078742127149
GREAT VALUE GRADE A USDA 5DZ LARGE X 5 DOZEN 078742127118

The voluntary recall was a result of some illnesses reported on the U.S. East Coast, which led to extensive interviews and eventually a thorough FDA inspection of the Hyde County farm, which produces 2.3 million eggs a day. The facility includes 3 million laying hens with a USDA inspector on-site daily.

As of  April 13, 2018, Marler Clark represents E. coli victims in Idaho, Missouri, New Jersey and Pennsylvania.

As of April 12, 2018, 35 people infected with the outbreak strain of E. coli O157:H7 have been reported from 11 states. Connecticut 2, Idaho 8, Illinois 1, Michigan 1, Missouri 1, New Jersey 7, New York 2, Ohio 2, Pennsylvania 9, Virginia 1 and Washington 1.  (CDC Report)

Illnesses started on dates ranging from March 22, 2018 to March 31, 2018. Ill people range in age from 12 to 84 years, with a median age of 29. Sixty-nine percent of ill people are female. Twenty-two ill people have been hospitalized, including three people who developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

The current outbreak is not related to a recent multistate outbreak of E. coli O157:H7 infections linked to leafy greens. People in the previous outbreak were infected with a different DNA fingerprint of E. coli O157:H7 bacteria.

Epidemiologic evidence collected to date indicates that chopped romaine lettuce is the likely source of this outbreak. Most people reported eating a salad at a restaurant, and romaine lettuce was the only common ingredient identified among the salads eaten. The restaurants reported using bagged, chopped romaine lettuce to make salads.

Traceback investigations are ongoing to determine the source of chopped romaine lettuce supplied to restaurant locations where ill people ate. At this time, no common grower, supplier, distributor, or brand has been identified. However, preliminary information indicates that the chopped romaine lettuce was from the Yuma, Arizona growing region. Information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.

Two Vancouver Island oyster farms have been closed following an outbreak of norovirus associated with eating the raw shellfish.

The British Columbia Centre for Disease Control says about 40 cases of acute gastrointestinal illness have been connected to the consumption of raw oysters since March. Testing has confirmed some of the cases were norovirus.

Federal officials with Fisheries and Oceans Canada (DFO) confirmed the affected farms are located on the east coast of Vancouver Island at Deep Bay and Denman Island.

While the two farms are no longer harvesting oysters for consumption, no recall of oysters has been issued by the Canadian Food Inspection Agency.

While the precise sources of contamination have not been identified, human sewage in the marine environment is currently believed to be the most plausible cause of shellfish contamination, according to BCCDC epidemiologist Marsha Taylor.

I am just not sure about this.  Should a grower responsible for illnesses and deaths and the devastation of the Australian rockmelon industry be allowed to start production of rockmelon months after an outbreak?

NWS Food Safety Authority announced yesterday the likely cause of 19 Listeria illnesses with sixth deaths.

What is Listeria and how do rockmelons become contaminated?

While rockmelons are grown off the ground on top of plastic sheeting, the fruit is grown in the open farm environment and subject to rain, wind and other natural contamination pathways. Listeria species, including Listeria monocytogenes, are soil bacteria that are naturally found in the environment, including farm paddocks. It is not unusual to find Listeria on the surfaces of any raw fruit and vegetable. Rockmelon skin is rough and irregular which allows more soil and bacteria like Listeria to be trapped.

How did this outbreak happen?

To reduce the risk of contamination farms usually wash and sanitise rockmelons. The investigation found that the contamination is likely to have occurred due to adverse weather (localised storm over the farm and subsequent dust storms during the season) increasing the levels of Listeria on the fruit prior to harvest. On this occasion and despite following industry best practice, the washing and sanitising at Rombola Family Farms was not able to remove all the trapped bacteria from the rockmelon surfaces, resulting in a low level of Listeria being present.

Inspections by the NSW Food Authority found there was also an opportunity for the introduction of Listeria after washing through contact with surfaces or equipment that may have had traces of Listeria monocytogenes. This includes dust blown from fans used to dry the fruit after washing, and from porous material on packing tables that was not able to be effectively cleaned at the time.

While Listeria monocytogenes is not an issue for healthy consumers, it poses a serious health risk for those vulnerable to infection, such as individuals who are immunocompromised or pregnant.

What are the results of the investigation?

The NSW Food Authority has completed extensive microbiological swabbing of the packing shed environment and equipment for Listeria. Listeria species and Listeria monocytogenes was found on the packing shed floor during the investigation, which is not surprising as Listeria are often found in soil.

Melons from boxed product at Flemington Markets tested positive for Listeria monocytogenes and a trade level recall was initiated on
28 February. That same day the NSW Food Authority issued a media release advising consumers to discard any rockmelon they may have purchased.

