The below from Dr. Scott Gottlieb just dropped into my inbox.  We all will miss Dr. Stephen Ostroff.  He has been a great champion for food safety for many years and will be missed.  I wish him well.  However, pulling Frank Yiannas from Walmart to the FDA is a brilliant move.  I have known and respected Frank for years.  His commitment to changing the culture of food safety – specifically through transparency – will be welcome at the FDA.

Dear Colleagues,

I’d like to share with you some important changes to our FDA food safety leadership team – changes that build on the program’s outstanding strength, but are also, for me, bittersweet.

Dr. Stephen Ostroff will be retiring from the agency on January 5th, after a distinguished and dedicated career in public service, including over five years of exceptional service to FDA.

Since joining the FDA in 2013, Dr. Ostroff has epitomized our commitment to the public health and science-based decision making, through his work across all of our product areas, and especially his work on modernizing the FDA’s – and the nation’s — food safety activities.

During his time at the FDA, Dr. Ostroff has served as a dedicated leader, first at the Chief Medical Officer in the Center for Food Safety and Applied Nutrition and then as the agency’s Chief Scientist.  Most recently, Steve has been instrumental in his role as Deputy Commissioner for Foods and Veterinary Medicine.

Notably, Dr. Ostroff served twice for a total of 15 months as the FDA’s Acting Commissioner, guiding the Agency through periods of transition, advancing its mission, and ensuring we upheld the FDA’s public health mission during times of change. Throughout my time as Commissioner, I’ve relied on Dr. Ostroff’s deep experience, thoughtful perspective, and strong leadership during many complicated and pivotal policy discussions, food outbreaks, and recall events.

Irrespective of his role at the Agency, Dr. Ostroff’s work advanced the FDA’s public health prerogatives and upheld its vital consumer mission. I’m immensely grateful for his many contributions. I know he’ll continue to have an important influence on the public health.

I’m delighted to announce that we’ll be welcoming Frank Yiannas to the FDA leadership team as Deputy Commissioner for Food Policy and Response. In this role, Mr. Yiannas will report directly to me, and he’ll head the Office of Foods and Veterinary Medicine.  Dr. Ostroff was instrumental in recruiting Mr. Yiannas to the Agency. Dr. Ostroff will remain at the FDA until January as a senior advisor to me, and will help Mr. Yiannas transition into his new role.

Mr. Yiannas is a globally renowned food safety and supply chain expert and thought leader.  Throughout his private sector career – most recently as Vice President of Food Safety and Health for Walmart, he’s been a food safety champion and instrumental in forging public-private collaborations to advance public health.

He’s been recognized for his role in elevating food safety standards and building effective food safety management systems based on modern science and risk-based prevention principles. Mr. Yiannas is a globally acknowledged pioneer in using blockchain technology to strengthen food traceability capabilities and enable greater food system transparency.

In addition to his food safety leadership roles at Walmart and Disney, Mr. Yiannas previously served as the president of the International Association for Food Protection. He’s an Adjunct Professor in the Food Safety Program at Michigan State University, and the author of many scholarly papers on food safety and books on food safety culture and behavior.

As Deputy Commissioner for Food Policy and Response, Mr. Yiannas will assume a critical set of charges related to food safety, first and foremost, leading the continued implementation of the Food Safety Modernization Act. In this role, he’ll work in close collaboration with the leadership of Center for Food Safety and Applied Nutrition, the Center for Veterinary Medicine, and the food components of the Office of Regulatory Affairs. Mr. Yiannas’s deep knowledge and diverse experience will support our continued efforts to advance the FDA’s strategies for continuing to reduce food safety risks and achieving high rates of compliance with our modernization standards.

Mr. Yiannas also will serve as a senior scientific advisor to the Commissioner on various food safety and supply chain matters, including FSMA implementation. Additionally, he’ll help lead and coordinate certain cross-cutting policy activities and associated external engagement activities related to food safety and animal health. We’ll also leverage his experience and leadership across the Agency, and all product areas, on the issues of supply chain security and the use of new tracking technology, recall effectiveness, and traceback investigation processes.

We look forward to his contributions to our food safety mission and our efforts to keep families safe. Please join me in wishing Dr. Ostroff well and welcoming Mr. Yiannas to FDA.

Sincerely,

Dr. Scott Gottlieb
Commissioner of Food and Drugs

From Food Safety News:

By Dan Flynn on September 24, 2018

A new edition of “Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat” by Jeff Benedict has been shipped to distributors by book publishers Thomson-Shore.

