CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) are investigating a multistate outbreak of multidrug-resistant Salmonella I 4,[5],12:i:- infections linked to contact with pig ear dog treats.

As of July 2, 2019, a total of 45 people infected with the outbreak strain of Salmonella I 4,[5],12:i:- have been reported from 13 states.

California – 1, Illinois – 3, Indiana – 3, Iowa – 12, Kansas – 3, Massachusetts – 2, Michigan – 7, Missouri – 3, New York – 6, North Dakota – 1, Pennsylvania – 2, South Carolina – 1 and Wisconsin – 1

Illnesses started on dates ranging from November 18, 2018, to June 13, 2019. Ill people range in age from less than 1 year to 81 years, with a median age of 23. Half (50%) of ill people are female. Of 39 ill people with information available, 12 (31%) 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 2 to 4 weeks.

Epidemiologic evidence indicates that contact with pig ear dog treats is the likely source of this outbreak.

In interviews, ill people answered questions about animal contact in the week before they became ill. Thirty-four (89%) of 38 ill people reported contact with a dog before getting sick. Of 24 people with available information, 17 (71%) reported contact with pig ear dog treats or with dogs who were fed pig ear dog treats. Both of these proportions are significantly higher than the results from a survey of healthy people who reported contact with dogs (61%) or handling dog treats, such as pig ears (16%), in the week before interview.

Officials from the Michigan Department of Agriculture and Rural Development gathered pig ear dog treats at retail locations where ill people reported buying the products. They sampled pig ears for Salmonella. Although the outbreak strain was not identified, other strains of Salmonella were. Investigators are checking to see if any human illnesses are linked to those strains. Retail locations where sampling occurred have removed pig ears from shelves.

A common supplier of pig ear dog treats has not been identified.

From Chipotle’s 10 Q: Receipt of Grand Jury Subpoenas:

On January 28, 2016, we were served with a Federal Grand Jury Subpoena from the U.S. District Court for the Central District of California in connection with an official criminal investigation being conducted by the U.S. Attorney’s Office for the Central District of California, in conjunction with the U.S. Food and Drug Administration’s Office of Criminal Investigations. The subpoena required the production of documents and information related to company-wide food safety matters dating back to January 1, 2013. Since then we have received two other subpoenas on the following dates requesting information related to illness incidents associated with the following specific restaurants: July 19, 2017, requesting information about a single Chipotle restaurant in Sterling, Virginia; and February 14, 2018, requesting information about a single Chipotle restaurant in Los Angeles, California. On April 18, 2019, we received a new subpoena requesting information related to illness incidents associated with the specific restaurants in Simi Valley, California, Boston, Massachusetts, Sterling, Virginia, and Los Angeles, California that were covered under the previous subpoenas, plus one additional restaurant in Powell, Ohio. We have fully cooperated and intend to continue to fully cooperate in the investigation. It is not possible at this time to determine whether we will incur, or to reasonably estimate the amount of, any fines or penalties in connection with the investigation pursuant to which the subpoenas were issued.

CMG (Chipotle Mexican Grill Inc.) (10-Q) 2019-04-25

I woke up this morning to the sad news of yet other injuries and a death linked to animal contact at a fair.

San Diego County health officials announced late Friday night that a 2-year-old child has died and three other children between 2 and 13 years old have become ill after having contact with animals at the San Diego County Fair.

The County of San Diego Health and Human Services Agency reported four confirmed pediatric cases of Shiga-toxin-producing E. coli linked to contact with the animals.

Officials from the HHSA’s Epidemiology Program and County Department of Environmental Health are investigating the cluster of four infections, officials said.

The four children who fell ill visited the fair between June 8 and June 15 and began showing symptoms between June 10 and June 16.

“Three of the four cases were not hospitalized,” county authorities said in a statement released at 10:10 p.m. Friday. “However, one of the four cases, a 2-year-old boy, was hospitalized and unfortunately died on June 24, from a complication of this disease.”

Officials at the San Diego County Fair closed public access to all animal areas, including the petting zoo, according to the statement issued by the county. The source of the E. coli bacteria remains under investigation, but all the children reportedly visited the animal areas or petting zoo or had other animal contact at the fair.

It reminded me of an Op-ed I penned several years ago about banning petting zoos.

