Clearly, tweeting is not just happening in the Oval Office.

Granted, assuming that the E. coli O157:H7 illnesses stopped in early December – CDC and Canadian health authorities have not yet updated the toll – 58 sick with two dead – and, given that romaine lettuce is a perishable product, Dr. Gottlieb may well be correct.  However, since there has been no report where the romaine was grown or processed, we do not really know where the contamination occurred and if subsequent lots of romaine (or other products) are at risk.

I’ll stick with the old CDC adage: “When in doubt, throw it out.”

Reuters reported today that the death toll from an outbreak of Listeria in South Africa has jumped to 61 in the past month from 36 in December.  In addition, the total numbers rose from 557 to 720.

The Department of Health said it had closed a poultry abattoir operated by Sovereign Foods in the capital Pretoria after detecting listeria there, and had banned the facility from preparing food in December.

The department said it did not yet know whether this abattoir was the source of the outbreak, which the NICD said was still unknown.

The department said it did not yet know whether this abattoir was the source of the outbreak, which the NICD said was still unknown.

Listeria food poisoning is a bacterial infection that can be treated with antibiotics if diagnosed in time. The bacteria can be found in animal products including cold cut meats, poultry and unpasteurised milk, as well as fresh fruits and vegetables.

The disease can cause flu-like symptoms and diarrhea, and in more severe cases spread from the intestine to the blood, causing bloodstream infections, or to the central nervous system, causing meningitis.

The Listeria strain known as ST6 had been identified in nine out of 10 of the South African cases. That should make tracing the source easier, “because now we know that it probably originates from one processing facility”.

The CDC, several states, and the FDA are investigating a multistate outbreak of Shiga toxin-producing E. coli O157:H7 infections in 13 states. Seventeen illnesses have been reported from California (3), Connecticut (2), Illinois (1), Indiana (1), Michigan (1), Nebraska (1), New Hampshire (2), New York (1), Ohio (1), Pennsylvania (1), Virginia (1), Vermont (1) and Washington (1). Illnesses started on dates from November 15 through December 8, 2017. Two individuals developed HUS and there has been one death in California.

On December 28, the CDC announced that because the CDC has not identified a source of the infections, CDC is unable to recommend whether U.S. residents should avoid a particular food. This investigation is ongoing, and more information will be released as it becomes available.

In Canada, the Public Health Agency of Canada has identified romaine lettuce as the source of the outbreak in Canada. Currently, there are 41 cases of E. coli O157 illness under investigation in five eastern provinces: Ontario (8), Quebec (14), New Brunswick (5), Nova Scotia (1), and Newfoundland and Labrador (13). Individuals became sick in November and early December 2017. Seventeen individuals have been hospitalized. One individual has died. Individuals who became ill are between the ages of 3 and 85 years of age. The majority of cases (73%) are female.

On December 28, the Public Health Agency of Canada announced that because of the ongoing risk in eastern Canada, the Public Health Agency of Canada is advising individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

On January 3, 2018, Food safety experts at Consumer Reports are advising that consumers stop eating romaine lettuce until the cause of the outbreak is identified and that product is removed from store shelves.

I certainly understand that many romaine lettuce growers would like the CDC to call the “outbreak over” because the last onset of illness – thus far in the US – was December 8, and given that lettuce is a perishable product, it is not likely the product is still in stores or restaurants.  Generally, I would agree with that, however, because neither Canada or the US has been able to confirm where the contamination occurred – on farm, in processing, in transit – I think I agree with the Canadian and Consumer Reports approach – “When in doubt, throw it out.”

There have been several romaine lettuce related E. coli outbreaks in both Canada and the United Sates in the past decades.

In April 2012, an outbreak of E. coli O157 which sickened 28 was linked to romaine lettuce grown and distributed by Amazing Coachella Inc., which is the parent company of Peter Rabbit Farms, both based in Coachella, California. Health officials in New Brunswick, Canada identified at least 24 people with bloody diarrhea beginning on April 23, 2012. Ill persons lived in the communities of Miramichi, St. John and Bathurst. Most of the patient’s laboratory confirmed with E. coli O157:H7 ate at Jungle Jim’s Restaurant in Miramichi. Food samples collected at Jungle Jim’s were negative for E. coli O157:H7. On June 29, 2012, the Government of New Brunswick issued a press release saying that a case control study involving 18 ill persons and 37 non-ill persons linked illness to consumption of romaine lettuce. The strain found in ill persons in this outbreak was also isolated in persons in Quebec and in at least 9 people California. Most of the California victims ate at a “single unnamed restaurant” according to California public health officials.

