Yesterday, the CDC, public health and regulatory officials in several states, and the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS) announced a multistate outbreak of Salmonella Enteritidis infections linked to raw frozen breaded stuffed chicken products. As of June 2, 2021, a total of 17 people infected with the outbreak strain of Salmonella Enteritidis have been reported from 6 states. Illnesses started on dates ranging from February 21, 2021 to May 7, 2021.

Sounds a bit familiar?  Why does the USDA-FSIS ignore this risky product?

2018 Multistate Outbreak of Salmonella Enteritidis Infections Linked to Frozen Breaded Chicken Products Distributed Ruby’s Pantry Pop-Up Locations

States:  Minnesota, Wisconsin

Cases:  13

Hospitalizations:  8

Deaths:  0

REFS:

2018_Rubys_MN_DOH_June_1,_2018.pdf (outbreakdatabase.com)

2018_Rubys_WI_DHS_June_1,_2018.pdf (outbreakdatabase.com)

2015 Outbreak of Salmonella Enteritidis Infections Linked to Raw, Frozen Chicken Entrees Produced by Aspen Foods

States:  Minnesota

Cases:  5

Hospitalizations:  2

Deaths:  0

REF:

2015_Aspen_Foods_CDC_Final_Update,_Oct._16,_2015_.pdf (outbreakdatabase.com)

2015 Multistate Outbreak of Salmonella Enteritidis Infections Linked to Barber Foods Chicken Kiev

States:  Connecticut, Illinois, Minnesota, New Hampshire, New York, Oklahoma, Wisconsin

Cases:  15

Hospitalizations:  4

Deaths:  0

REF: 2015_Barber_Foods,_CDC_FInal_Update_Oct._16,_2015_.pdf (outbreakdatabase.com)

2014 Outbreak of Salmonella Enteritidis Infections Linked to Antioch Farms “A La Live” Stuffed Chicken Breast

State:  Minnesota

Cases:  8

Hospitalizations:  1

Deaths:  0

REF:

2014_Antioch_Farms_MDA_announcement.pdf (outbreakdatabase.com)

2014_Antioch_Farms,_MDH.pdf (outbreakdatabase.com)

2012-2013 Multistate Outbreak of E. coli O121 Infections Linked to Farm Rich Brand Frozen Mini Meals and Snack Items

States:  Alabama, Arkansas, California, Colorado, Florida, Illinois, Indiana, Michigan, Missouri, Mississippi, New York, Ohio, Pennsylvania, South Dakota, Texas, Utah, Virginia, Washington, Wisconsin

Cases:  19

Hospitalizations:  9

Deaths:  0

REF:  Farm_Rich_Outbreak-CDC_Final_Summary.pdf (outbreakdatabase.com)

2010 Multistate Outbreak of Salmonella Chester Infections Linked to Marie Callender’s Cheesy Chicken and Rice Frozen Entrees

States:  Alaska, California, Colorado, Georgia, Illinois, Kentucky, Massachusetts, Minnesota, Missouri, North Carolina, Oklahoma, Oregon, South Carolina, Tennessee, Texas, Utah, Virginia, Washington

Cases:  44

Hospitalizations:  16

Deaths:  0

REFS:  CDC – Multistate Outbreak of Human Salmonella Chester Infections – September 9, 2010 – Salmonella

2006 Outbreak of Salmonella Typhimurium Infections Linked to Cub Brand Frozen, Stuffed Chicken Entrees

State:  Minnesota

Cases:  3

Hospitalizations:  2

Deaths:  0

REF:  Journal of Food Protection, Vol. 71, No. 10, 2008, Pages 2153–2160

2005 Multistate Outbreak of Salmonella Enteritidis Infections Linked to Frozen, Stuffed Chicken Entrees Distributed by Serenade Foods and Aspen Foods

