According to the Seattle & King County Department of Health, with a number of viral respiratory germs circulating right now, Public Health – Seattle & King County urges King County residents to take precautions if they are ill, but not to assume it is COVID-19.

Public Health is reporting 33 new COVID-19 cases today. The official case count total in King County is now 116. In addition, three new deaths are reported, bringing the total deaths to 20.

Statewide total illnesses are 162 with 22 deaths.

I have told my staff and lawyers to stay home if ill.  I added $2,500 into each persons account to buy essentials in case people need to stay at home for an extended period of time.  I was able to secure masks and gloves for everyone at Marler Clark if needed. Everyone has also been set up in their homes with the technology that they have at their desks in the office.  Finally, I have offered for those who take public transport to pay for parking if they need to come to the office.

Get prepared – and, wash your hands.

Here is the most current thinking from the Pacific Northwest:

COVID-19 is similar to the seasonal flu (influenza) in that:

  • Both cause fever, cough, body aches, fatigue; sometimes vomiting and diarrhea.
  • Both can be mild or severe — even fatal in rare cases
  • Both can result in pneumonia
  • Both can be spread from person to person through droplets in the air from an infected person (coughing, sneezing, or even just talking)
  • Flu can be spread by an infected person for several days BEFORE their symptoms appear, and COVID-19 is believed to be spread in the same manner, but we don’t yet know for sure .

But COVID-19 is different in that:

  • COVID-19 might additionally be spread through the airborne route (i.e., through ventilation ducts and if people are breathing the same air in close proximity to an infected person**). Research is still underway.
  • COVID-19 is caused by the novel 2019 coronavirus, now called severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2, whereas the seasonal flu is a combination/mutation of the different influenza viruses (it different each year)
  • The COVID-19 virus is very similar to SARS-CoV that spread in 2003, which is where most of our current understanding for COVID-19 is coming from.

Treatment is similar:

  • Neither virus is treatable with antibiotics, which only work on bacterial infections
  • Both may be treated by addressing symptoms, such as reducing fever
  • Severe cases may require hospitalization and support such as mechanical ventilation
  • Flu: Antiviral medications can address symptoms and sometimes shorten the duration of the illness
    COVID-19: Antiviral medications are currently being tested to see if they can address symptoms
  • Flu: A vaccine is available and effective to prevent some of the most dangerous types, or to reduce the severity, of the flu
    COVID-19: NO vaccine is available at this time, though it is in progress

Prevention:

  • Both flu and COVID-19 may be prevented by frequent, thorough hand washing (20 seconds), coughing and sneezing into the crook of your elbow, staying home when sick, and limiting contact with people who are infected (i.e., do your shopping outside of peak hours at the grocery store
  • Other tips: avoid crowded areas (public transport, malls, public events, grocery stores at peak hours, crowded gyms, other frequented establishments, etc.), frequently sanitize surfaces that come into contact with people’s hands often (door handles, tables, phones, keyboards, faucet knobs, etc.), wash hands when entering and leaving home/work/restaurants/bathrooms to limit spread, avoid touching your face (mouth, nose, and eyes) in general
  • If sick, stay home, limit contact with others (including pets), avoid coughing or sneezing onto people and things, clean surfaces often, and call a medical care provider about care and testing (do NOT go to the doctor or ER with mild symptoms unless you are in a high risk group)
  • Note: Older people and people with compromised immune systems are most at risk based on current knowledge, so protect them by staying away from them. Children are currently noted to have milder symptoms.

**NOTE ABOUT ‘CASUAL TRANSMISSION’ — I.E., COMMUNITY TRANSMISSION WITH NO KNOWN EXPOSURE TO AN INFECTED PERSON: 

  • As mentioned above, COVID-19 might be spread through the airborne route, meaning that tiny droplets remaining in the air could cause disease in others even after the ill person is no longer near.
  • There have been documented cases of asymptomatic transmission of COVID-19 up to 14 days before the onset of symptoms.
  • The use of masks and gloves is controversial.  The use of such personal protective equipment is helpful in specific situations, such as when caring for a person known to be infected. If you are interested having masks and/or gloves for personal use, please talk to Chris about the proper use and precautions to take when doing so.
  • Make sure you are not the one contaminating the environment with commonsense measures such as: using disinfecting wipes on shopping cart handles, touching railings and countertops others may  touch after you, opening doors with unclean, bare hands.

Here is what I sent my staff late last week:

All, see symptoms below – if you are sick, please stay home.

https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

I have asked Chris and Michelle to give me some ideas on recommendations on how to responsibly deal with this from a medical issue.  We will give you all our thoughts early next week.

All, please email to Leslie all your contact information and a close contact too.  Leslie, please share that with all.

All, please let me know if anyone needs any technology to work from home if necessary if this becomes a bigger problem.  Think about what you might need to work from home for an extended period of time.  What do you need to effectively do your job from home – computer, paper, pens, etc.?  COVID-19 is not an excuse to work from home, but I want to be prepared and sensible.

Also, let’s look at travel schedules over the coming months to see if there are alternatives.  Please shoot me your travel over the next 30-60 days.

All, take a hard look at your cases – what deadlines might be impacted by Court and other office closures, etc.  I want us to be proactive and think ahead.  I do not want deadlines missed.

Finally, not to be a “prepper,” but Kelli, please drop $2,500 (pre-tax) into everyone’s account on Monday to be used as they see fit to prepare for some disruptions.  I have not thought of exactly what those needs might be, but there are probably a few websites that have suggestions.

Here are some ideas for being prepared for home:

All medications (over the counter *ibuprofen* , allergy, cold etc and prescriptions )

All household products you will need for two weeks (toilet paper, soap, paper towels, laundry detergent, cleaning supplies, etc)

Supply of water for two weeks

Food for two weeks

         ⁃        Chicken broth

         ⁃        Beans

         ⁃        Onions

         ⁃        Garlic

         ⁃        Potatoes – sweet, Yukon, etc

         ⁃        Pasta

         ⁃        Canned tomatoes

         ⁃        Steel cut oats

         ⁃        Peanut butter

         ⁃        Bread *freezer*

         ⁃        Eggs

         ⁃        Frozen meat

         ⁃        Canned fish

         ⁃        Jerky or dried meat

         ⁃        Dried nuts and fruit

         ⁃        Popcorn

         ⁃        Chocolate

         ⁃        Wine/booze of choice

As of February 25, 2020, 14 people infected with the outbreak strain of E. coli O103 have been reported from five states.