In October 2011, an outbreak of E. coli O157:H7 which sickened 58, was first identified in the region around Saint Louis, Missouri. Cases were found in Saint Louis, Jefferson, Saint Charles, and Saint Clair counties and in the city of Saint Louis. The cases ranged in age from 1 to 94. At least six persons were hospitalized. Many of the cases had eaten items from salad bars prior to becoming ill. On October 28, Illinois state health officials revealed that they were investigating an illness that might be linked to the outbreak in Missouri. The link was not described. On October 31, health department officials acknowledged that Schnucks salad bars were a focus of the investigation, however other sources had not been excluded. Cases were identified in Minnesota and Missouri that were linked to college campuses. Additional cases were found in other states; the exposure location in these states was not described. Traceback analysis determined that a common lot of romaine lettuce, from a single farm, was used to supply the Schnucks’ grocery stores and the college campuses. The lettuce was sold to Vaughn Foods, a distributor, that supplied lettuce to the university campus in Missouri, but records were not sufficient to confirm that this lot was sent to this university campus. Preliminary findings of investigation at farm did not identify the source of the contamination.

In May 2010, Cases of a genetically-identical strain of E. coli O145 which sickened 33 were identified in the states of Michigan, Ohio, Tennessee, Pennsylvania, and New York. Illness onsets occurred between April 10 and 26. Several of the cases were students at Ohio State University, the University of Michigan, and Daemen College (Buffalo, New York). Several of the ill in Ann Arbor, Michigan, had eaten at a common restaurant. At least four students in the Wappinger Central School District, in New York State, were also involved in the outbreak. Shredded lettuce served in the school district tested positive for E. coli bacteria. Romaine lettuce was named as the vehicle for this outbreak, on May 6, after the same strain of E. coli O145 was found in a Freshway Foods romaine lettuce sample in New York state. Freshway Foods issued a voluntary recall of various bagged lettuces. The traceback investigation suggested that the source of the lettuce was a farm in Yuma, Arizona. In Ohio, a second, independent strain, of pathogenic E. coli was isolated from Freshway Foods bagged, shredded, romaine lettuce, E. coli O143:H34. This strain was not linked to any known food-borne illness. The isolation of the second strain of E. coli led to an additional recall of lettuce. Andrew Smith Company, of California, launched a recall of lettuce sold to Vaughan Foods and to an unidentified third firm in Massachusetts. Vaughan Foods of Moore, Oklahoma, received romaine lettuce harvested from the same farm in Yuma, Arizona; the romaine lettuce had been distributed to restaurants and food service facilities.

In September, 2009, a cluster of 29 patients who had been infected with an indistinguishable strain of E. coli O157:H7 was identified. Initially case-patients were identified in Colorado, Utah, and New York State. Additional case-patients were identified subsequently in South Dakota, Wisconsin, and North Carolina. The Colorado case-patients had all eaten at the same Chipotle Restaurant in Boulder, Colorado, on September 4, 2009. In Utah, all case-patients had eaten at the Cafe Rio Restaurant located in Salt Lake City, Utah, between August 31 and September 4, 2009. The New York State case patient had eaten at a Chipotle Restaurant. A case control study involving Utah and Colorado case-patients was conducted; it showed that eating romaine, or iceberg, lettuce was associated with risk of illness. The New York State case-patient had eaten romaine lettuce at the Chipotle Restaurant. A traceback of the romaine lettuce led to a common harvester/shipper, Church Brothers, LLC, located in Salinas, California. No lettuce remained for testing and environmental samples collected at Church Brothers, LLC, did not show the presence of E. coli O157:H7. Investigation of the cases in South Dakota, Wisconsin, and North Carolina did not provide useful information for the trace-back investigation. Lettuce was the most likely vehicle for this outbreak because of the common lettuce source for the cases in Utah, Colorado, and New York State. These cases represented 16 out of the 19 confirmed cases. Although Cotija cheese, pinto beans, and pico de gallo consumption were also associated with illness, it was likely that these results reflected confounding as lettuce is usually served with these ingredients in Mexican style restaurants. Cotija cheese was not used in the Colorado and New York Chipotle Restaurants. A common source of cilantro, the most suspect ingredient in pico de gallo, was not identified for Cafe Rio or for the Chipotle Restaurants.