States:  Michigan, Minnesota

Cases:  27

Hospitalizations:  3

Deaths:  0

REF:  Journal of Food Protection, Vol. 71, No. 10, 2008, Pages 2153–2160

2005 Outbreak of Salmonella Heidelberg Infections Associated with Cub Brand Chicken Broccoli and Cheese Frozen Entrée

State: Minnesota

Cases:  4

Hospitalizations:  1

Deaths:  0

REF:  Journal of Food Protection, Vol. 71, No. 10, 2008, Pages 2153–2160

1998 Outbreak of Salmonella Typhimurium Infections Linked to Chicken Kiev

State:  Minnesota

Cases:  33

Hospitalizations:  3

Deaths:  0

REF:  Journal of Food Protection, Vol. 71, No. 10, 2008, Pages 2153–2160

INTERNATIONAL OUTBREAKS

1998 Outbreak of Salmonella Typhimurium Infections Linked to Chicken Nuggets, Australia

State:  South Australia

Cases:  10

Hospitalizations:  unk

Deaths:  unk

REF:  http://www.ncbi.nlm.nih.gov/pubmed/10330731

2003 Outbreak of Salmonella Heidelberg Infections Linked to Frozen Chicken Nuggets, Canada

Province:  British Columbia

Cases:  23

Hospitalizations:  10

Deaths:  0

REF:  MacDougall, L., M. Fyfe, L. McIntyre, A. Paccagnella, K. Cordner, A. Kerr, & J. Aramini, (2004). Frozen chicken nuggets and strips – a newly identified risk factor for Salmonella Heidelberg infection in British Columbia, Canada. Journal of Food Protection: 67 (6) 1111-1115.

When someone talks about having “the stomach flu,” they are probably describing acute-onset gastroenteritis caused by one of the noroviruses. 

The Centers for Disease Control and Prevention (CDC) estimates that noroviruses cause nearly 21 million cases of acute gastroenteritis annually, making noroviruses the leading cause of gastroenteritis in adults in the United States. Norovirus is highly contagious and transmitted by infected individuals at an enormous rate. According to CDC estimates, this translates into about 2,500 reported norovirus outbreaks in the United States each year. Norovirus outbreaks have been reported in many settings, including healthcare facilities, restaurants and catered events, schools, and childcare centers. Cruise ships account for a small percentage (1%) of reported norovirus outbreaks overall. Norovirus outbreaks occur throughout the year but are most common from November to April. The most common symptoms are sudden onset of vomiting and watery diarrhea, although stomach cramps and pain also often occur. Some people experience fever and body aches. Symptoms usually start 12 to 48 hours after being exposed and typically last about 1 to 3 days.

Remember, FSIS does not consider Salmonella to be an adulterant.

For a bit(e) of reading on the topic, see Seriously, FSIS and Congress, it is time to deem Salmonella an Adulterant

As part of the investigation, the Minnesota Department of Agriculture collected frozen, raw, breaded, stuffed chicken products from a retail store for testing. The raw product samples tested positive for the outbreak strain of SalmonellaEnteritidis. At this time, the production lots tested in Minnesota are not known to have been purchased by any of the case patients. FSIS has not received any purchase documentation, shopper records, or other traceable information at this time. Therefore, FSIS does not have the necessary information to request a recall. FSIS will continue to evaluate any new illness or traceable information as it becomes available. The investigation is ongoing, and FSIS continues to work with the CDC and state partners.

The U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) is issuing a public health alert due to concerns about illnesses caused by Salmonella Enteritidis that may be associated with frozen, raw, breaded and pre-browned, stuffed chicken products. These items may be labeled “chicken cordon bleu”, chicken with “broccoli and cheese”, or “chicken Kiev”. This public health alert is being issued to remind consumers about the proper handling and cooking of raw poultry products.

FSIS is investigating a Salmonella Enteritidis illness cluster with the Centers for Disease Control and Prevention (CDC) and state partners. FSIS suspects that there may be a link between the frozen, raw, breaded, and pre-browned stuffed chicken products and this illness cluster based on information gathered in conjunction with the CDC and state partners. Cases have been identified with illness onset dates ranging from February 21, 2021 to May 7, 2021.