Illnesses started on dates ranging from January 6, 2020, to February 11, 2020. Ill people range in age from 1 to 79 years, with a median age of 28. Sixty-two percent of ill people are male. No hospitalizations and 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 3 to 4 weeks. Please see the Timeline for Reporting Cases of E. coli Infection for more details.

Epidemiologic evidence indicates that sprouts from Jimmy John’s restaurants are a likely source of this outbreak.

State and local public health officials are interviewing ill people to determine what they ate and other exposures in the week before their illness started. Five of six people (83%) interviewed reported eating at a Jimmy John’s restaurant. Of the six people interviewed, four (67%) remembered eating sprouts on a sandwich from Jimmy John’s.

Jimmy John’s LLC reported that all of its restaurants stopped serving clover sprouts on February 24, 2020. Investigators are working to trace the source of the clover sprouts served at the Jimmy John’s restaurants where sick people ate, and to determine whether other restaurants or retailers received the same clover sprouts.

Restaurants, PLEASE vaccinate your employees.

According to New York press reports, the Oneida County Health Department as well as Rome Memorial Hospital are partnering to provide Hepatitis A. vaccinations to those who think they were exposed.

This comes after the health department announced that an employee at Cianfroccos in Rome tested positive for Hepatitis A. Management at the restaurant has urged that the health department has checked the property and their customers have nothing to be worried about.

But health officials aren’t taking any chances, so far this weekend, over 130 people have participated in the vaccinations.

Hospital officials want to stress that there has been no outbreak of the virus. But encourage anyone who thinks they may have been exposed during a certain period of time, to take advantage of the vaccination.

The window of exposure that we have identified seems to be between February 12th and 23rd.

Vaccines will be available at the E. Chestnut Commons from 8 am to 4 pm on Sunday, March 1st.

In Missouri, health officials in Joplin confirm a case of Hepatitis A at Chili’s on Range Line. The department was first notified of the Hepatitis A case on Tuesday by a local hospital. That notification was made per state regulations not only for tracking purposes, but because it was at a restaurant.

Health officials say a work restriction was placed on Chili’s employees who may have had contact with the person involved. “To lift the restriction the employee has to provide proof of prior Hepatitis A vaccination, they have to get a hepatitis a vaccination now and not be ill currently.”

Chili’s parent company, Brinker International sent a statement saying quote:

“After learning one of our team members was affected, we immediately excluded this individual from work and partnered with the Joplin Department of Health to prevent the potential spread by proactively offering vaccinations to all of our team members.”

From the FDA:

Although you stated that corrective actions were implemented following the 2019 and 2012 outbreaks, you have not provided FDA with any information demonstrating long-term, sustainable corrections have been implemented throughout your organization to prevent this violation from recurring in the future.  For example, providing FDA with documentation of policies and practices demonstrating that you have made a corporate commitment to ensure produce covered by the Standards for the Growing, Harvesting, Packing, and Holding of Produce for Human Consumption (Produce Safety Rule), Title 21 Code of Federal Regulations, Part 112 (21 CFR Part 112), specifically sprouts, and sourced by any Jimmy John’s restaurant will be procured from a farm or firm operating in compliance with the Produce Safety Rule, the Act, and, as applicable, the Current Good Manufacturing Practice, Hazard Analysis, and Risk-Based Preventive Controls for Human Foods (PC Rule), 21 CFR Part 117.

Jimmy John’s outbreaks in the past dozen years

  • Multistate E. coli O103 Outbreak, Jimmy John’s Restaurants Sprouts 2020

Sprouts Unlimited has initiated a recall of clover sprouts because of possible E. coli O103 contamination. The clover sprouts were distributed to Hy Vee Food stores, Fareway Food Stores and used by Jimmy John’s restaurants in Iowa.

“Sprouts Unlimited Inc. became aware of the potential contamination after receiving information from the Iowa Department of Inspections and Appeals, Des Moines, IA, that a cluster of E. coli O103 illnesses epidemiologically linked to clover sprouts from Sprouts Unlimited Inc.,” according to the company’s recall notice. “An investigation and further tests are being conducted to determine the source.”

  • Multistate Salmonella Outbreak, Jimmy John’s Restaurants Sprouts 2018

As of January 18, 2018, eight people infected with the outbreak strain of Salmonella Montevideo had been reported from Illinois, Wisconsin and Minnesota. Illnesses started on dates ranging from December 20, 2017, to January 3, 2018. Ill people ranged in age from 26 to 50, with a median age of 34. All 8 were female. No hospitalizations and no deaths were reported.  Evidence indicated that raw sprouts served at Jimmy John’s restaurants were a likely source of outbreak.

Federal, state, and local health and regulatory officials conducted traceback investigations from the six Jimmy John’s locations where ill people ate raw sprouts.

  • Multistate E. coli O121 Outbreak, Jimmy John’s Restaurants Alfalfa Sprouts 2014

19 Sickened – Public health officials in California, Idaho, Michigan, Montana, Utah and Washington collaborated with their federal partners at the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) to investigate an outbreak of E. coli O121 that occurred in May 2014.  A total of 19 people with the outbreak strain, identified by the CDC’s PulseNet PFGE Pattern Identification Numbers EXKX01.0011/EXKA26.0001, were reported.  Among people for whom information was available, dates of illness onset ranged from May 1, 2014, to May 20, 2014. Ill people ranged from 11 years to 52 years old.  Seven of 16 victims for whom information was available were hospitalized. None of the confirmed patients developed hemolytic uremic syndrome and no deaths were reported.

Epidemiologic and traceback investigations conducted by public health officials implicated raw clover sprouts produced by Evergreen Fresh Sprouts LLC of Hayden, Idaho as the likely source of this outbreak.  Thirteen (81%) of 16 ill people reported eating raw clover sprouts in the week before becoming ill. Ill people in Washington and Idaho reported eating sprouts in sandwiches at several local food establishments including several Jimmy John’s locations, the Pita Pit, and Daanen’s Deli.

As part of the investigation the FDA performed a traceback analysis and determined that Evergreen Fresh Sprouts supplied sprouts to seven restaurants with outbreak associated cases.  This analysis used documents collected directly from the distributors and the grower, Evergreen Fresh Sprouts, as well as documents collected by the states from the points of service.

The FDA conducted several inspections at the Evergreen Fresh Sprouts facility in May and June.  During the inspections FDA investigators observed a number of unsanitary conditions, including condensate and irrigation water dripping from rusty valves, a rusty and corroded watering system in the mung bean room, tennis rackets were being used to scoop mung bean sprouts that had scratches, chips and frayed plastic; a pitchfork used to transfer mung bean sprouts had corroded metal, and a squeegee used to agitate mung bean sprouts inside a soak vat that had visible corroded metal and non-treated wood.