In September 2009, public health officials in Colorado, Minnesota, North Carolina, Iowa, Connecticut, and Missouri identified a cluster of 10 patients with an indistinguishable strain of E. coli O157. The cluster was assigned 0910MLEXH-1. Two Colorado cases ate at Giacomos, a restaurant located in Pueblo, Colorado on the same date, September 6. Cases in Minnesota and Iowa ate at the same restaurant in Omaha, Nebraska. The suspected source of the outbreak was romaine lettuce.

In October 2008, an outbreak of E. coli O157:H7 which sickened 12 was associated with eating at M.T. Bellies Restaurant, Welland, Ontario, Canada. This was one of four, concurrent, restaurant-associated, outbreaks of E. coli O157:H7 that occurred in Ontario, Canada. Romaine lettuce was the suspected outbreak vehicle in this outbreak.

In October 2008, Johnathan’s Family Restaurant in Burlington, Ontario, Canada, was implicated in an outbreak of E. coli O157:H7 which sickened 43 involving romaine lettuce. This outbreak was one of four, concurrent, restaurant-associated outbreaks in Ontario, Canada. The E. coli O157:H7 strain was said to be different from the strain of E. coli O157:H7 outbreak associated with the Harvey’s Restaurant (235 sick) in North Bay, Ontario, the largest of the four outbreaks. The E. coli O157:H7 strain from Johnathan’s was said to be the same as the strain implicated in the restaurant outbreaks occurring at Little Red Rooster (21 sick) and M.T. Bellies Restaurants (12 sick).

In September 2005, genetic fingerprinting test results for an E. coli O157:H7 isolate were posted by the state of Minnesota on the national PulseNet website. Later the state of Minnesota received additional reports of illness among persons who were found to carry the same strain of E. coli O157:H7 bacteria. Epidemiologists, through food histories and a case control study, identified pre-packaged, bag lettuce, produced by the Dole Food Company, Inc., as the likely vehicle of transmission. E. coli O157:H7 was subsequently found in bagged lettuce samples and a public health alert and a FDA recall about the product was issued. Oregon and Wisconsin also found case-patients who had eaten the lettuce. The total number of sickened was 32.

In July 2002, an outbreak of E. coli O157:H7 which sickened 78 occurred among attendees of a dance camp held between July 11-14 on the campus of Eastern Washington University. The camp was for middle and high school girls. Attendees were from Washington, Montana, and Minnesota. Some of the ill girls attended a church camp in Spokane at the conclusion of the dance camp. Secondary cases were subsequently reported at the church camp and also in the girls’ home communities. The cases shared a Pulsed Field Gel Electrophoresis (PFGE), genetic fingerprint, pattern. Case-control study results strongly showed that the Caesar salad, made with Romaine lettuce and served during the July 11 dinner meal and the July 12 lunch, was associated with illness.

Health officials are investigating a series of recent illnesses from a dangerous strain of E. coli bacteria that may be linked to romaine lettuce.  Five people in the U.S. have been hospitalized and one has died, according to the Centers for Disease Control and Prevention (CDC).  There has also been one death reported in Canada.

Food safety experts at Consumer Reports are advising that consumers stop eating romaine lettuce until the cause of the outbreak is identified and that product is removed from store shelves.

Over the past seven weeks, 58 people in the U.S. and Canada have become ill from the strain of E. coli (0157:H7). In the U.S., the infections have occurred in 13 states — California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington state.

Canadian health authorities identified romaine lettuce as the source of the outbreak in Canada, and are advising people in the country’s eastern provinces to consider eating other types of salad greens until further notice. In the U.S., government health officials are investigating the outbreaks, but have stopped short of recommending people avoid romaine lettuce or any other food.

From Business Insider:

A deep knowledge of thousands of food poisoning cases across the US has scared Bill Marler off of certain foods.

With more than two decades working as a food poisoning advocate and attorney, there are simply some things that Marler has cut out of his diet. Marler has won more than $600 million for clients in foodborne-illness cases — and become convinced that some foods aren’t worth the risk.

In an article by Health Insider from BottomLine and in conversations with Business Insider, Marler has identified certain foods that he avoids — and that others should be wary of as well.

Here are the foods that this expert says scare him the most:

Marler told Business Insider that the idea he would have to warn people against drinking unfiltered, untreated water didn’t cross his mind until recently.

“Almost everything conceivable that can make you sick can be found in water,” Marler says.

Unfiltered, untreated water — even from the cleanest streams — can contain animal feces, spreading Giardia, which has symptoms such as vomiting and diarrhea and results in roughly 4,600 hospitalizations a year. Hepatitis A, which resulted in 20 deaths in a California outbreak in 2017, can be spread through water if it isn’t treated. E. coli and cholera can also be transmitted via untreated water.