I can hear the wailing and gnashing of teeth over such an un-American suggestion.

The Centers for Disease Control and Prevention (CDC) reports the creation of yet another multiagency task force in North Carolina “to evaluate the preventive measures that were in place during the 2011 state fair and to identify additional interventions that could be applied to prevent disease transmission in livestock exhibitions where physical contact with the public might occur.” Hmm, didn’t that happen after the 2004 North Carolina State Fair E. coli outbreak, which resulted in 187 illnesses, including 15 complicated by hemolytic uremic syndrome (HUS)?

This latest task force is looking into what happened at the 2011 North Carolina State Fair, held October 13-23 in Raleigh. According to the CDC, 25 cases of E. coli O157:H7 infection were identified with case-patients’ illness onsets during October 16-25; median age was 26 years (range: 1-77 years). Eight case-patients (32 percent) were hospitalized; four (16 percent) experienced HUS. Once again, the only exposure associated with illness was having visited one of the permanent structures in which sheep, goats, and pigs were housed for livestock competitions.

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After decades of outbreaks, the CDC and a collection of state veterinarians have issued these stern warnings and suggestions about animal exhibits and petting zoos:

– Wash hands after contact with animals to reduce the risk of zoonotic disease transmission.

– Do not allow food, drink, or pacifiers in animal areas.

– Include transition areas between animal areas and non-animal areas.

– Educate visitors about disease risk and prevention procedures.

– Properly care for and manage animals.

But, if history is any guide, guidelines are not working very well.  Here is a sample of zoonotic outbreaks over the last decade:

2011 English Animal Farm Outbreak – Cruckley Animal Farm in Foston-on-the-Wolds, England is closing its gates permanently following an outbreak of E. coli O157:H7.  The family-run farm was linked to at least six cases of the life-threatening infection as of August 2011.  The owners, John and Sue Johnston, expressed sorrow at the illness and stated that “the health and safety of our visitors has always been our top priority,” thus with the news the farm was the likely source of illnesses, they decided to close.

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2011 Snohomish County Petting Zoo – At least 6 people who visited the Forest Park Petting Zoo in Everett, Washington, in June 2011 became ill with E. coli O157:H7 infections. The Snohomish County Health Department investigated the E. coli outbreak and determined that there was a “clear association between disease and being in the open animal interaction area of the forest Park Animal Farm.”

2009 Utah Rodeos Outbreak – Utah state and local health officials and the CDC noted a cluster of E. coli O157:H7 cases in the summer of 2009.  The illnesses were associated with attendance to rodeos, but not all the same one.  The vast majority of the 14 cases (93 percent) had food histories containing ground beef, unsurprising for rodeo visitors. 
However, a traceback on the meat products provided at the rodeos found no contamination.

2009 Godstone Park Farm and Plan Barn E. coli Outbreak in Surrey, England – A final report of the Outbreak Control Committee of the Surrey and Sussex Health Protection Unit describes an outbreak of E. coli O157 (VTEC O157 PT21/28) occurring in August and September 2009. This was the largest documented outbreak of VTEC O157 associated with farms in the UK. Individuals became infected either through direct or indirect contact with farm livestock.

2009 “Feed the Animals” Exhibit E. coli Outbreak at the Western Stock Show – In January 2009, the Communicable Disease and Consumer Protection Divisions of the Colorado Department of Public Health noticed an increase is in the number of laboratory confirmed cases of E. coli O157.  Thirty cases were identified–including nine hospitalizations and 2 cases of HUS.  All the children had visited the National Western Stock Show in Denver, Colorado.

2007 Petting Zoo E. coli O157:H7 Outbreak in Pinellas County, FL – In May and June 2007, seven Florida children were infected with E. coli O157:H7. Six of the children had visited a Day Camp petting zoo, and the seventh was a sibling. Two of the children were hospitalized, all seven recovered.  The petting zoo was closed on the recommendation of the health department.

2005 Big Fresno Fair Petting Zoo E. coli Outbreak – At least six children were infected with E. coli O157:H7 – one gravely – visiting the petting zoo at the 2005 Big Fresno Fair. One child was 2 years old at the time of her visit to the petting zoo. She developed HUS and was hospitalized for months. Her kidneys were severely damaged and a series of strokes left her with impaired movement and vision.