On June 26, 2014, the FDA and CDC held a meeting with the owner of Evergreen Fresh Sprouts to advise the firm of FDA’s concerns that the seed lot used to row clover sprouts linked to this outbreak might be contaminated and to encourage Evergreen Fresh Sprouts to discontinue using that seed lot.  The owner of Evergreen Fresh Sprouts agreed to stop using the suspect lot of seeds.

  • Multistate E. coli O157 Outbreak, Jimmy John’s Restaurants Cucumbers 2013

On Friday, October 18, 2013, public health investigators at the Colorado Department of Public Health (CDPHE) detected an increase in Denver area patients reported as having E. coli O157. Preliminary interviews revealed that patients had eaten at Jimmy John’s restaurants and shopped at an area grocery store chain. CDPHE epidemiologist, Nicole Comstock, noted in an October 22 email sent to county health departments that “at this time we are not ruling any exposures out yet.” Ms. Comstock encouraged county investigators to interview newly reported patients diagnosed with E. coli O157 promptly using a standardized questionnaire. By October 23, CDPHE epidemiologists described the association between illness and sandwiches prepared at area Jimmy John’s restaurants “too strong to ignore.”

CDPHE and their local and federal public health partners conducted case finding, two case control studies (“Study I” and “Study II”), an environmental investigation, produce traceback, and laboratory testing. Case finding occurred via routine public health surveillance methods. Case control “Study I” was conducted to assess restaurant exposures reported by case-patients. Case control “Study II” was conducted subsequently to assess foods consumed at Jimmy John’s. For “Study II” online and phone order records were used to recruit controls (non-ill Jimmy John’s customers) who purchased food from the same Jimmy John’s locations on the dates as case-patients.

Eight patient’s laboratory confirmed with E. coli O157:H7 were identified as outbreak associated cases. All eight patients were infected with an indistinguishable genetic strain (EXHX01.0074/EXHA26.0569) of E. coli O157 as determined by PFGE and MLVA. This strain was not seen elsewhere in the United States in October 2014. One patient was classified as a “probable” case since she was not culture positive for E. coli O157 due to collection of her stool specimen post-antibiotic treatment. Three blood specimens collected from her would later test positive for IgG and IgM antibodies to E. coli O157:H7, confirming a recent acute infection with E. coli O157. All nine outbreak-associated-cases ate food from one of three Jimmy John’s locations in the metro-Denver area. This finding was highly statistically significant based on analysis of data collected in Case control Study I. Case control Study II data showed that all nine outbreak-associated-cases consumed cucumbers on Jimmy John’s sandwiches, also a highly statistically significant finding. No other food items were statistically associated with illness. Meal dates for case patients were October 5th, 6th, 7th and 9th. Median age of patients was 23 years; 78% were female.

Three (3) Jimmy John’s locations were identified by patients. One was located in Lakewood, Colorado at 180 South Union and was inspected by the Jefferson County Health Department (JCHD). Two (2) fell within the jurisdiction of the Tri-County Health Department (TCHD): 2610 West Belleview Avenue, Littleton, Colorado and 1140 South Colorado Boulevard, Glendale, Colorado. Local health environmental health staff conducted on-site investigations at each restaurant. They examined produce-handling practices and obtained invoices for traceback. Colo-Pac Produce Inc. (“Colo-Pac”) delivered whole cucumbers and other produce to all three stores approximately two times a week. Cucumbers and other produce (lettuce, tomatoes and onions) were washed, chopped, and prepared fresh daily for use at each restaurant. Although no restaurant had leftover food from the implicated meal dates, TCPH and JCHD staff collected food samples for laboratory testing at the CDPHE Public Health Laboratory. All food tests were negative for the presence of E. coli O157 at the state laboratory.

Based on customer purchase order number/bills of lading provided by Colo-Pac, investigators determined that a single lot (Lot 19158) of cucumbers was delivered to all three implicated Jimmy John’s locations during the time frame of interest (September 9, 2013 to October 9, 2013). Further traceback showed that the cucumbers were grown in Torreon, Coahulia, Mexico by grower/packer Ganadera Vigo. They were imported into the United States by GR Produce of McAllen, Texas, which then sold full cases to Colo-Pac. Colo-Pac sold full cases to two of the implicated Jimmy John’s; one store received split cases boxed at Colo-Pac. CDPHE staff conducted an onset inspection at Colo-Pac and obtained 55 swab samples from the warehouse and delivery trucks. All specimens were negative for E. coli O157.

  • Multistate E. coli O26 Outbreak, Jimmy John’s Restaurants Alfalfa Sprouts 2012

29 Sickened – A total of 29 individuals infected with the outbreak strain of E. coli O26 were reported from 11 states, including:  Alabama (1), Arkansas (1), Iowa (5), Kansas (2), Michigan (10), Missouri (3), Ohio (3), Pennsylvania (1), Washington (1), Wisconsin (1), and West Virginia (1).

Of the 27-ill people with available information, 23 (85%) reported consuming sprouts at Jimmy John’s restaurants in the seven days preceding illness. Among 29 ill people, illness onset dates ranged from December 25, 2011, to March 3, 2012. Ill people ranged in age from 9 years to 57 years old, with a median age of 26 years; 89% of the patients were female. Among the 29 ill persons, seven (24%) were hospitalized. None developed HUS, and no deaths were reported.

Preliminary traceback information identified a common lot of clover seeds used to grow clover sprouts served at Jimmy John’s restaurant locations where ill persons ate.  FDA and states conducted a traceback that identified two separate sprouting facilities; both used the same lot of seed to grow clover sprouts served at these Jimmy John’s restaurant locations.  On February 10, 2012, the seed supplier initiated a notification process for sprouting facilities that received the implicated lot of clover seed to stop using it.

Results of the epidemiologic and traceback investigations indicated eating raw clover sprouts at Jimmy John’s restaurants was the likely cause of this outbreak.

  • Sprouters Northwest, Jimmy John’s Restaurants Clover Salmonella Sprouts Outbreak 2010

7 Sickened – Sprouters Northwest of Kent, WA, issued a product recall after the company’s clover sprouts had been implicated in an outbreak of Salmonella Newport in Oregon and Washington. At least some of the cases had consumed clover sprouts while at a Jimmy John’s restaurant. Concurrent with this outbreak, a separate outbreak of Salmonella, serotype I 4,5,12,i- ; involving alfalfa sprouts served at Jimmy John’s restaurants was under investigation. The recall of Northwest Sprouters products included: clover; clover and onion; spicy sprouts; and deli sprouts. The Sprouters Northwest products had been sold to grocery stores and wholesale operations in Washington, Oregon, Idaho, Alaska, British Columbia, Saskatchewan, and Alberta. The FDA inspection found serious sanitary violations.