Uncooked flour is on the other end of the spectrum — something that most people see as harmless, but that can actually spread bacteria, Marler says.

From late 2015 to 2016, 56 people in 24 states developed an E. coli infection from eating raw or uncooked flour, Consumer Reports reported. 

Most people think that raw eggs are the biggest food poisoning threat in cookie dough, Marler says. However, flour can also be a culprit — and you don’t even have to eat it. Simply not washing your hands after getting uncooked flour on them can spread E. coli.

Marler says that he has seen more foodborne illnesses linked to shellfish in the past five years than in the two preceding decades.

The culprit: warming waters. As global waters heat up, they produce microbial growth, which ends up in the raw oysters consumers are slurping down.

Marler says that he avoids these “like the plague.” Convenience may be nice, but, as more people handling and processing the food means more chances for contamination, it isn’t worth the risk.

For example, a study from Consumer Reports found unacceptable levels of bacteria that commonly cause food poisoning in about a third of the 208 salad bags that were tested. As Business Insider’s Rebecca Harrington notes, that doesn’t mean these bacteria would cause illness; just that they had the potential to do so.

Sprout outbreaks are surprisingly common, with more than 30 bacterial outbreaks — primarily salmonella and E. coli — in the past two decades.

“There have been too many outbreaks to not pay attention to the risk of sprout contamination,” Marler says. “Those are products that I just don’t eat at all.”

Marler agrees with known-germaphobe President Trump on at least one thing: well-cooked meat is the way to go.

According to the expert, meat needs to be cooked to 160 degrees throughout to kill bacteria that could cause E. coli or salmonella.

For anyone who remembers the salmonella epidemic of the 1980s and early ’90s, this is a no-brainer. According to Marler, the chance of getting food poisoning from raw eggs is much lower today than it was 20 years ago, but he still isn’t taking any chances.

A precursor to the raw water trend is the movement encouraging people to drink “raw” milk and juices, arguing that pasteurization depletes nutritional value.

Marler says that pasteurization is not dangerous — but raw beverages can be, as skipping the safety step means an increased risk of contamination by bacteria, viruses, and parasites.

“There’s no benefit big enough to take away the risk of drinking products that can be made safe by pasteurization,” he says.

Our plan is to ask nicely for the records in this case so the FDA can see the benefit or transparency.  If the FDA refuses to respond by disclosing the information, we will ask a Court to decide if the public has a right to know.  FSIS has done this on recalls of beef, pork and poultry for over a decade and the world did not stop spinning.

 

January 3, 2018

Food and Drug Administration

Division of Freedom of Information

Office of the Executive Secretariat, OC

5630 Fishers Lane, Room 1035

Rockville, MD 20857

 

 

REQUEST FOR PUBLIC RECORDS

Outbreak of E. coli, January-March 2017

                        I.M Healthy SoyNut Butter, I.M Healthy Granola, Dixie Diner’s Club Carb Not Beanit Butter, and 20/20 Life Styles Yogurt Peanut Crunch Bars

                       

To Whom It May Concern:

I am writing to request copies of public records on file at the Food and Drug Administration (FDA) regarding the names and locations of all retailers known by the FDA to have received shipments of I.M. Healthy SoyNut Butter, I.M. Healthy Granola, Dixie Diner’s Club Brand Carb Not Beanit Butter, and 20/20 Life Styles Yogurt Peanut Crunch bars that have been recalled due to potential contamination with E. coli.

On March 3, 2017, The SoyNut Butter Company voluntarily recalled its I.M. Healthy Original Creamy SoyNut Butter with Best By dates of August 30, 2018 and August 31, 2018. On March 4, 2017, The SoyNut Butter Company expanded the recall of its I.M. Healthy Original Creamy SoyNut Butter to include product packaged in 15oz. plastic jars with Best By dates of July 05, 2018, August 30, 2018, and August 31, 2018; individual portion cups with a Best By date of August 08, 2018; and 4lb. plastic tubs with Best By dates of November 16, 2018 and July 25, 2018.

On March 7, 2017, The SoyNut Butter Company recalled all lots of I.M. Healthy SoyNut Butter and I.M. Healthy Granola. I.M. Healthy SoyNut Butter is packaged in 15 oz. plastic jars, individual portion cups, 4 lb. plastic tubs or 45 lb. pails. The products are available in Original Creamy, Chunky, Honey Creamy, Unsweetened and Chocolate. I.M Healthy Granola is packaged in individual serving packages, 12 oz. bags, 50 oz. bags, and 25 lb. bulk bag. I.M. Healthy Granola is available in Original, Apple, Blueberry, with Raisin, and Cranberry.