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2005 Campylobacteriosis Outbreak Associated with a Camping Trip to a Farm – In June 2005, King County Public Health was notified that a several children on a school trip had been ill with diarrhea, abdominal pain and fever following the trip. Campylobacter was isolated from the stool of one ill individual, and later in the week, two more cases of campylobacteriosis were reported in persons who had been on the same camping trip, held at a private farm.

2005 Florida State Fair, Central Florida Fair, and Florida Strawberry Festival E. coli Outbreak – The AgVenture Farms E. coli O157:H7 outbreak was first recognized after two separate HUS case reports were reported to the Florida Department of Health in mid-March.  The two cases (a 5-year-old girl and a 7-year-old boy) both reported hav
ing visited a fair with a petting zoo (AgVenture) a few days prior to becoming ill. The two children did not have any other common risk factors. A total of 22 confirmed, 45 suspect and 6 secondary cases were reported.

2003 Fort Bend County Fair E. coli Outbreak – Rosenberg, TX – In 2003, 25 people (fair visitors and animal exhibitors) became ill with HUS and one case of a related disease, thrombotic thrombocytopenic purpura. All seven laboratory-confirmed cases had an indistinguishable PFGE pattern, which matched 10 isolates obtained from environmental samples taken from animal housing areas.

2002 E. coli Outbreak at a Petting Zoo in Zutphen, The Netherlands  – A young child developed a Shiga toxin 2 producing strain of Escherichia coli (STEC) O157 infection after visiting a petting zoo in Zutphen, The Netherlands. The STEC strains were isolated from the fecal samples from goats and sheep on the farm and were indistinguishable from the human patient isolate.

2002 Lane County, Oregon, Fair E. coli Outbreak – The Oregon Department of Human Services (Oregon, 2002) initially documented a patient with bloody diarrhea, who attended the Lane County Fair held during August 2002. Epidemiologists identified 82 ill persons, 22 who were hospitalized, and 12 with HUS. This is the largest E. coli O157:H7 outbreak recorded in Oregon.

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2002 Wyandot County, OH, Fair E. coli Outbreak – The Ohio Wyandot County Health Department received a report of an E. coli O157 outbreak in September 2001 (CDC memorandum, February, 2002). A total of 92 cases were identified, including 27 laboratory-confirmed E. coli O157 infections. Two cases were diagnosed with hemolytic uremic syndrome. Eighty-eight cases reported attending Wyandot County Fair before becoming ill.

2001 Lorain County, OH, Fair E. coli Outbreak – The Department of Health and Human Services, Public Health Services (CDC memorandum, February, 2002) reported that 23 cases of E. coli O157:H7 infection were associated with the attendance at the Lorain County Fairgrounds in September 2001. Additional cases were identified as likely due to secondary transmission from attendees at the fairgrounds. An investigation associated illness with environmental contamination at the Cow Palace.

2001 Ozaukee County, WI, Fair E. coli Outbreak – The Ozaukee County Public Health Department and Wisconsin Department of Health and Family Services (2001) investigated an outbreak of E. coli O157:H7 associated with animals at the Ozaukee County Fair in August 2001. A total of 59 E. coli O157:H7 cases were identified in this outbreak, with 25 laboratory confirmed cases (25 “primary cases” and 34 probable cases).

2001 E. coli Outbreak at a Petting Zoo in Worcester, PA – An article published by WebMD Medical News on April 23, 2001 (Bloomquist, 2001), reported an outbreak of E. coli O157:H7 among visitors to the Merrymead Farm petting zoo in Worcester, Pennsylvania. In all, 16 children who had visited the zoo contracted E. coli, and it was suspected that another 45 people became ill from the bacteria. The report indicated that one week after visiting the zoo, one of the children came down with violent stomach cramps and was hospitalized.

2000 Cryptosporidiosis Outbreak at a Farm in Wellington, New Zealand – An outbreak of Cryptosporidiosis was linked to a two-day farm educational event in the Wellington region of New Zealand. Twenty-three cases were laboratory-confirmed. The route of infection was most likely from an infected animal.