The CDC reports:

As of June 2, 2021, a total of 17 people infected with the outbreak strain of Salmonella Enteritidis have been reported from 6 states. Illnesses started on dates ranging from February 21, 2021 to May 7, 2021.

Sick people range in age from 3 to 83 years, with a median age of 52 years, and 60% are female. Of 13 people with information available, 8 (62%) have been hospitalized; no deaths have been reported.

The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to determine if a sick person is part of an outbreak.

State and local public health officials are interviewing people about the foods they ate in the week before they got sick. Of the 12 people interviewed, 10 (83%) reported preparing and eating frozen breaded stuffed chicken products. People reported buying many different brands of raw frozen breaded stuffed chicken products from multiple stores. When asked about how the products were prepared at home, seven people reported undercooking, microwaving, or air frying the product.

The Minnesota Department of Agriculture collected for testing five raw frozen breaded stuffed chicken products from a grocery store where an ill person purchased these products. The outbreak strain was identified in two samples of Kirkwood’s Chicken Cordon Bleu.

The products of concern may appear to be ready-to-eat but are in fact raw and need to be fully cooked before consumption. Many of these stuffed chicken products were labeled with instructions identifying that the product was uncooked (raw). The labels also identified cooking instructions for preparation in an oven. Some of the patients reported that they did not follow the cooking instructions and reported microwaving the product, cooking it in an air fryer or cooking it in the oven for less than the recommended time and without using a meat thermometer to confirm the recommended temperature was achieved. Thus, FSIS advises all consumers that particular attention needs to be taken to safely prepare and cook these frozen, raw poultry products to a temperature of 165 F. The only way to confirm raw poultry products are cooked to a temperature high enough to kill harmful bacteria is to use a food thermometer that measures internal temperature, as indicated in this chart. Additionally, FSIS advises all consumers to keep raw poultry away from other food that will not be cooked. Use one cutting board for raw poultry and a separate one for fresh produce and cooked foods.

Consumption of food contaminated with Salmonella can cause salmonellosis, one of the most common bacterial foodborne illnesses. The most common symptoms of salmonellosis are diarrhea, abdominal cramps, and fever within 6 hours to 6 days after exposure to the organism. The illness usually lasts 4 to 7 days. Most people recover without treatment. In some persons, however, the diarrhea may be so severe that the patient needs to be hospitalized. Older adults, infants, and persons with weakened immune systems are more likely to develop a severe illness. Individuals concerned about an illness should contact their health care provider.

I felt another blog post coming on after reading Spectrum 1’s headline:

More vaccination clinics offered this week after possible Hepatitis A exposure at Fredonia restaurant

There will be two more Hepatitis A vaccination clinics in Chautauqua County this week after a potential exposure to the virus at a restaurant.

The Chautauqua County Health Department says anyone who ate at The Mustard Seed in Fredonia between April 1 and May 19 could have been exposed and should consider getting vaccinated.

There is a drive-up clinic Tuesday from 4:30-6:30 p.m. at the Cassadaga Valley Central School bus garage. Another will be held on Friday from 3-7 p.m. at SUNY Fredonia’s Steele Hall.

Doctors say most people don’t get sick when an employee at a restaurant has Hepatitis A, but there is still a risk. Symptoms include fever, loss of appetite and nausea.

It is important to note the vaccine is only effective within two weeks of exposure.

As I said before:

It is Irresponsible for Restaurants to not offer Hepatitis A Vaccines to Employees

Or, ignore the issue, sicken your customers and be assured, you will be sued.

A fact from the CDC: “Since the hepatitis A outbreaks were first identified in 2016, more than 39,000 cases, 24,000 hospitalizations, and 374 deaths as a result of hepatitis A virus (HAV) infection have been reported.”

True, some of the above have been the homeless or drug addicts, but how many of those work at restaurants?  Where exposed at restaurants? Note: 30% to 40% of the people impacted are NOT the homeless or drug addicts.