On March 10, 2017, The SoyNut Butter Company expanded its recall to include all best buy dates of Dixie Diner’s Club brand Carb Not Beanit Butter. The recalled product was only available for purchase via mail order or online portals.

On March 24, 2017, Pro Sports Club recalled 20/20 Life Styles Yogurt Peanut Crunch bars because they were made with soy nut butter supplied by The SoyNut Butter Company.

Despite the recall of these products, Amazon was still selling I.M. Healthy SoyNut Butter as of September 5, 2017, a Lucky’s Market in Redwood City, California was still selling I.M. Healthy SoyNut Butter as of September 26, 2017, and Shop.com was still selling I.M. Healthy SoyNut Butter as of October 12, 2017.

We are willing to pay all costs associated with providing the requested records.  If you require pre-payment, please contact me and I will arrange for it to be made. Responsive documents can be sent via email, facsimile (206-346-1898) or by U.S. Mail.  If you choose to mail documents please send them to my attention at the following address.

 Marler Clark Law Firm

1012 First Avenue, Fifth Floor

Seattle, WA 98104-1008

If you have any questions about my request or need further information, please contact me.  Thank you in advance for your prompt reply.

 

 

Very truly yours

Katrina Deardorff, MPH

Epidemiologist

I talked to Kate Taylor at Business Insider about “Raw Water” yesterday:

When food-safety expert Bill Marler saw The New York Times’ trend pieceon Silicon Valley’s recent obsession with raw water, he thought he was reading a headline from The Onion.

According to The Times, demand for unfiltered water is skyrocketing as tech-industry insiders develop a taste for water that hasn’t been treated, to prevent the spread of bacteria or other contaminants.

In San Francisco, “unfiltered, untreated, unsterilized spring water” is selling for as much as $60.99 for a 2.5 gallon jug. Startups dedicated to untreated water are popping up. People — including startup Juicero’s cofounder Doug Evans — are gathering gallons of untreated water from natural springs to bring to Burning Man.

Tourmaline Spring sells an untreated water as “sacred, living water.” 

While Evans and other fans say raw water is perfect for those who are “extreme about health,” Marler — a food-safety advocate and a lawyer — says the opposite is true.

“Almost everything conceivable that can make you sick can be found in water,” Marler told Business Insider.

Unfiltered, untreated water, even from the cleanest streams, can contain animal feces, spreading Giardia, which has symptoms such as vomiting and diarrhea and results in roughly 4,600 hospitalizations a year. Hepatitis A, which resulted in 20 deaths in a California outbreak in 2017, can be spread through water if it isn’t treated. E. coli, and cholera can also be transmitted via untreated water.

Because filtered, treated water has become the norm, Marler says, most people don’t realize how dangerous s0-called raw water can be.

“The diseases that killed our great-grandparents were completely forgotten about,” he said.

Most Americans don’t personally know anyone who died of Hepatitis A or cholera, thanks to advances in technology and more stringent safety standards. As a result, they had a hard time realizing the risks involved in consuming untreated water.

“It’s fine till some 10-year-old girl dies a horrible death from cholera in Montecito, California,” Marler said.

On January 2, Business Insider’s Melia Robinson visited a San Francisco supermarket where a small company called Live Water sells its untreated water. Rainbow Grocery was sold out of the Fountain of Truth Spring Water from Live Water, but a sign indicated a “slight price increase.”

The cost of a 2.5 gallon jug increased from $36.99 to $60.99 since The Times’ article published. While the price includes the glass container, a refill costs only $14.99, according to The Times.

According to Marler, the raw-water trend is similar to people’s obsession with raw milk or opposition to vaccines. While they lack scientific evidence, they’re convinced that they are correct, in part because they have failed to see the repercussions of life without scientific advances.

“You can’t stop consenting adults from being stupid,” Marler said. “But we should at least try.”

Thanks to Canada for telling US about what’s happening in the US

According to Alex McKeen of the Star, the Center for Disease Control is reporting 17 cases of E. coli infection across 13 American states, dating as early as Nov. 15, 2017.

While the cases extend coast-to-coast, from California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington, the bulk of the U.S. instances of the infection were in the northeast part of the country.

Of the 17 U.S. cases, five people have been hospitalized, one of whom has died. Two have developed hemolytic uremic syndrome, a type of kidney failure, which Canada’s public health authority calls a rare life-threatening symptom of E. coli infection.