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2000 E. coli Outbreak at a Dairy Farm – Crump et al (2002) discussed an outbreak of E. coli O157:H7 among visitors to a dairy farm in Pennsylvania in September 2000. A case control study among the visitors was conducted to identify the risk factors of infection, along with a household survey to determine the rates of diarrheal illness. The total number of confirmed or suspected E. coli O157:H7 cases was 51. The median age among the patients was four. Eight of the cases developed hemolytic uremic syndrome (HUS).

2000 Snohomish County, WA, Petting Zoo E. coli Outbreak – The Snohomish Health District, Communicable Disease Department (June, 2000) reported five cases of bacterial diarrhea caused by E. coli O157:H7 in children in Snohomish County in May 2000. Three of the children visited a petting zoo several days before they became sick. The fourth child did not visit the petting zoo, but lived on another farm where cattle were raised.

2000 Medina County, OH, Fair E. coli Outbreak – A cluster of E. coli O157:H7 isolates was observed in Medina County, Ohio, in August of 2000. In the case-control investigation, 43 culture confirmed E. coli O157:H7 cases were identified. The environmental investigation suggested that contamination of a section of the water distribution system supplying various vendors was the likely exposure.

So, what do you think should be done?

For more information on outbreaks and prevention measures, visit Fair-Safety.Com

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

As of June 26, 2019, a total of 62 people infected with the outbreak strain of Salmonella Uganda have been reported from 8 states – Texas, Florida, New York, Pennsylvania, New Jersey, Massachusetts, Connecticut and Rhode Island.

Illnesses started on dates ranging from January 14, 2019, to June 8, 2019. Most illnesses have occurred since April 2019. Ill people range in age from 1 to 86 years, with a median age of 60. Fifty-three percent of ill people are female. Of 35 people with available information, 23 (66%) have been hospitalized. No deaths attributed too Salmonella have been reported. Of 33 ill people with available information, 22 (67%) reported being of Hispanic ethnicity.

Epidemiologic evidence and early product distribution information indicate that whole, fresh papayas imported from Mexico and sold in Connecticut, Massachusetts, New Jersey, New York, Pennsylvania, and Rhode Island, are a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of 21 people who were interviewed, 16 (76%) reported eating papayas. This proportion was significantly higher than results from a survey pdf icon[PDF – 787 KB] of healthy Hispanic people in the months of January through June in which 13% reported eating papayas in the week before they were interviewed.

Two people who lived in different households got sick in Connecticut after eating papayas purchased from the same grocery store location in the week before becoming ill. This provides additional evidence that papayas are a likely source of this outbreak. One ill person in Florida had traveled to Connecticut in the week before they got sick. Officials are working to gather more information about an ill person in Texas.

According to press reports, TV personality Melissa Rycroft has been ill since recently returning home from the Dominican Republic. Apparently, sources told “Page Six” the former “Dancing With the Stars” and “The Bachelor” star has been battling a mysterious bug after vacationing with her family on the island that has been making headlines for sick visitors (some deathly so) in recent weeks.

A source described Rycroft as “really sick.”

Rycroft elaborated via a rep that she “has had major stomach issues since returning from the Dominican Republic.”

“She got an upset stomach on the second day of vacation, but it passed. Once they came home, she got severe cramping,” the rep said. “It has lasted for over a week, and she’s currently getting tested for possible parasites and any other infections. She’s assuming it’s something foodborne, but no one else in her family is ill.”

Police are also  investigating whether at least nine tourists who mysteriously died in the Dominican Republic were poisoned by counterfeit booze, according to other media reports.

Officials want to know who supplied the alcoholic beverages the victims drank in the minutes and hours before their deaths over the past year — and if the drinks had any dangerous chemicals in them, law enforcement sources said.

The FBI is assisting and will take blood samples from the dead back to its research center in Quantico, Virginia.

Bill (and team),

Thank you for your most excellent work on behalf of our son.  I thought about sending a fruit basket or something but …. well …. probably not my best option for you of all people, so my heartfelt gratitude will have to do. ;)  I know __________ has extended our appreciation, but I wanted to add mine to his.