Melons obtained at retail, wholesale, and a swab of melons at the packing shed tested positive for Listeria monocytogenes. The genetic sequence of these Listeria isolates was an exact match with clinical cases. No rockmelons or swabs from other farms tested positive for Listeria monocytogenes.

During the investigation there was an allegation of raw organic fertiliser use on the rockmelon crop which was found to be incorrect. There is no reason to believe this played a role in the outbreak.

Why is the NSW Food Authority allowing the farm to pack rockmelons?

The production of rockmelons on the farm and packing shed environment has been investigated. During March 2018, further rockmelon packing trials and swabbing verified effective washing and sanitising is in place. The company has fully cooperated with the NSW Food Authority and has made significant line modifications to improve cleaning. They have also increased cleaning and sanitising of the packing line environment and increased the sanitiser concentration during the washing of melons. The company and the NSW Food Authority will continue to monitor the situation through inspections and product sampling. The NSW Food Authority is currently satisfied that the company has adequate steps in place to minimise the risk of foodborne illness, noting that immunocompromised people should avoid rockmelons.  No melons from the farm will be released for sale prior to testing for Listeria.

Will it happen again?

While rockmelons from Rombola are washed, sanitised and packed under hygienic conditions there is no absolute guarantee that any fresh produce item will be free from Listeria. The NSW Food Authority recommends that any farm produce eaten raw should be thoroughly washed before consumption. Consumers who are immunocompromised or pregnant are also advised to avoid high risk foods, including rockmelons.

What happens next?

The NSW Food Authority will continue to work with the industry and food regulatory agencies to share lessons learnt from this outbreak. This includes interstate businesses and food safety agencies so the industry as a whole can move forward with confidence in the future.

Employees at two local Louisville, Kentucky businesses have been diagnosed with Hepatitis A.

That has been a similar and common headline in newspapers across the country over the last several months.

One worker at Sarino (1030 Goss Avenue) was diagnosed. Customers who dined at the establishment from February 24 through March 15 may have been exposed to the virus. One worker from Kroger (520 N 35th Street) was diagnosed. Customers who shopped at the store from March 2 through March 19 may have been exposed to the virus.

Kentucky

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 198 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

Counts as of Mar. 17, 2018

  • Total Outbreak: 198
  • Hospitalizations: 142
  • Deaths: 1

Utah

Since January 1, 2017, Utah public health has identified 226 confirmed cases of hepatitis A virus (HAV) infection; many among persons who are homeless and/or using illicit drugs. Several cases have been linked by investigation and/or viral sequencing to a national outbreak of hepatitis A involving cases in California and Arizona. Hospitalization rates of less than 40% have been described in previous hepatitis A outbreaks; however, other jurisdictions associated with this outbreak are reporting case hospitalization rates approaching 70%.

California

On Jan. 23, 2018, the San Diego County ended the local health emergency, declared on September 1, 2017, in response to the local hepatitis A outbreak. The action does not mean the outbreak is over, and the County will continue efforts it has taken to control the spread of the disease.  There has been a total of 586 illnesses, 401 hospitalizations and 20 deaths.

Arizona

Arizona officials believe the local outbreak was mainly confined to homeless people in Maricopa County. The county recorded only 15 known cases and no deaths, and officials have detected no new Arizona cases since the end of May 2017.  The illnesses in Arizona were linked to a person who traveled from San Diego.

Michigan

Since the beginning of the outbreak in August 2016, the Michigan public health response has included increased healthcare awareness efforts, public notification and education, and outreach with vaccination clinics for high-risk populations. No common sources of food, beverages, or drugs have been identified as a potential source of infection. Transmission appears to be through direct person-to-person spread and illicit drug use. Those with history of injection and non-injection drug use, homelessness or transient housing, and incarceration are thought to be at greater risk in this outbreak setting. Notably, this outbreak has had a high hospitalization rate.  There has been a total of 789 illnesses, 635 hospitalizations and 25 deaths.

What about all the rest of the states?  What is the cause?  What is the source?  What can we do – in addition to vaccinations – to stop this?

According to the CDC, as of March 20, 2018, 13 people infected with the outbreak strain of Salmonella Typhimurium have been reported from 8 states. WGS performed on bacteria isolated from ill people showed that they were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

Illnesses started on dates ranging from September 22, 2017 to February 26, 2018. Ill people range in age from 1 to 73 years, with a median age of 40. Sixty-seven percent are female. Three hospitalizations have been reported. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicates that dried coconut 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. Seven (88%) of eight people interviewed reported eating dried coconut from grocery stores. Of the seven people who reported eating dried coconut, four people purchased the product at different Natural Grocers store locations. Public health officials continue to interview ill people to learn more about what they ate in the week before becoming sick.