  • Multistate Salmonella Outbreak, Tiny Greens Organic Farm, Jimmy John’s Restaurants Alfalfa Sprouts 2010

140 Sickened – On December 17, the Illinois Department of Health announced that an investigation was underway into an outbreak of Salmonella, serotype I4,[5],12:i:-. Many of the Illinois patients had eaten alfalfa sprouts at various Jimmy John’s restaurants in the Illinois counties of Adams, Champaign, Cook, DuPage, Kankakee, Macon, McHenry, McLean, Peoria, and Will counties. The sprouts were suspected to be the cause of the illnesses. On Dec. 21 that year Jimmy John Liautaud, the owner of the franchised restaurant chain, requested that all franchisees remove all sprouts from the menu as a “precautionary” measure. On Dec. 23, the Centers for Disease Control revealed that outbreak cases had been detected in other states and that the outbreak was linked with eating alfalfa sprouts from a nationwide sandwich chain. On Dec. 26, preliminary results of the investigation indicated a link to eating Tiny Greens’ Alfalfa Sprouts at Jimmy John’s restaurant outlets. The FDA subsequently advised consumers and restaurants to avoid Tiny Greens Brand Alfalfa Sprouts and Spicy Sprouts produced by Tiny Greens Organic Farm of Urbana, Illinois. The Spicy Sprouts contained alfalfa, radish and clover sprouts. On January 14, 2011, it was revealed that the FDA had isolated Salmonella serotype I4,[5],12:i:- from a water runoff sample collected from Tiny Greens Organic Farm; the Salmonella isolated was indistinguishable from the outbreak strain. The several FDA inspections of the sprout growing facility revealed factors that likely led to contamination of the sprouts.

  • CW Sprouts, Inc., SunSprout Sprouts, “restaurant chain (Chain A),” a.k.a. Jimmy John’s Salmonella Outbreak 2009

256 Sickened – In February, Nebraska Department of Health and Human Services officials identified six isolates of Salmonella Saintpaul. Although this is a common strain of Salmonella, during 2008, only three cases had been detected in Nebraska and only four subtypes of this outbreak strain had been identified in 2008 in the entire USA. As additional reports were made, a case control study was conducted; alfalfa sprout consumption was found to be significantly related to illness. The initial tracebacks of the sprouts indicated that although the sprouts had been distributed by various companies, the sprouts from the first cases originated from the same sprouting facility in Omaha, NE. Forty-two of the illnesses beginning on March 15 were attributed to sprout growing facilities in other states; these facilities had obtained seed from the same seed producer, Caudill Seed Company of Kentucky. The implicated seeds had been sold in many states. On April 26, the FDA and CDC recommended that consumers not eat raw alfalfa sprouts, including sprout blends containing alfalfa sprouts. In May, FDA alerted sprout growers and retailers that a seed supplier, Caudill Seed Company of Kentucky, was withdrawing all alfalfa seeds with a specific three-digit prefix. Many of the illnesses occurred at “restaurant chain (Chain A),” according to the CDC, which generally does not identify specific business.

  • Jimmy John’s Restaurant Alfalfa Sprouts and Iceberg Lettuce E. coli Outbreak 2008

28 Sickened – Several University of Colorado students from one sorority became ill with symptoms of bloody diarrhea and cramping. Additional illnesses were reported. E. coli O157:NM(H-) was determined to be the cause. Consumption of alfalfa sprouts at the Jimmy John’s Restaurants in Boulder County and Adams County were risk factors for illness. In addition, the environmental investigation identified Boulder Jimmy John’s food handlers who were infected with E. coli and who had worked while ill. The health department investigation found a number of critical food handling violations, including inadequate hand-washing. The fourteen isolates from confirmed cases were a genetic match to one another.

The FDA is cautioning pet owners not to feed their pet’s certain Aunt Jeni’s Home Made frozen raw pet food “as it poses a serious threat to consumer and animal health” because of Salmonella Infantis contamination.

The Salmonella was discovered in January when the FDA collected one retail sample of Aunt Jeni’s Home Made Turkey Dinner Dog Food.  The Salmonella was also found to be resistant to multiple antibiotic drugs.

Salmonella in pet food is a threat to human and animal health because pets can get sick from this pathogen and can also be carriers of the bacteria and pass it on to their owners without appearing to be ill. People can also get sick from handling the contaminated pet food, or touching surfaces that have had contact with the contaminated food.

The Product:

  • Aunt Jeni’s Home Made All-Natural Raw Turkey Dinner Dog Food, 5 lb. (2.3 kg), lot 175331 NOV2020.

Consumers who purchased the product are urged to not feed it to their pet, throw it away, and sanitize surfaces that may have come in contact with the product. If consumers have the product and cannot determine the lot code,  the FDA recommends that the product be thrown away.

Retailers, distributors and other operators who have sold the product should wash and sanitize display cases and refrigerators where the product was stored.

The FDA also suggests that, “Consumers who have had this product in their homes should clean refrigerators/freezers where the product was stored and clean and disinfect all bowls, utensils, food prep surfaces, pet bedding, toys, floors, and any other surfaces that the food or pet may have had contact with.

“Because animals can shed the bacteria in the feces when they have bowel movements, it’s particularly important to clean up the animal’s feces in yards or parks where people or other animals may become exposed, in addition to cleaning items in the home. Consumers should thoroughly wash their hands after handling the affected product or cleaning up potentially contaminated items and surfaces.”

Consumers who think their pet has salmonellosis after consuming the pet food product should contact their veterinarian.

In today’s New England Journal of Medicine – https://www.nejm.org/doi/full/10.1056/NEJMoa1907462?query=TOC

Thanks to the good work of:

  • Juno Thomas, M.D.,
  • Nevashan Govender, M.Sc., M.P.H.,
  • Kerrigan M. McCarthy, M.D.,
  • Linda K. Erasmus, M.D.,
  • Timothy J. Doyle, Ph.D.,
  • Mushal Allam, Ph.D.,
  • Arshad Ismail, Ph.D.,
  • Ntsieni Ramalwa, M.P.H.,
  • Phuti Sekwadi, M.P.H.,
  • Genevie Ntshoe, M.P.H.,
  • Andronica Shonhiwa, M.P.H.,
  • Vivien Essel, M.D.,
  • Nomsa Tau, M.S.,
  • Shannon Smouse, M.S.,
  • Hlengiwe M. Ngomane, M.T.,
  • Bolele Disenyeng, M.T.,
  • Nicola A. Page, Ph.D.,
  • Nelesh P. Govender, M.D.,
  • Adriano G. Duse, M.D.,
  • Rob Stewart, M.T.,
  • Teena Thomas, M.D.,
  • Deon Mahoney, M.S.,
  • Mathieu Tourdjman, M.D.,
  • Olivier Disson, Ph.D.,
  • Pierre Thouvenot, B.S.,
  • Mylène M. Maury, Ph.D.,
  • Alexandre Leclercq, M.S.,
  • Marc Lecuit, M.D., Ph.D.,
  • Anthony M. Smith, Ph.D.,
  • Lucille H. Blumberg, M.D.