Hardly a day passes without a warning from a health department somewhere that an infected food handler is the source of yet another potential hepatitis A outbreak.

Absent vaccinations of food handlers, combined with an effective and rigorous hand-washing policy, there will continue to be more hepatitis A outbreaks. It is time for health departments across the country to require vaccinations of food-service workers, especially those who serve the very young and the elderly.

Hepatitis A is a communicable disease that spreads from person-to-person. It is spread almost exclusively through fecal-oral contact, generally from person-to-person, or via contaminated food or water. Hepatitis A is the only foodborne illness that is vaccine-preventable. According to the U.S. Centers for Disease Control and Prevention (CDC), since the inception of the vaccine, rates of infection have declined 92 percent.

CDC estimates that 83,000 cases of hepatitis A occur in the United States every year and that many of these cases are related to foodborne transmission. In 1999, more than 10,000 people were hospitalized due to hepatitis A infections, and 83 people died. In 2003, 650 people became sickened, four died, and nearly 10,000 people got IG (immunoglobulin) shots after eating at a Pennsylvania restaurant. Not only do customers get sick, but also businesses lose customers or some simply go out of business.

Although CDC has not yet called for mandatory vaccination of food-service workers, it has repeatedly pointed out that the consumption of worker-contaminated food is a major cause of foodborne illness in the U.S.

Hepatitis A continues to be one of the most frequently reported, vaccine-preventable diseases in the U.S., despite FDA approval of hepatitis A vaccine in 1995. Widespread vaccination of appropriate susceptible populations would substantially lower disease incidence and potentially eliminate indigenous transmission of hepatitis A infections. Vaccinations cost about $50. The major economic reason that these preventive shots have not been used is because of the high turnover rate of food-service employees. Eating out becomes a whole lot less of a gamble if all food-service workers faced the same requirement.

According to the CDC, the costs associated with hepatitis A are substantial. Between 11 percent and 22 percent of persons who have hepatitis A are hospitalized. Adults who become ill lose an average of 27 days of work. Health departments incur substantial costs in providing post-exposure prophylaxis to an average of 11 contacts per case. Average costs (direct and indirect) of hepatitis A range from $1,817 to $2,459 per case for adults and from $433 to $1,492 per case for children younger than 18. In 1989, the estimated annual direct and indirect costs of hepatitis A in the U.S. were more than $200 million, equivalent to more than $300 million in 1997 dollars.  A new CDC report shows that, in 2010, slightly more than 10 percent of people between the ages of 19 and 49 got a hepatitis A shot.

Vaccinating an employee make sense.  It is moral to protect customers from an illness that can cause serious illness and death. Vaccines also protect the business from the multi-million-dollar fallout that can come if people become ill or if thousands are forced to stand in line to be vaccinated to prevent a more serious problem.

Or, ignore the issue, sicken your customers and be assured, you will be sued.

I don’t watch Fox, I value my grey matter.

Someone sent me Tucker’s Friday segment “asking” about the CDC warning of the risks of poultry and Salmonella.

The Fox News host invited Tiara Soleim, a “poultry enthusiast” and former contestant on “The Bachelor,” onto his show Friday night to discuss her love for cuddling chickens and her distaste for the CDC.

Seriously, Tucker, Shut the Cluck up!

As of May 20, 2021, a total of 163 people infected with one of the outbreak strains have been reported from 43 states. Illnesses started on dates ranging from February 12, 2021, to April 25, 2021.

Sick people range in age from less than 1 to 87 years, with a median age of 24 years, and 58% are female. Of 109 people with information available, 34 (31%) have been hospitalized. No deaths have been reported.

The true number of sick people in an outbreak is likely much higher than the number reported, and the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for Salmonella. In addition, recent illnesses may not yet be reported as it usually takes 2 to 4 weeks to determine if a sick person is part of an outbreak.