In the new edition, Benedict catches up with America’s best-known food safety lawyer in South Africa where the world’s largest ever listeriosis outbreak was underway with eerie parallels to America’s 1993 E. coli outbreak, which “Poisoned”explores in detail.

Twenty-five years after that game-changing E. coli O157: H7 outbreak, Benedict finds food safety lawyer Bill Marler older and grayer, but still going from one food safety crisis to another. And South Africa’s listeriosis outbreak is the worst of its kind ever, according to the World Health Organization.

The new edition of “Poisoned” is the first since the original hardback came out in 2011, followed by the paperback in 2014. Its release comes as Benedict, one of America’s top nonfiction writers, finds his book, “Tiger Woods,” riding atop the New York Times Best Seller list.

In the new second edition of “Poisoned,” he reports on Marler teaming up with South African human rights lawyer Richard Spoor to seek justice for more than 1,000 Listeria victims, including the more than 200 that died. “Nearly half of the victims were newborns that had been infected during gestation,” Benedict reports.

Benedict took some time out of one of his increasingly busy days to answer a few questions from Food Safety News (FSN). Here’s what we learned:

FSN: Jeff, we did not know just how busy you’ve been. Congratulations sir, on your new book, “Tiger Woods.” It’s a No. 1 New York Times bestseller with stunning reviews. How does that feel?

JB: “It was a privilege to write the biography of the world’s greatest golfer. Tiger is a Shakespearian figure whose popularity transcends sport. The great thing is that his comeback is a triumphant tale that has captured the attention of the world.”

FSN: About half of your books involve the world of sports. In addition to golf, you’ve authored serious works about college and pro football, the NBA, Indian gaming, and domestic violence involving athletes. How do you follow so many sports and still get anything done?

JB: “It’s not so much about following so many sports. When I write a book, I do full immersion into the subject matter, whether it’s a biography about a famous athlete or an exposé on a phony Indian tribe that built the world’s largest casino. Once I’m into a book, I pretty much block out everything else.”

FSN: You also made famous action on the Supreme Court with “Little Pink House,” the takings case out of New London, CT. Your book was made into a movie that was in theaters earlier this year. What was your role in that?

JB: “I was an executive producer on the film, which starred Catherine Keener and Jeanne Tripplehorn. One of my responsibilities was to persuade David Crosby to compose an original theme song, which turned out to be one of my favorite aspects of working on the film.”

FSN: In returning to “Poisoned” to write for the new edition, were you surprised to find so many instances of foodborne illness still occurring 25 years after the events your first wrote about?

JB: “Not really. What’s interesting is the diversity of foods that are now responsible for E. coli outbreaks. When the Jack in the Box outbreak, which is the subject of “Poisoned,” happened 25 years ago, E. coli poisoning was traced to contaminated ground beef. That used to be the norm. Now E. coli is found in leafy greens and other foods. It shows, in part, how complex our food system has become.”

FSN: Poisoned is a must read for anyone in the food safety community and many will likely want to read the updated version. Beyond this professional community, do you know who makes up the audience for a book like “Poisoned” with it’s behind the scenes look at food safety?

JB “I chose a narrative style that I thought would appeal to parents, especially mothers. I also tried to write the story in a cinematic way. It’s a very visual story. And I remain hopeful that one day it will find its way to the screen.

FSN: Jeff, you’ve been highly productive as an author and producer during the past decade and longer. What’s next for you?

JB:   “The biography of LeBron James.”

Editor’s notes: Jeff Benedict is licensed to practice law in Connecticut. He’s a distinguished professor of writing and mass media at Southern Virginia University. He is represented by Richard Pine at InkWell Management in New York City.

Poisoned FOREWARD 6-29-18

As some of the readers might know, in my spare time I am the managing partner at Marler Clark in Seattle.  Our long-time Epidemiologist, Patti Waller, has moved into semi-retirement and is running www.outbreakdatabase.com for us.  Katrina Deardorff, who has been with us for a nearly two years, has decided to take a job back in the public sector, and we wish her well.

So, I am working here on a Saturday (not that uncommon), thinking about how to replace the irreplaceable, but knowing how important this job is to the quality of work we do at Marler Clark.

Minimum requirements are a Masters in Public Health or Epidemiology and some experience in foodborne disease investigations and willingness to live in Seattle.