The Center for Disease Control has not yet determined whether the people sick with E. coli infection in that country have a type of food in common, but Canada has linked the cases in this country to romaine lettuce.

There are 40 sick in Canada with 1 death in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador.

With a Hepatitis A outbreak boiling in southeast Michigan for the last year, one would think common sense would dictate vaccinating employees and protecting your customers?

Monroe County Health Department (MCHD) has confirmed a second case of Hepatitis A in an individual who works at a local restaurant. MCHD is providing information to alert residents and guests to the possible exposure and to recommend prompt Hepatitis A vaccination or Immune Globulin (IG) treatment to potentially exposed individuals.

The diagnosed individual works at Tim Hortons Restaurant located at 404 S. Monroe Street in Monroe. Anyone who consumed food and/or drink from the restaurant between December 10, 2017 and December 28, 2017 may have been exposed.

MCHD is working with the restaurant to vaccinate all employees, determine if there are any additional cases and to eliminate any additional risk of exposure. Concerned individuals are urged to contact MCHD or their health care provider with questions.

Anyone who has consumed food and/or drink at Tim Hortons from December 10th to December 28th, should monitor for symptoms of Hepatitis A which include fatigue, poor appetite, stomach pain or tenderness, nausea or vomiting, dark urine, and yellowing of the skin (jaundice). Most children less than 6 years of age do not experience symptoms. Symptoms typically appear 2 to 6 weeks after exposure. Individuals with symptoms should call their health care provider and seek medical care.

Earlier, The Department extended the free Hepatitis A walk-in clinic, through the week of December 18 through the 22 where at least 1,800 people were vaccinated after the first employee with hepatitis A was announced. The clinic was for anyone who consumed food and/or drink between November 21 and December 8 from the same Tim Horton’s location.

Hepatitis A vaccine or Immune Globulin (IG) treatment may provide protection against the disease if given within two weeks of exposure. Anyone potentially exposed to Hepatitis A should contact their healthcare provider to be assessed for vaccination or IG treatment. Hepatitis A vaccine is available from health care providers, pharmacies and at MCHD. People who have had Hepatitis A disease or have previously received two doses of the hepatitis A vaccine do not need to be vaccinated.

Hepatitis A is caused by the Hepatitis A virus, and it can cause damage to the liver and cause other health problems.

The most effective method to prevent Hepatitis A is to get vaccinated. The Hepatitis A vaccine is now routinely recommended for children at 1 year of age. Most adults, however, may not be vaccinated, unless they did so for travel or other risk factors.

The Hepatitis A virus is most commonly spread from person-to-person by the fecal-oral route. Most infections result from contact with an infected household member or sex partners. Sometimes, infection results from food or drink that is contaminated with the virus. It is not spread through coughing or sneezing. Anyone who has Hepatitis A can spread the virus to others for 1-2 weeks prior to symptoms appearing.

Frequent hand-washing with soap and warm water after using the restroom and before handling food can help prevent the spread of Hepatitis A. Thoroughly preparing foods can also help prevent infection. Freezing food does not kill the virus.

Outbreak in Southeast Michigan From August 2016 to December 20, 2017 there have been 630 cases of Hepatitis A diagnosed in Southeast Michigan. Monroe County has 14 confirmed cases of Hepatitis A.

Affected states include California, Connecticut, Illinois, Indiana, Michigan, Nebraska, New Hampshire, New York, Ohio, Pennsylvania, Virginia, Vermont, and Washington.  Link to recent Canadian Outbreak.

Federal and state health officials are investigating a multistate Escherichia coli O157:H7 outbreak that has sickened 17 people in 13 states, and preliminary tests by the US Centers for Disease Control and Prevention (CDC) show that the outbreak strain is closely related to one in Canada that has been associated with romaine lettuce.

The CDC said illness onsets range from Nov 15 through Dec 8, according to a press release today sent to journalists.

State and local authorities are interviewing sick people to see what they ate in the week before they became ill. Because a source of the US infections hasn’t been identified, the CDC said it is unable to recommend if US residents should avoid a particular food. “This investigation is ongoing, and more information will be released as it becomes available,” it said.

The Public Health Agency of Canada (PHAC) issued its first announcement about an E coli outbreak linked to romaine lettuce on Dec 11. In a Dec 21 update, it said it is so far investigating 41 cases from five provinces: Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador. There was one reported death. It urged the public to avoid eating romaine lettuce until more is known about the contamination.