BACKGROUND

An outbreak of listeriosis was identified in South Africa in 2017. The source was unknown [Note, the source was polony produced by Tiger Brands – how the Listeria monocytogenes entered the plant was not determined].

METHODS

We conducted epidemiologic, trace-back, and environmental investigations and used whole-genome sequencing to type Listeria monocytogenes isolates. A case was defined as laboratory-confirmed L. monocytogenes infection during the period from June 11, 2017, to April 7, 2018.

RESULTS

A total of 937 cases were identified, of which 465 (50%) were associated with pregnancy; 406 of the pregnancy-associated cases (87%) occurred in neonates. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant). Among the patients in whom human immunodeficiency virus (HIV) status was known, 38% of those with pregnancy-associated cases (77 of 204) and 46% of the remaining patients (97 of 211) were infected with HIV. Among 728 patients with a known outcome, 193 (27%) died. Clinical isolates from 609 patients were sequenced, and 567 (93%) were identified as sequence type 6 (ST6). In a case–control analysis, patients with ST6 infections were more likely to have eaten polony (a ready-to-eat processed meat) than those with non-ST6 infections (odds ratio, 8.55; 95% confidence interval, 1.66 to 43.35). Polony and environmental samples also yielded ST6 isolates, which, together with the isolates from the patients, belonged to the same core-genome multilocus sequence typing cluster with no more than 4 allelic differences; these findings showed that polony produced at a single facility was the outbreak source. A recall of ready-to-eat processed meat products from this facility was associated with a rapid decline in the incidence of L. monocytogenes ST6 infections.

CONCLUSIONS

This investigation showed that in a middle-income country with a high prevalence of HIV infection, L. monocytogenes caused disproportionate illness among pregnant girls and women and HIV-infected persons. Whole-genome sequencing facilitated the detection of the outbreak and guided the trace-back investigations that led to the identification of the source.

Listeriosis, a severe foodborne disease that has substantial mortality (20 to 30%), primarily affects persons with impaired cell-mediated immunity associated with pregnancy, extremes of age, underlying malignant conditions, human immunodeficiency virus (HIV) infection, chronic disease, or immunosuppressive therapy.1-5 Outbreaks are increasingly recognized,6,7 predominantly in upper-income countries where infection is more readily diagnosed,8where existing surveillance programs facilitate early recognition,9 and where strain typing by whole-genome sequencing, which allows for identification of outbreak-linked cases and definitive attribution of the source, is accessible.10-14

An increase in the number of cases of listeriosis at two public hospitals in Gauteng Province, South Africa, during July and August 2017 prompted an investigation. Case numbers rapidly increased nationwide, and whole-genome multilocus sequence typing15 of Listeria monocytogenes isolates from patients identified a single sequence type (sequence type 6 [ST6]) in 93% of the cases. We used whole-genome sequencing and intensive epidemiologic and trace-back investigations to pursue the source of the outbreak. This report describes the key findings from the investigation.

Methods

CASE DEFINITION

Figure 1. Incidence of Laboratory-Confirmed Cases of Listeriosis in South Africa during the Outbreak Period, According to District.

We defined an outbreak-associated case as laboratory-confirmed infection with L. monocytogenes, as determined by means of bacterial culture or polymerase-chain-reaction (PCR) assay of any clinical sample, during the outbreak period (June 11, 2017 [epidemiologic week 24 of that year], to April 7, 2018 [epidemiologic week 14]). This period was defined as the interval during which the case numbers at the national level exceeded and remained above a weekly threshold of five cases per week. The threshold of five cases per week was determined with the use of baseline laboratory data from January 1, 2013, to December 31, 2016. All L. monocytogenes infections were initially included in the case definition, because it was not possible to definitively exclude non-ST6 cases from the outbreak event; however, for the case–control analysis, the case definition was later refined to include ST6 cases only. Pregnancy-associated cases included illness with an onset during pregnancy or within the first 2 weeks of the postpartum period and illness in the neonate. The mothers of infected neonates were not counted among those who had cases if they did not have symptomatic laboratory-confirmed listeriosis; infection in a maternal–neonatal pair was defined as laboratory-confirmed infection in both the mother and neonate and was counted as a single case. Neonatal cases were classified as early onset (diagnosed between birth and day 6) or late onset (diagnosed between days 7 and 28). A map showing the incidence of infections according to district was generated (Figure 1).

EPIDEMIOLOGIC CASE INVESTIGATION

Clinical and demographic details and underlying medical conditions were ascertained through patient interviews or abstracted from medical records or laboratory reports with the use of a standardized case-investigation form. This investigation was reviewed in accordance with local and Centers for Disease Control and Prevention procedures for protection of human research participants and was considered nonresearch disease-control activity in a public health emergency. From November 1, 2017, all patients with newly reported cases were contacted to assess food exposures during the 4 weeks preceding the onset of illness with the use of a semistructured questionnaire. In cases in which the patient was a child, had died, or was too ill to respond, the next of kin were interviewed as proxies. In neonatal cases, history of food consumption by the mother during pregnancy was obtained.

Among the subgroup of patients with a detailed food history and available whole-genome sequencing results, a case–control analysis was performed to estimate the odds ratios for the association between specific food exposures and outbreak-associated illness. In this analysis, a case patient was defined as a person with L. monocytogenes ST6 infection and a control patient as a person with non-ST6 listeriosis during the outbreak period.

ENVIRONMENTAL AND TRACE-BACK INVESTIGATIONS

Health authorities initiated the collection of food samples from the homes of patients in mid-November 2017. When L. monocytogenes was isolated from a food sample, a trace-back investigation was conducted.