Please send your resume and salary requirements to me at bmarler@marlerclark.com.  Also, take a chance to see the below.  I think it helps understand the job and its importance.

SPEAKER: William Marler, Managing Partner, Marler Clark, The Food Safety Law Firm
TIME: 4:30 – 5:30 pm
LOCATION: Wynne Courtroom and atrium, Inlow Hall, 530 W. New York Street, Indianapolis, IN
CONTACT: Hall Center for Law and Health at centerlh@iupui.edu

Please join the Indiana University Robert H. McKinney School of Law Hall Center for Law and Health Grand Rounds on Thursday, September 13th at 4:30pm.

William Marler, Managing Partner, Marler Clark, The Food Safety Law Firm

This is a free event, but registration is required.

Bio:

An accomplished attorney and national expert in food safety, William (Bill) Marler has become the most prominent foodborne illness lawyer in America and a major force in food policy in the U.S. and around the world.  Marler Clark, The Food Safety Law Firm, has represented thousands of individuals in claims against food companies whose contaminated products have caused life altering injury and even death.

He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the historic Jack in the Box E. coli O157:H7 outbreak, in her landmark $15.6 million settlement with the company.  The 2011 book, Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat, by best-selling author Jeff Benedict, chronicles the Jack in the Box outbreak and the rise of Bill Marler as a food safety attorney.

For the last 25 years, he has represented victims of nearly every large foodborne illness outbreak in the United States.  He has filed lawsuits against such companies as Chili’s, Chi-Chi’s, Cargill, ConAgra, Dole, Excel, Golden Corral, KFC, McDonald’s, Odwalla, Peanut Corporation of America, Sheetz, Sizzler, Supervalu, Taco Bell and Wendy’s, securing over $600,000,000 for victims of E. coli, Salmonella, and other foodborne illnesses.

Among the most notable cases he has litigated, Bill counts those of nineteen-year-old dancer Stephanie Smith, who was sickened by an E. coli-contaminated hamburger that left her brain damaged and paralyzed, and Linda Rivera, a fifty-seven-year-old mother of six from Nevada, who was hospitalized for over 2 years after she was stricken with what her doctor described as “the most severe multi-organ [bowel, kidney, brain, lung, gall bladder, and pancreas] case of E. coli mediated HUS I have seen in my extensive experience.”

New York Times reporter Michael Moss won a Pulitzer Prize for his coverage of Smith’s case, which was settled by Cargill in 2010 for an amount “to care for her throughout her life.” Linda’s story hit the front page of the Washington Post and became Senate Majority Leader Harry Reid’s touchstone for successfully moving forward the Food Safety Modernization Act in 2010.

Bill Marler’s advocacy for a safer food supply includes petitioning the United States Department of Agriculture to better regulate pathogenic E. coli, working with nonprofit food safety and foodborne illness victims’ organizations, and helping spur the passage of the 2010-2011 FDA Food Safety Modernization Act.  His work has led to invitations to address local, national, and international gatherings on food safety, including testimony before the U.S. House of Representatives Committee on Energy and Commerce.

At little or no cost to event organizers, Bill travels widely and frequently to speak to food industry groups, fair associations, and public health groups about the litigation of claims resulting from outbreaks of pathogenic bacteria and viruses and the issues surrounding it.  He gives frequent donations to industry groups for the promotion of improved food safety and has established numerous collegiate science scholarships across the nation.

He is a frequent writer on topics related to foodborne illness.  Bill’s articles include “Separating the Chaff from the Wheat: How to Determine the Strength of a Foodborne Illness Claim”, “Food Claims and Litigation”, “How to Keep Your Focus on Food Safety”, and “How to Document a Food Poisoning Case” (co-authored with David Babcock.)  He is the publisher of the online news site, Food Safety News and his award-winning blog, www.marlerblog.com is avidly read by the food safety and legal communities. He is frequent media guest on food safety issues and has been profiled in numerous publications.

In 2010 Bill was awarded the NSF Food Safety Leadership Award for Education and in 2008 earned the Outstanding Lawyer Award by the King County Bar Association.  He has also received the Public Justice Award from the Washington State Trial Lawyers Association.

Bill graduated from the Seattle University School of Law in 1987, and in 1998 was the Law School’s “Lawyer in Residence.”  In 2011 he was given Seattle University’s Professional Achievement Award.  He is a former board member of the Washington State Trial Lawyers, a member of the board of directors of Bainbridge Youth Services, former President of the Governor-appointed Board of Regents at Washington State University.