State and local public health officials are interviewing people about the animals they came into contact with in the week before they got sick. Of the 92 people interviewed, 81 (88%) reported contact with backyard poultry before getting sick.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. CDC PulseNet manages a national database of DNA fingerprints of bacteria that cause gastrointestinal illnesses. DNA fingerprinting is performed on bacteria using a method called whole genome sequencing (WGS). WGS showed that bacteria from sick people’s samples are closely related genetically. This means that people in this outbreak likely got sick from the same type of animal.

On April 15, public health officials in Ohio collected samples from a sick person’s ducklings for testing. WGS showed that the bacteria, Salmonella serotype Hadar, in duckling poop are closely related to bacteria from sick people. This means that people likely got sick from contact with backyard poultry.

Salmonella:  Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of Salmonella outbreaks. The Salmonella lawyers of Marler Clark have represented thousands of victims of Salmonella and other foodborne illness outbreaks and have recovered over $800 million for clients.  Marler Clark is the only law firm in the nation with a practice focused exclusively on foodborne illness litigation.  Our Salmonella lawyers have litigated Salmonella cases stemming from outbreaks traced to a variety of foods, such as cantaloupe, tomatoes, ground turkey, salami, sprouts, cereal, peanut butter, and food served in restaurants.  The law firm has brought Salmonella lawsuits against such companies as Cargill, ConAgra, Peanut Corporation of America, Sheetz, Taco Bell, Subway and Wal-Mart.

If you or a family member became ill with a Salmonella infection, including Reactive Arthritis or Irritable bowel syndrome (IBS), after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark Salmonellaattorneys for a free case evaluation.

Last night Food Safety News reported that the Arizona Department of Health was reporting a “secondary E. coli case,” linked to Pure Eire Dairy that has thus far sickened over a dozen – mainly children – some with acute kidney failure.

“We have a case of E. coli O157 in a 2-year-old girl that matches by whole genome sequencing the cluster of cases in Washington linked to Pure Eire yogurt. It’s likely she was exposed by a relative (who consumed the product) who traveled from Washington state,” Steve Elliott of the department told Food Safety News.

Outbreaks of foodborne illness nearly always involve both primary and secondary cases, meaning that secondary cases are neither unusual nor rare.  More importantly, a secondary case is, by definition, part of an outbreak.  To an epidemiologist, the person who defines the outbreak, what is definitive is whether a person is infected with the outbreak strain.  Person-to-person transmission of infectious bacteria within a family is well-documented.  See, e.g., K. Ludwig, “Outbreak of Escherichia coli O157:H7 Infection in a Large Family,” Eur. J. Clin. Microb. Infect. Dis. 16:238-41 (1997).  P. Rowe, “Diarrhea in Close Contacts as a Risk Factor for Childhood Hemolytic Uremic Syndrome,” Epidem. Infect. 110:9-16 (1993).

Court’s have previously recognized that food manufacturers are liable to those who are injured through “secondary” exposure in foodborne illness outbreaks.  Almquist v. Finley Sch. Dist. No. 53, 114 Wn. App. 395, 57 P.3d 1191 (2002).

Pure Eire Dairy is as responsible for the kidney failure this Arizona two-year-old suffered as it would be to a child that ate the product directly – there is no “break in the chain.”

Food Safety News report that more patients are being identified by investigators working on an E. coli O157 outbreak that has been limited to Washington State. However, today Arizona officials confirmed there is a child in that state with an infection from the same strain of the pathogen.

There are 11 confirmed patients in Washington in the outbreak linked to locally produced organic yogurt sold by Pure Eire Dairy. Another three probable patients are from the Moses Lake area in Grant County, WA. Teresa McCallion of the Washington Department of Health said it is not unusual for counties and local health departments to know of probable cases before they are added to the state’s tally.

“We only report confirmed cases,” McCallion told Food Safety Newson Wednesday evening. The Washington Health Department is working on a special outbreak information web page, which McCallion said should be available soon.

Officials with the Grant County, WA, health department were not available for comment Wednesday afternoon.

In Arizona, health officials are working to confirm a suspected link between a patient there and the Washington outbreak.