CHARACTERIZATION OF THE OUTBREAK STRAIN

L. monocytogenes isolates were sent to a national reference laboratory, where genomic bacterial DNA was isolated and whole-genome sequencing analysis performed as described previously.17Genome assemblies were analyzed with the use of the multilocus sequence typing analysis pipeline at the Center for Genomic Epidemiology (www.genomicepidemiology.org. opens in new tab). Data from multilocus sequence typing were used to determine clonal complexes and sequence types.15 Raw sequencing data were analyzed with the use of the Bacterial Isolate Genome Sequence Database for L. monocytogenes (BIGSdb-Lmhttp://bigsdb.pasteur.fr/listeria/listeria.html. opens in new tab) to determine sublineages and core-genome multilocus sequence types.18 The data exported from the BIGSdb-Lm were analyzed with BioNumerics Software, version 7.6.2 (bioMérieux) in order to perform a core-genome multilocus sequence typing–based phylogenetic analysis with the use of a single-linkage clustering algorithm.

The virulence of the ST6 strain was assessed in 7-to-10-week-old E16P KI C57BL/6 female mice, as previously described19; approval was obtained from the Institut Pasteur ethics committee. We assessed the virulence of the ST6/CT4148 YA00061615 CLIP2018/00699 human isolate (L1-SL6-ST6-CT4148, in which L denotes phylogenetic lineage, SL sublineage, ST sequence type, and CT core-genome multilocus sequence type) as the South African strain, and compared it with that of the EGDe ST9 reference strain (L2-SL9-ST35-CT637; National Center for Biotechnology Information (NCBI) GenBank accession number, NC_003210)20 and the CLIP2009/01092 ST6 isolate (L1-SL6-ST6-CT451; NCBI accession number, PRJEB10792).21 Overnight culture of L. monocytogenes was diluted in brain–heart infusion medium to reach mid-log growth phase. The mice were inoculated intragastrically through a feeding needle with 2×108 colony-forming units. The infected animals were killed 4 days after inoculation, and the organs were dissected and homogenized. Serial dilutions of ground-tissue suspensions in phosphate-buffered saline were inoculated on brain–heart infusion agar plates. After 24 hours of incubation at 37°C, the colony-forming units were counted.

Results

OUTBREAK CASES

Figure 2. Number of Laboratory-Confirmed Cases of Listeriosis, According to Epidemiologic Week and Major Events (January 1, 2017, to August 21, 2018).

A total of 937 cases were reported during the outbreak period, with case numbers peaking at 41 per week in mid-November 2017 (epidemiologic week 46) (Figure 2). ST6 was identified in 567 of 609 sequenced clinical isolates (93%). Although ST6 cases predominated during the outbreak period, smaller peaks of non-ST6 cases were noted. The number of cases decreased dramatically after recall of the implicated products on March 4, 2018. By mid-April 2018 (6 weeks after recall), fewer than 5 cases were reported weekly. Although cases were reported in all provinces, 543 of the 937 cases (58%) occurred in Gauteng Province, where the incidence reached 5 cases per 100,000 population in several districts (Figure 1).

CLINICAL INFORMATION

Table 1. Characteristics of Patients with Laboratory-Confirmed Listeriosis during the Outbreak Period (June 11, 2017, to April 7, 2018).

A total of 465 of the 937 cases (50%) were associated with pregnancy: 406 cases (43%) occurred in neonates and 59 (6%) in pregnant girls and women. Nine maternal–neonatal pairs were identified. Early-onset disease occurred in 95% of the neonatal cases. Of the 937 cases, 229 (24%) occurred in patients 15 to 49 years of age (excluding those who were pregnant) (Table 1). With the exclusion of the 59 girls and women known to be pregnant, female patients were overrepresented in the age group of 15 to 49 years (140 of 229 [61%]). A total of 83 cases (9%) occurred in persons 65 years of age or older. Overall, all but 2 patients were hospitalized, and no health care–associated infections were documented.

HIV status was known in 415 of the 937 cases (44%). In 204 pregnancy-associated cases with known HIV status, 77 patients (38%) had positive HIV status, which included HIV exposure in 60 of 158 neonates (38%) and HIV infection in 17 of 46 pregnant girls and women (37%). Among the remaining 211 patients, 97 (46%) were infected with HIV. Among the 114 patients (excluding neonates) who were infected with HIV, 82 (72%) had available data on the CD4 T-lymphocyte count; the median count was 194 cells per cubic millimeter (interquartile range, 91 to 387). Maternal CD4 T-lymphocyte counts were known for 12 HIV-exposed neonates (20%); the median count was 479 cells per cubic millimeter (interquartile range, 322 to 575). After adjusting for age and sex, we found that the odds of ST6 infection were 48% lower among HIV-infected patients than among those without HIV infection, although odds lower than 78% or higher than 25% are also compatible with our data (odds ratio for ST6 infection, 0.52; 95% confidence interval [CI], 0.22 to 1.25). HIV-infected patients older than 1 month of age were 2.6 times as likely to have meningitis (confirmed by means of PCR assay of cerebrospinal fluid or cerebrospinal fluid culture) as HIV-negative patients (odds ratio, 2.55; 95% CI, 1.38 to 4.72). Predisposing medical conditions other than HIV infection were more common among patients 50 years of age or older.

The outcome was known for 728 patients (78%), among whom 193 deaths were reported (case-fatality ratio, 27%). HIV infection was associated with a 53% increased odds of death among patients older than 1 month, after adjustment for age and sex (odds ratio, 1.53; 95% CI, 0.75 to 3.15). Of the 4 maternal deaths reported, the underlying risk factors were known in 1 patient (diabetes mellitus and HIV infection). Fetal loss occurred in 27 of the 59 pregnant girls and women (46%).

CASE–CONTROL ANALYSIS

Table 2. Case–Control Analysis of the Association between Specific Food Exposures and Listeria monocytogenes ST6 Infection.

A total of 109 patients were interviewed. Consumption of polony (a ready-to-eat processed meat containing chicken, pork, beef, or any combination of these, similar to bologna) was reported by 93 patients (85%), and the brands produced by Facility A were the most commonly reported. Sequence data were available for 76 of the 109 patients: 65 had ST6 infections (case patients) and 11 had non-ST6 infections (control patients). The food items most strongly associated with ST6 infection included polony (odds ratio, 8.55; 95% CI, 1.66 to 43.35) and frozen chicken (odds ratio, 4.90; 95% CI, 1.04 to 25.55) (Table 2). Of the 57 case patients who reported eating polony, 50 (88%) reported eating brands manufactured at Facility A, although several patients reported eating several brands or did not specify a particular brand.