FDA and state health and regulatory officials collected leftover dried coconut from ill people’s homes, as well as dried coconut from Natural Grocers store locations where ill people shopped and from the Natural Grocers’ Distribution Center. FDA testing identified the outbreak strain of Salmonella Typhimurium in an unopened sample of Natural Grocers Coconut Smiles Organic collected from Natural Grocers. The outbreak strain was also identified in an opened, leftover sample of Natural Grocers Coconut Smiles Organic collected from an ill person’s home.

FDA also collected dried coconut from International Harvest, Inc. The outbreak strain of Salmonella Typhimurium was identified in samples of International Harvest Brand Organic Go Smile! Dried Coconut Raw and Go Smiles Dried Coconut Raw.

On March 16, 2018, International Harvest, Inc. recalled bags of Organic Go Smile! Raw Coconut and bulk packages of Go Smiles Dried Coconut Raw. The recalled Organic Go Smile! Raw Coconut was sold online and in stores in 9-ounce bags with sell-by dates from January 1, 2018 through March 1, 2019. Recalled bulk Go Smiles Dried Coconut Raw was sold in a 25-pound case labeled with batch/lot numbers OCSM-0010, OCSM-0011, and OCSM-0014. These products were sold in various grocery stores. Regulatory officials are working to determine where else Organic Go Smile! Raw Coconut and Go Smiles Dried Coconut Raw were sold.

On March 19, 2018, Vitamin Cottage Natural Food Markets, Inc. recalled packages of Natural Grocers Coconut Smiles Organic labeled with barcode 8034810 and packed-on numbers lower than 18-075. Recalled Natural Grocers Coconut Smiles Organic were sold in 10-ounce clear plastic bags with the Natural Grocers label. The packed-on number can be found in the bottom left-hand corner of the label.

Ill employee prompts Kroger to vaccinate employees but not customers.

According to Kentucky press reports, an employee in the produce department of the Kroger store at 4915 Dixie Highway has been diagnosed with Hepatitis A.

Kroger said the man worked at the store in Pleasure Ridge Park in February, and customers who bought produce between Feb. 4 to Feb. 28 may have been exposed to the virus. Any produce purchased during that time frame should be thrown away, Kroger said.

The employee worked third shift in the produce section and was diagnosed with Hepatitis A on Feb. 28 at a visit to the doctor. He immediately notified his supervisor, and Kroger notified the Health Department later that day, the company said.

Kroger said officials are cooperating with local and state health officials. Other employees threw away all the produce that the man is believed to have come in contact with and cleaned the store.

Additionally, Kroger is offering all associates and their families Hepatitis A vaccines. About 300 people work at the Pleasure Ridge Park store.

Hepatitis A can be transmitted through eating or drinking contaminated food or water. Symptoms include fatigue, loss of appetite, stomach pain, nausea and jaundice.

Since Jan. 1, 2017, the Kentucky Department for Public Health (KDPH) has identified 125 confirmed cases of acute hepatitis A, a liver disease caused by hepatitis A virus. An increase in cases since Aug. 1, 2017, primarily among the homeless and drug users, prompted declaration of a statewide outbreak in Nov. 2017. Viral sequencing has linked several outbreak-associated cases in Kentucky with outbreaks in California and Utah.

KDPH is working closely with the Centers for Disease Control and Prevention and local health departments to provide guidance and education to health professionals and at-risk populations. Treatment for acute hepatitis A generally involves supportive care, with specific complications treated as appropriate. Hepatitis A is a vaccine-preventable disease.

Counts as of Feb. 24, 2018

  • Total Outbreak: 125
  • Hospitalizations: 91
  • Deaths: 0

According to the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), and National Institute for Communicable Diseases (NICD)/ National Health Laboratory Service (NHLS), as of February 27, 2018, a total of 945 cases have been reported since 1 January 2017, with 30 additional cases recorded since the last update , February 20, 2018.  To date, 743 cases were reported in 2017, and 202 cases in 2018. Females account for 55% (516/943) cases where gender is reported. Where age was reported (n=909), ages range from birth to 92 years (median 19 years) and 41% (377/902) are neonates aged ≤28 days (Figure 2). Of neonatal cases, 94% (355/377) had early-onset disease (birth to ≤6 days). Most cases have been reported from Gauteng Province (59%, 555/945) followed by Western Cape (12%, 116/945) and KwaZulu-Natal (7%, 66/945) provinces. Outcome at the end of hospitalization is known for an additional 18 cases, bringing the total with known outcome to 635/945 (67%) patients. 176 (19%) patients are known to have died.

At present, the source of the outbreak is not known. The public are advised that processed, ready-to-eat meat products, soft cheeses, and unpasteurised milk and dairy products should be avoided by persons who are at risk of listeriosis. In addition, processed, ready-to-eat meat products include viennas, polonies, russians, ham, other ‘cold’ meats, sausages, various corned meats, salami, pepperoni and similar products typically found in the processed meat sections of food retailers and butcheries should be avoided, or thoroughly cooked in boiling water or heated at high temperatures of 70°C or higher before eating.