We appreciate so very much your tireless efforts on _________’s behalf.  At every stage of this case we felt confident that his best interests were at the forefront of all you were doing.  In the early days when he was still so very sick, we appreciated the leadership and knowledge you showed when we were struggling to think past our fear and emotions, and we knew we could leave things in your very capable hands.  As time went on, we were so grateful for the extra efforts you made in a case (and a state) that proved to be very frustrating for you at times.  I cannot image another firm instilling such confidence in us or taking better care of ___________ and his interests.

It has been an absolute pleasure working with your team at Marler Clark and we will forever be grateful for our experience with your firm.  Please know how much it means to this mama that you took such good care of my son.

Bill, if you ever make it into ___________, it would be our pleasure to treat you to dinner and to shake your hand in person.  We wish you ongoing success in your fight to bring food safety issues to light and to hold those accountable until we see real changes and improvements.

Warmest regards,

_________  ___________

As of June 7, 2019, a total of 279 people infected with the outbreak strains of Salmonella have been reported from 41 states.

Illnesses started on dates from January 1, 2019, to May 24, 2019. Ill people range in age from less than one year to 92 years, with a median age of 25 years. Fifty-seven percent are female. Of 152 people with information available, 40 (26%) have been hospitalized. No deaths have been reported.

One of the outbreak strains making people sick was identified in samples collected from backyard poultry in Ohio.  Additional testing in several states is being conducted.

In interviews, ill people answered questions about animal contact in the week before they became ill. Of 153 people interviewed, 118 (77%) reported contact with backyard poultry before becoming ill. Ill people reported buying poultry from various sources, including agricultural stores, websites, and hatcheries.

Backyard poultry from multiple hatcheries are the likely source of these outbreaks. Regardless of where poultry are purchased, they can carry Salmonella germs that can make people sick. Backyard poultry owners should always follow steps to stay healthy around their poultry.

We have had hens in our backyard since just after the DeCoster egg debacle in 2010.  I clean the chicken house about twice a month and the shoes and clothes I wear are removed before going inside.  I wear a mask and gloves when I clean and either wash my hands well or take a shower.  I do not pick up the chickens unless they are ill, and I wash my hands after I do.  I wash the eggs and refrigerate then.  They tend to get used within the week.

I do my best to think about the possibility of cross-contamination with Salmonella and/or Campylobacter.  So far, so good.

Today Marler Clark filed six lawsuits on behalf of clients related to the 2017 I.M. Healthy brand SoyNut Butter E. coli O157:H7 outbreak. Of the six plaintiffs, three are minors who contracted acute kidney failure, hemolytic uremic syndrome, from their E. coli O157:H7 infections. All six of the plaintiffs were hospitalized for multiple days or weeks.  Four lawsuits were filed in California, one in Washington and one in Wisconsin.

In March 2017, the FDA and CDC, along with state and local authorities, linked a multi-state outbreak of E. coli O157:H7 to I.M. Healthy SoyNut Butter. 32 people were sickened and 12 were hospitalized due to their infections. The soy nut butter was produced jointly by the SoyNut Butter Company and Dixie Dew Products Inc., at a facility owned by Dixie Dew in Kentucky. During an investigation of the facility, the FDA found grossly insanitary conditions with soy nut butter buildup on the floors, walls, and ceilings from previous production runs and fly infestation.  Jars of soy nut butter tested positive for E. coli O157:H7.

I.M. Healthy and Dixie Dew went bankrupt after using the total of their insurance in settlements to the victims. The Bankruptcy Court Evaluator valued all claims at $70 million. The remaining medical bills and costs now fall to the retailers.

“We have tried for over a year to work with these retailers and suppliers to fairly compensate their customers, however, Target, Kroger (Fred Meyer), Safeway and their suppliers, Kehe and World Finer, are more concerned with pointing fingers at each other than treating their customers with respect. The time has come for a judge and jury to hold them responsible,” stated Marler Clark managing partner, Bill Marler.

Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli O157:H7 outbreaks and hemolytic uremic syndrome (HUS). The E. coli O157:H7 lawyers of Marler Clark have represented thousands of victims of E. coli O157:H7 and other foodborne illness infections and have recovered over $650 million for clients. Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our E. coli O157:H7 lawyers have litigated E. coli O157:H7 and HUS cases stemming from outbreaks traced to ground beef, raw milk, lettuce, spinach, sprouts, and other food products.  The law firm has brought E. coliO157:H7 lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such E. coli O157:H7 victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

For copies of the complaints: Conformed Complaint (Klingelhoffer), Conformed Complaint (Leavitt-Garcia), Conformed Complaint (Simmons), Conformed Complaint (Vanderby), Stuller – Complaint Kehe, Weber – Complaint FRED MYERS

To talk with Bill, please contact Lauren Fricke at 1-206-346-1888 or lfricke@marlerclark.com.