Parking:

Due to road construction on or near campus, we recommended parking at the IUPUI Sports Garage at 875 West New York Street.  Please note this is a change from previous years.

Parking is available for a nominal fee (credit/debit card) at the Sports Garage, as well as the Gateway Garage.

Special Accommodations:

Individuals with disabilities who need special assistance should call (317) 278-4789 no later than one week prior to the event. Special arrangements can be made to accommodate most needs.

On March 17, 2018, I penned the following: (Other than Tiger Brands admitting that its product tested positive for the exact same strain of Listeria that sickened now over 1,000 and killed 200), not much.  Lawrence, I’m still willing to write the check.

Imagine that the phone call comes or an email pops into your inbox – “Sir, we have been contacted by the health authorities and they say our product (polony) has been linked to illnesses and deaths. What do we do?”

So, what do you do?  Lawrence MacDougall received that call.  Now, what has he done and what will he do?

After being involved in every major (and a few minor) food poisoning outbreaks since the Jack in the Box E. coli Outbreak of 1993, I have seen it all. I have seen good CEOs act badly and make their and their company’s problems worse and I have seen bad CEOs handle the outbreak with such aplomb that they become associated with both food safety and good PR.

So, what do you do?

Of course, it is always best to avoid the outbreak to begin with. When I have spoken to CEOs or their Boards–generally, pre-outbreak and pre-lawsuit–I always pitch them on “why it is a bad idea to poison your customers.” Putting safe food as the primary goal–yes, alas, even before profits–will (absent an error) give you a very, very good chance of never seeing me on the other side of a courtroom.

But, what if despite your best efforts, or what if you simply did not care, and an outbreak happens.

So, what do you do?

First, have a pre-existing relationship with the folks that regulate you. If someone holds your business in the palm of his or her hand, you should at least be on a first name basis. No, I am not suggesting that you can influence your way out of the outbreak but knowing who is telling you that your company has a problem allows you the ability to get and understand the facts. Do regulators and their investigators make mistakes? Perhaps, but not very often and not often enough to waste time arguing that your company did not poison customers.

Second, stop production of the implicated product and initiate a recall of all products at risk immediately. This procedure should have been practiced, and practiced, and practiced before. All possibly implicated suppliers should be alerted and all retailers should be offered assistance. Consumers need to be engaged too.  The goal now is to get poisoned product out of the marketplace and certainly out of the homes of consumers.

Third, launch your own investigation with two approaches, and at the same time. Are the regulators correct? And, what went wrong? Tell everyone to save all documents and electronic data. The goal here is to get things right. If it really is not your product, what has happened is bad, but survivable. If it really was your product, then learning what happened helps make sure it is likely to never happen again. More than anything, be transparent. Tell everyone what you find–good or bad.

According to the South African Minister of Public Health, Minister of Health Dr. Aaron Motsoaledi:

Listeria monocytogenes was isolated from stool collected from one of the ill children, and from both of the polony specimens collected from the crèche. These isolates were sent to the NICD Centre for Enteric Diseases and underwent whole genome sequencing and genomic analysis. The ST6 sequence type was confirmed on all three isolates on Saturday 27th January. Remember that in the last press conference I informed you that from clinical isolates obtained from patients (patient blood), 9 sequence types of Listeria monocytogenes were isolated and 91% were of sequence type 6 (ST6). We had then concluded that time that this outbreak is driven by ST6.

Following the lead from the tests performed on these children from Soweto and the food they had ingested, the EHPs (Environmental Health Practitioners), together with the NICD and DAFF representatives, accompanied by 3 technical advisors from the World Health Organization in Geneva, visited a food-production site in Polokwane and conducted an extensive food product and environmental sampling.

Listeria monocytogenes was isolated from over 30% of the environmental samples collected from this site, which happens to be the Enterprise factory in Polokwane.

To conclude the investigation, whole genome sequencing analysis was performed from this Enterprise factory and the results became available midnight or last night. The outbreak strain, ST6, was confirmed in at least 16 environmental samples collected from this Enterprise facility.