TRACE-BACK AND ENVIRONMENTAL INVESTIGATIONS

On January 13, 2018, febrile gastroenteritis developed in 10 children from a nursery in Gauteng Province. Several stool samples were collected, and one yielded L. monocytogenes ST6. Sandwiches prepared and eaten at the nursery were the only common food exposure, and polony was the common ingredient. Polony was recovered from the nursery refrigerator, and L. monocytogenes ST6 was identified in the polony produced at Facility A.

On February 2, 2018, an environmental investigation was conducted at Facility A, located in Limpopo Province. Production of the polony entailed grinding and mixing raw ingredients, stuffing the emulsion into clipped nylon casings, cooking the polony loaves in hot water, and cooling the loaves in a brine chiller. Several areas were in poor repair, and many opportunities for cross-contamination of food products were identified, including condensation, unrestricted movement of workers, and prolonged reuse of brine for chilling.

L. monocytogenes was isolated from 47 of the 317 environmental samples (15%) collected at Facility A. A total of 34 of the 47 typed isolates (72%) were identified as ST6. These isolates originated from samples collected at several facility sections (precooking and postcooking), including from food-contact surfaces, non–food-contact surfaces, and chilling brine. L. monocytogenes ST6 was detected in 2 of 13 samples of unopened polony loaves collected at the facility and subsequently from polony loaves sold in retail stores.

CHARACTERIZATION OF THE OUTBREAK STRAIN

Whole-genome sequencing was performed in 710 human L. monocytogenes isolates (8 isolates collected in 2015; 37 in 2016; 455 in 2017; and 210 in 2018) and in 1061 food and environmental L. monocytogenesisolates collected between September 1, 2017, and March 31, 2018. On the basis of multilocus sequence typing, 567 of 609 isolates (93%) from the outbreak cases were identified as ST6, and the remainder represented 14 other sequence types. A total of 34 environmental isolates from Facility A and 19 isolates from food produced at Facility A were identified as ST6.

Figure 3. Population Structure of the South AfricanListeria monocytogenes ST6 Outbreak–Associated Isolates and of L. monocytogenes ST6 Isolates Collected Worldwide.

Whole-genome sequencing data for 386 ST6 isolates were analyzed with the use of core-genome multilocus sequence typing. Four human ST6 isolates that were recovered in 2017 and 2018 differed by at least 14 alleles, but the remaining 382 differed by no more than 4 alleles (out of 1748 loci included in the scheme) (Figure 3A).18This maximum 4-allelic difference is within the 7-allelic difference threshold that defines potentially epidemiologically linked isolates, as described by Moura et al.18 These 382 isolates, including 336 human isolates and 19 food and 27 environmental isolates from Facility A, were assigned to the same core-genome multilocus sequence type (CT4148; complete genotype, L1-SL6-ST6-CT4148). The oldest South African CT4148 isolates date from September 2015 and are related to a cluster of three cases of listeriosis in Western Cape Province28; this finding suggests a potential epidemiologic link to the 2017–2018 outbreak (Figure 3A).

Whole-genome sequencing data were compared with information from curated databases through international networks and with isolates representative of previous major ST6 outbreaks to detect possible matches, and none were found (Figure 3B, and Fig. S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org); genome sequences for 10 L. monocytogenes ST6 isolates associated with this South African outbreak have been deposited at the NCBI GenBank repository under the accession numbers QEXB00000000 to QEXK00000000 (BioProject number, PRJNA451422; and BioSample numbers, SAMN08970424 to SAMN08970415). Outbreak ST6 isolates had a hypervirulent phenotype, as described previously for L. monocytogenes ST6,21 but were not more virulent than a strain representative of ST6 (Fig. S2).

CONTROL MEASURES

On March 4, 2018, the Minister of Health announced the outbreak source. Facility A products were traced and recalled from distributors and retailers, and the public was advised to return products for reimbursement. Facility A was closed immediately. The World Health Organization assisted in recalling the products that had been exported to 15 African countries (Angola, Botswana, Democratic Republic of Congo, Ghana, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Nigeria, eSwatini, Uganda, Zambia, and Zimbabwe). A single case of listeriosis was reported in Namibia during March 2018, but the patient’s isolate was confirmed as non-ST6; no other countries reported cases during the period from January 1, 2017, to September 3, 2018, when the outbreak was declared over.

Discussion

Contaminated polony that was produced at a single facility was the cause of a large national outbreak of listeriosis predominantly associated with an L. monocytogenes ST6 strain in South Africa. Evidence supporting the cause includes a strong association between eating polony and ST6 infection, the detection of ST6 isolates in polony recovered from the refrigerator in the nursery, the detection of ST6 isolates in unopened polony loaves collected at the production facility, the detection of ST6 isolates in environmental samples collected from the production facility, a decline in ST6 cases after a recall of the products and closure of the facility, and the fact that outbreak-associated ST6 isolates from patients as well as food and environmental isolates from the facility belonged to a single core-genome multilocus sequence type.

Ready-to-eat processed meats are a well-known vehicle for listeriosis outbreaks.29,30 Polony is a low-cost, readily available food popular across all socioeconomic groups in South Africa and is used in kota, a fast food favored in urban areas. Polony has a shelf life of 5 months and is produced in large quantities by several manufacturers for local consumption and export.

Unique features of this outbreak include its recognition in a middle-income country with a high prevalence of HIV infection and a high fertility rate. HIV infection is a well-recognized risk factor for listeriosis.2,31-34 In 2017, the prevalence of HIV infection in South Africa was 12.6%, and an estimated 7.9 million people were living with HIV infection. The prevalence of HIV infection in the age group of 15 to 49 years was 26.3% among female persons and 14.8% among male persons.16 Of the nearly 1.2 million girls and women who gave birth in 2017, approximately 265,000 (22%) were infected with HIV.35In this outbreak, HIV infection was the most common predisposing condition among patients younger than 65 years of age. We also found that a large percentage of pregnant girls and women were infected with HIV (37% [17 of 46]), and a similar percentage of neonates were exposed to HIV (38% [60 of 158]). The percentage of female patients was highest in the age group of 15 to 49 years, which suggests that possible unrecognized HIV infection or pregnancy were predisposing conditions. Culture-confirmed or PCR assay–confirmed L. monocytogenes infections were reported in more cerebrospinal fluid samples from HIV-positive patients than from HIV-negative patients. It is possible that HIV infection is associated with an increased mortality, but given the missing data and study design, the analyses were not powered to detect a difference between the HIV-infected group and the HIV-uninfected group.