According to reporting by “The New Food Economy” and “Food Safety News,” last Friday, a federal judge in California told the Food and Drug Administration (FDA), the nation’s leading food regulator, to stop dragging its feet on the long-awaited rules surrounding food recalls and outbreaks of foodborne illness.

U.S. District Court Judge Yvonne Gonzalez Rogers ordered the Department of Health and Human Services (HHS) and FDA to designate a list of “high-risk foods,” create new record-keeping requirements for some companies that handle those foods and post that information publicly by 2020. The agencies had been sued by two consumer advocacy groups, the Oregon-based Center for Food Safety and the California-based Center for Environmental Health, alleging that the government agencies were not complying with an important food safety timetable.  2019-06-07–doc-33-1–consent-decree_35775

In the complaint, which was filed last October, the two groups said the government agencies weren’t implementing rules in the Food Safety Modernization Act (FSMA), a landmark law signed by President Barack Obama in 2011. A wide-ranging package of regulations, FSMA is concerned, above all, with preventing outbreaks of foodborne illness. It gives FDA—the division of HHS which regulates 80 percent of the country’s food supply—greater authority to track potentially hazardous ingredients and compel product recalls. 2018-10-15–doc-01–complaint_50519

Part of those regulations revolve around high-risk foods—defined as those that are most commonly recalled or are produced in a way that makes them more likely to harbor harmful bacteria.

In the Consent Decree filed on June 7, 2019, FDA agreed to a schedule for FDA action, including:

  • Sept. 8, 2020 – Deadline for FDA to designate the list of “high risk” foods as required by the FSMA Section 204(d)(2)(A).
  • Sept. 8, 2020 – Deadline for FDA to publish a proposed rule, including record-keeping requirements for high-risk foods, also as required by FSMA Section 204(d)(2)(A).
  • Nov.7, 2022 – Deadline for FDA to issue a final rule, including record-keeping requirements for high-risk foods, also as required by FSMA Section 204(d)(2)(A).

The FDA has do date considered “High Risk” as soft cheeses, seafood, custard-filled bakery products, some fruits and vegetables and baby formula.  So, going forward, how will the FDA determine what is “High Risk”? Perhaps FDA drafts might give clue?

Section 204(d)(2) of the FDA Food Safety Modernization Act (FSMA) requires the Food and Drug Administration (“FDA” or “we”) to designate high-risk foods (HRFs) for which additional record keeping requirements are appropriate and necessary to protect the public health. These additional record keeping requirements will make it easier to rapidly and effectively identify recipients of a food to prevent or mitigate a foodborne illness outbreak. Designation of HRFs must be based on the historical public health significance of the food with respect to outbreaks and cases of foodborne disease, as well as a number of food- and processing-related factors.

Factors to Be Considered Under section 204(d)(2)(A) of FSMA, FDA’s designation of HRFs must be based on the following factors:

i.          the known safety risks of a particular food, including the history and severity of foodborne illness outbreaks attributed to such food, taking into consideration foodborne illness data collected by the Centers for Disease Control and Prevention (CDC);
ii.         the likelihood that a particular food has a high potential risk for microbiological or chemical contamination or would support the growth of pathogenic microorganisms due to the nature of the food or the processes used to produce such food;
iii.        the point in the manufacturing process of the food where contamination is most likely to occur;
iv.        the likelihood of contamination and steps taken during the manufacturing process to reduce the possibility of contamination;
v.         the likelihood that consuming a particular food will result in a foodborne illness due to contamination of the food; and
vi.        the likely or known severity, including health and economic impacts, of a foodborne illness attributed to a particular food.

My vote:

Raw Milk
Raw Juice
Raw Sprouts
Pre-cut Fruit and Vegetables (including Leafy Greens)
Raw Shellfish
Uncooked Flour

Any others?