“We have a case of E. coli O157 in a 2-year-old girl that matches by whole genome sequencing the cluster of cases in Washington linked to Pure Eire yogurt. It’s likely she was exposed by a relative who traveled from Washington state,” Steve Elliott of the department told Food Safety News.

In Washington, investigators from the state Department of Agriculture have collected 27 product samples of various types and 40 environmental samples, according to a department spokesman. Results of those tests are expected in the coming days.

“We are still working on assessing the yogurt production process and reviewing records as part of the investigation,” the spokesman told Food Safety News.

The dairy has shut down production of all of its products, which include unpasteurized, raw milk.

Washington State officials report that the 11 confirmed cases include six children younger than 10 years old. Seven people have been so sick they had to be admitted to hospitals. Three people have developed hemolytic uremic syndrome (HUS), a serious complication that can lead to complete kidney failure and sometimes death. The sick people are spread across four counties.

Pure Eire Dairy recalled all of its organic PCC brand yogurt Friday, May 14, after outbreak patients reported eating it before becoming sick. All flavors and best-by dates of the 8-ounce and 16-ounce yogurt sold under the PCC brand has been recalled.

Barton Complaint

Johnson Complaint DV

This week at least two lawsuits will be filed by parents of three children impacted by E. coli O157:H7-tainted PCC yogurt produced by Pure Eire Dairy.  Two of the children suffered hemolytic uremic syndrome (HUS), a potentially life threatening complication.

The Washington State Department of Health (DOH) has identified a likely link to PCC Community Market brand yogurt produced by Pure Eire Dairy as the source of the current in E. coli O157:H7 outbreak.

The outbreak now includes 11 confirmed cases, including six children under the age of 10, infected with bacteria that have been genetically linked. Counties with cases include Benton (1), King (8), Snohomish (1) and Walla Walla (1). Seven people have been hospitalized. Three people have developed hemolytic uremic syndrome, a serious complication of E. coliinfection.

Anyone who has PCC Community Market brand yogurt at home should not eat it and should throw it away. Pure Eire Dairy is working with the state Department of Agriculture to identify and recall all affected products.

“The fact that Eire Dairy is a small, local dairy, and its Jersey Cows are ‘Certified Organic, Non-GMO Project Verified, Animal Welfare Approved, Completely Grass-fed, and free of the A1 Beta Casein,’ is all well and good, but it is not a substitute for food safety,” said William D. Marler, counsel for the three children. “These parents thought by purchasing this product at PCC they were doing something right for their kids, they never imagined that it would contain a pathogen, like E. coli O157, that would nearly kill their children,” added Marler.

E. coli: Marler Clark, The Food Safety Law Firm, is the nation’s leading law firm representing victims of E. coli outbreaks and hemolytic uremic syndrome (HUS). The E. coli lawyers of Marler Clark have represented thousands of victims of E. coli and other foodborne illness infections and have recovered over $800 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 lawyers have litigated E. coli 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. coli lawsuits against such companies as Jack in the Box, Dole, ConAgra, Cargill, and Jimmy John’s.  We have proudly represented such victims as Brianne Kiner, Stephanie Smith and Linda Rivera.

If you or a family member became ill with an E. coli infection or HUS after consuming food and you’re interested in pursuing a legal claim, contact the Marler Clark E. coli attorneys for a free case evaluation.

May 14, 2021

Out of an abundance of caution, Pure Éire Dairy has voluntarily recalled the following product due to the possible presence of E. coli O157:H7.

PCC ORGANIC GRASS-FED YOGURT
ALL 8-OZ & 16-OZ FLAVORS
Best By Dates: All

THE FOLLOWING PCC DELI ITEMS ALSO CONTAIN PCC ORGANIC GRASS-FED YOGURT:

• Yogurt (salad bar)
• Butter Chicken (hot bar and to-go casseroles)
• Spicy Yellow Curry Chicken (hot bar and to-go casseroles)
• Tzatziki Sauce (grain bowl bar, to-go spreads)
• Sticky Toffee Pudding (refrigerated desserts)