THE CONCLUSION FROM THIS IS THAT THE SOURCE OF THE PRESENT OUTBREAK CAN BE CONFIRMED TO BE THE ENTERPRISE FOOD-PRODUCTION FACILITY IN POLOKWANE

As of the March 14, 2018 update of Listeria monocytogenes Outbreak from the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), National Institute for Communicable Diseases (NICD)/National Health Laboratory Service (NHLS), a total of 978 cases has been reported since 2017. Since the last situational update (8 March 2018), 11 additional cases have been reported to the NICD. The death total remained at 183. Given the above work by NICD and the fact that the number of ill is failing post-recall, Tiger Brands – Enterprise has nothing to argue about the source of the outbreak.

Fourth, assuming that the outbreak is in fact your fault, publicly admit it. If it is not your fault, then fight it. However, pretending that you are innocent when you are actually at fault will get you nowhere. Asking for forgiveness is not a bad thing when you have something to be forgiven for. Saying you are sorry is not wrong when you are in fact wrong.

Mr. MacDougall, given the facts saying this was both heartless and stupid: “There is no direct link with the deaths to our products that we are aware of at this point. Nothing.”

Fifth, do not blame your customers.  If your food has a pathogen it is not your customers responsibility to handle it like it will likely kill them or a member of their family.  Hoping that the consumer will fix your mistake takes your eye off of avoiding the mistake in the first place.

Sixth, reach out to your customers and consumers who have been harmed. Offering to pay legitimate losses will save money and your company’s reputation in the long run.  The public with give you credit and it will be a reduction from the future award during litigation.

Seventh, teach all what you have learned. Do not hide what you have learned. Make your knowledge freely available so we all limit the risk that something similar will happen again.

Mr. MacDougall, I will match you personally 1,000,000 Rand to donate to an Organization or University in South Africa to lead a review of both food processing standards and governmental regulations and oversight.  I will help find experts from around the world to assist.

Yes, you can do all of the above and still get sued. And, I might be the one to sue you, and in Mr. MacDougall’s case I am. Yet, companies who have followed the above find their passage through an outbreak, recall, and litigation temporary. The companies that struggle for unfounded reasons will seldom exist in the long run, or they will simply pay my clients more money.

Bill Marler is trial lawyer who spends a great deal of time trying to convince companies around the world why it is a bad idea to poison customers. Twitter @bmarler and Blog at www.marlerblog.com

The 2017 list, rechristened the Web 100, includes 50 blogs, 25 law podcasts and 25 tweeters for lawyers to follow. Perennial favorites are honored in the Blawg 100 Hall of Fame.

Some blogs listed over the years are still thriving after a decade or more, while others went dark long ago. Go beyond our annual lists to search thousands of blogs by specialty and location in the ABA Journal Blawg Directory.

What’s the Blawg Hall of Fame?

In 2012, we introduced our inaugural Blawg Hall of Fame class. These are blawgs that we’ve decided will always be among our favorites and so deserve their own listing that we add to each year. The list of best blogs has grown to 55, with five new additions for 2017.

How does the ABA Journal select digital media to include in the annual Web 100?

The Web 100 is compiled by ABA Journal staff and is largely a favorites list. We ask for nominations from our readers through the Web 100 Amici process. Most successful nominees are regularly updated, with original content, opinion and/or analysis. Blogs, podcasts and social media also are on our radar because they tip off the Journal staff to news, or the posts themselves are worthy of coverage.

Marler Blog

Bill Marler has consistently earned a place on our Blawg 100 list, and it’s not just because the tales of food poisoning outbreaks recounted on his blog keep us up at night. We feel he has truly proven how blogs can help lawyers with niche practices become sought-after experts.

Fast Facts of CDC: Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015 Surveillance Summaries / July 27, 2018 / 67(10);1–11:

2009–2015: 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths.

Among 2,953 outbreaks with a single confirmed etiology:

  1. Norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]).
  2. Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%).
  3. Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported.

Among 1,281 outbreaks in which the food reported could be classified into a single food category:

  1. Fish were the most commonly implicated category (222 outbreaks [17%]).
  2. Dairy (136 [11%]).
  3. Chicken (123 [10%]).

The food categories responsible for the most outbreak-associated illnesses were:

  1. Chicken (3,114 illnesses [12%]).
  2. Pork (2,670 [10%]).
  3. Seeded vegetables (2,572 [10%]).

Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Problem/Condition: Known foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur.

Description of System: The Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year.

Results: During 2009–2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Location: A location of preparation was provided for 5,022 outbreak reports (87%), with 4,696 (94%) indicating a single location. Among outbreaks reporting a single location of preparation, restaurants were the most common location (2,880 outbreaks [61%]), followed by catering or banquet facilities (636 [14%]) and private homes (561 [12%]). Sit-down dining style restaurants (2,239 [48%]) were the most commonly reported type of restaurant. The locations of food preparation with the most outbreak-associated illnesses were restaurants (33,465 illnesses [43%]), catering or banquet facilities (18,141 [24%]), and institutions, such as schools (9,806 [13%]). The preparation location with the largest average number of illnesses per outbreak was institutions (46.5), whereas restaurants had the smallest (11.6).

Outbreaks: Outbreak investigators identified a food in 2,442 outbreaks (42%). These outbreaks resulted in 51,341 illnesses (51%). The food reported belonged to a single food category in 1,281 outbreaks (22%). The food category most commonly implicated was fish (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Scombroid toxin in fish was the single confirmed etiology and food category pair responsible for the most outbreaks (85), followed by ciguatoxin in fish (72) and Campylobacter in dairy (60). The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941). In comparison, scombroid toxin and ciguatoxin outbreaks from fish resulted in 519 outbreak-associated illnesses, an average of three illnesses per outbreak. Outbreaks of Salmonella infections from seeded vegetables resulted in an average of 88 illnesses per outbreak, and outbreaks of Salmonella infections from eggs resulted in an average of 78 illnesses per outbreak.

Food Implicated: Several novel food vehicles caused outbreaks during the study period. In 2011, an outbreak of Salmonella serotype Enteritidis infections linked to pine nuts imported from Turkey resulted in 53 illnesses and two hospitalizations. In 2014, an outbreak of Salmonella serotypes Gaminara, Hartford, and Oranienburg in chia seed powder imported from Canada caused 45 illnesses and seven hospitalizations. An outbreak of STEC serogroups O26 and O121 infections that began in 2015 was linked to raw wheat flour produced in the United States; it resulted in 56 illnesses and 16 hospitalizations in 24 states. An outbreak of Salmonella serotype Virchow infections attributable to moringa leaf powder imported from South Africa began in 2015 and caused 35 illnesses and six hospitalizations in 24 states. It was an ingredient of an organic powdered shake mix branded to be used as a meal replacement.

Multistate Outbreaks: Multistate outbreaks comprised only 3% of outbreaks but were responsible for 11% of illnesses, 34% of hospitalizations, and 54% of deaths. Multistate outbreaks involved a median of seven states with a range of two to 45 states in which exposure occurred. The largest of the 177 multistate outbreaks was caused by Salmonella serotype Enteritidis and due to contaminated shell eggs. An estimated 1,939 persons were infected in 10 states beginning in 2010. An outbreak of Salmonella serotype Poona infections attributed to cucumbers in 2015 had the second highest number of illnesses (907 illnesses in 40 states). This outbreak also had the most outbreak-associated hospitalizations (204 [22% of cases]). An outbreak of Salmonella serotype Heidelberg infections attributed to chicken during 2013–2014 had the second most hospitalizations (200 [32% of cases]) and involved persons from 29 states and Puerto Rico. An outbreak of Listeria monocytogenes infections attributed to cantaloupes in 28 states in 2011 had the most deaths (33 [22% of cases]), followed in 2014 by an outbreak in 12 states of Listeria monocytogenes infections attributed to caramel apples, another novel food vehicle (9), in which seven persons (20% of cases) died.

Daniel Dewey-Mattia, MPH; Karunya Manikonda, MPH; Aron J. Hall, DVM; Matthew E. Wise, PhD; Samuel J. Crowe, PhD.

  1. CDC Annual summaries of foodborne outbreaks. Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://www.cdc.gov/fdoss/annual-reports/index.html
  2. Scallan E, Hoekstra RM, Angulo FJ, et al. Foodborne illness acquired in the United States—major pathogens. Emerg Infect Dis 2011;17:7–15. CrossRefPubMed
  3. National Notifiable Diseases Surveillance System (NNDSS). Foodborne disease outbreak 2011 case definition. Atlanta, GA: US Department of Health and Human Services, CDC; 2013. http://wwwn.cdc.gov/nndss/conditions/foodborne-disease-outbreak/case-definition/2011
  4. PulseNet. Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/pulsenet/index.html
  5. Guide to confirming an etiology in foodborne disease outbreak. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. https://www.cdc.gov/foodsafety/outbreaks/investigating-outbreaks/confirming_diagnosis.html
  6. Interagency Food Safety Analytics Collaboration (IFSAC) Food Categorization Scheme. Atlanta, GA: US Department of Health and Human Services, CDC; 2015. https://www.cdc.gov/foodsafety/ifsac/projects/food-categorization-scheme.html
  7. Richardson LC, Bazaco MC, Parker CC, et al. An updated scheme for categorizing foods implicated in foodborne disease outbreaks: a tri-agency collaboration. Foodborne Pathog Dis 2017;14:701–10. CrossRefPubMed
  8. US Census Bureau. Population and housing unit estimates. Washington, DC: US Department of Commerce, US Census Bureau; 2016. https://www.census.gov/programs-surveys/popest.html
  9. Angelo KM, Conrad AR, Saupe A, et al. Multistate outbreak of Listeria monocytogenesinfections linked to whole apples used in commercially produced, prepackaged caramel apples: United States, 2014–2015. Epidemiol Infect 2017;145:848–56. CrossRef PubMed
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As of July 13, 2018, 212 people infected with the outbreak strains of Salmonella have been reported from 44 states.

  • Illnesses started from February 15, 2018 to June 21, 2018.
  • 34 ill people have been hospitalized, and no deaths have been reported.
  • 26% of ill people are children younger than 5 years.

Epidemiologic, traceback, and laboratory findings link these outbreaks to contact with live poultry, such as chicks and ducklings, which come from multiple hatcheries.

  • In interviews, 100 (72%) of 138 ill people with information available reported contact with chicks or ducklings in the week before their illness started.
  • People reported obtaining chicks and ducklings from several sources, including feed supply stores, websites, hatcheries, and from relatives.

WGS analysis to identify antibiotic resistance was performed for 118 isolates from ill people in this outbreak. Twenty-two isolates from ill people contained genes expected to cause resistance or decreased susceptibility to all or some of the following antibiotics: ampicillin, streptomycin, sulfamethoxazole, tetracycline, gentamicin, ceftriaxone, amoxicillin-clavulanic acid, cefoxitin, ciprofloxacin, and fosfomycin. Ninety-six isolates did not identify predicted resistance. Testing of 5 outbreak isolates using standard antibiotic susceptibility testing by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these results. Some infections may be difficult to treat with commonly recommended antibiotics, and may require another kind of antibiotic.

Here is a good reminder:

This year’s FoodNet report summarizes 2017 preliminary surveillance data and describes trends since 2006 for infections caused by the following pathogens monitored by FoodNet: Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, Yersinia. The report also summarizes cases of hemolytic uremic syndrome (HUS) for 2016, the most recent year for which those data are available.

  • In 2017, FoodNet received reports of 24,484 illnesses, 5,677 hospitalizations, and 122 deaths in its surveillance area, which includes 15% of the U.S. population.
  • The incidence of infections per 100,000 people was highest for Campylobacter and Salmonella, which is similar to previous years.
  • The number of infections diagnosed by CIDT, a newer type of test, is increasing. The overall number of Campylobacter, Listeria, Salmonella, Shigella, Vibrio, and Yersinia infections diagnosed by CIDT increased 96% in 2017 compared with the 2014–2016 average.
  • CIDTs are revealing many infections – such as those caused by Cyclospora, Yersinia, Vibrio, and STEC non-O157 – that would not have been diagnosed before because of limited testing. CIDTs are fast and easy to use, and they detect some illnesses that would have otherwise been missed. However, CIDTs also challenge our ability to find outbreaks and monitor disease trends, because they do not provide certain information needed to characterize organisms that cause infections. For example, some information about the bacteria that cause infections, such as subtype and antimicrobial susceptibility, can be obtained only if a CIDT-positive specimen is cultured. FoodNet is gathering information to better understand the effect of CIDTs on surveillance.
  • The incidence of Salmonella infections overall did not change significantly, but there were significant changes among serotypes:
  • The incidence of infections caused by serotypes Typhimurium and Heidelberg has been decreasing since 2006–2008, with overall declines of more than 40% for both. Infections cause by serotypes Javiana, Thompson, and Infantis have all increased by more than 50% since 2006–2008.
  • Infections caused by STEC O157 have decreased in the past 10 years. The increasing use of CIDTs makes interpretation of trends in STEC infections difficult because CIDTs do not indicate which STEC serogroup caused the infection. The incidence of HUS among children younger than 5 years decreased during 2016 compared with 2006–2008. Because most cases of HUS are caused by STEC O157, the decline in HUS provides evidence that supports the finding of the decline in STEC O157 cases.