The size and velocity of the outbreak were noteworthy and most likely resulted from the wide distribution of large volumes of contaminated products in a large population vulnerable to invasive listeriosis. Likely explanations for the predominance of cases in Gauteng Province include consumer behavior, food preferences, and higher socioeconomic status in this densely populated province, but increased reporting or differential health-seeking and physician-testing behavior may have been contributing factors. We found no evidence that this ST6 outbreak–associated strain was more virulent than a strain representative of ST6.21

No outbreak-associated cases were detected in the 15 low-to-middle-income countries that imported polony from Facility A. However, cases were probably missed because of nonspecific clinical presentation, physician-testing behavior, limited diagnostic capacity at the laboratory, and lack of surveillance for listeriosis. The burden of listeriosis is most likely higher than is currently recognized in low-income and middle-income countries,8 particularly those with large populations of people living with HIV.

Before this outbreak, listeriosis was not required to be reported and not under surveillance in South Africa. A national surveillance system has since been implemented, and all isolates from patients are analyzed by means of whole-genome sequencing. This outbreak catalyzed a revision of local food-safety regulations; certification through the Hazard Analysis and Critical Control Point system is now a legal requirement for ready-to-eat meat producers, and microbiologic criteria for L. monocytogenes in ready-to-eat foods are under review.

This outbreak investigation had several limitations. Not all clinical isolates were available for whole-genome sequence typing. Microbiologic investigations are not routinely conducted in pregnant women with mild, nonspecific febrile illness or in those who have had miscarriages or stillbirths; therefore, the number of patients with pregnancy-related listeriosis was most likely underestimated. With respect to the period under study, limited case-investigation forms were available, and data were of varying completeness. Insufficient clinical data prohibited a description of clinical syndromes. Sources of the data on HIV status included laboratory reports and reports from the patients themselves, which probably resulted in underreported positive status. On the basis of the findings from core-genome multilocus sequence typing, it is likely that the ST6 cluster in 2015 was associated with the 2017–2018 outbreak; however, incomplete histories of food consumption and trace-back data precluded a conclusive epidemiologic link.

The findings showcase the power of complementary epidemiologic data and whole-genome sequence typing for detecting and investigating foodborne disease outbreaks and show that whole-genome sequencing technology can be ably implemented and used in developing countries. As the global shift to whole-genome sequence typing for foodborne-pathogen surveillance accelerates,36-38 developing countries should build the capacity to leverage this technology in a rapidly evolving landscape of food-safety concerns. Targeted health communication for the prevention of listeriosis among pregnant girls and women and HIV-infected persons in developing countries may help mitigate the risk of disease in these vulnerable groups.

Fresh Herbs Results as of 10/1/2019

The FDA plans to collect 1,600 fresh herbs samples (761 domestic, and 839 of international origin) under this assignment. As of September 30, 2019, the agency had collected and tested 746 domestic samples (98 percent) and 468  import samples (56 percent) of the totals. The following figures summarize the interim sampling results. As the testing is still underway, no conclusions can be drawn at this time.

Herb Sampling Results 10012019

Processed Avocado and Guacamole Results as of 10/15/2019

The FDA initially planned to collect 1,600 processed avocado and guacamole samples (800 domestic, and 800 of international origin) under this assignment. In July 2018, the FDA adjusted its collection target to 1,200 samples (936 domestic, and 264 of international origin) after initial sampling confirmed that a relatively small number of firms produce and/or distribute processed avocado. The agency’s intent was to avoid biasing the data by oversampling product from the same firms and to minimize the burden on industry. Further, the FDA learned that an increasing number of processors have begun to use high pressure processing, which is a kill step. In March 2019, the FDA further reduced its collection target to 1,056 samples (824 domestic, and 232 of international origin) given the 35-day lapse in appropriations that began on December 22, 2018, and the associated impact on the workload of the agency’s field staff.

The FDA has stopped its collection of processed avocado and guacamole samples, coinciding with the close of FY2019. The final collection total is 887 samples (777 domestic, and 110 import). The final collection total, as compared to the original target, will increase the margin of error of the prevalence estimate from 0.5 percent to approximately 0.65 percent.  The FDA has recently begun its analyses of the data; final figures and a breakdown of the findings will be included in the forthcoming summary report.

Processed Avocado and Guacamole Sampling Results as of 10152019

In 2013, five years after the nationwide Salmonella outbreak in 2009 that killed 9 people and sickened more than 700, the U.S. Department of Justice on Thursday announced a 76-count indictment has been filed charging four former officials of the Peanut Corporation of America (PCA) and a related company for selling Salmonella-contaminated peanut butter products.

Former PCA owner and president Stewart Parnell, of Lynchburg, VA, and three other former company leaders, have been charged with mail and wire fraud, the introduction of adulterated and misbranded food into interstate commerce with the intent to defraud or mislead, and conspiracy, according to the Department of Justice.  Stewart Parnell and two others were also charged with obstruction of justice.

In a White House press release, DOJ said charges against former PCA operations manager Daniel Kilgore, of Blakely, GA, was unsealed and that he pleaded guilty to charges of mail and wire fraud, the introduction of adulterated and misbranded food into interstate commerce with the intent to defraud or mislead, and conspiracy.

The investigation into the activity at PCA began in 2009, after the U.S. Food and Drug Administration and the U.S. Centers for Disease Control and Prevention traced a national outbreak of Salmonella to a PCA plant in Blakely.  As alleged in the indictment, the Blakely plant was a peanut roasting facility where PCA roasted raw peanuts and produced granulated peanuts, peanut butter, and peanut paste; PCA sold these peanut products to its customers around the country.

In company emails obtained through investigation, Parnell allegedly ordered the shipment and sale of products known to be contaminated with Salmonella. When other lots of peanuts tested positive for Salmonella, he ordered them to be retested.

“These indictments will have a far reaching impact on the food industry,” said attorney Bill Marler, who represented hundreds of individuals in claims against PCA. “Corporate executives and directors of food safety will need to think hard about the safety of their product when it enters the stream of commerce.  Felony counts like this one are rare, but misdemeanor charges that can include fines and jail time can and should happen.”

The PCA indictment can be viewed here. Kilgore’s filed information can be viewed here.

Last night Food Safety News reported that Mary Wilkerson, quality control officer for the defunct Peanut Corporation of America, is free after serving a 5-year federal prison sentence for obstruction of justice. Wilkerson, 46 of Edison, GA., was released from a re-entry center, or half-way house, in Atlanta earlier this week. Her full release date was moved up by one month to Feb 2 by the U.S. Probation Office in Albany, GA. The mother of two has been separated from her husband and family for the past five years.

Wilkerson was indicted and tried with the company CEO and his brother, Stewart and Michael Parnell. Stewart Parnell was the chief executive of PCA, while Michael Parnell was its peanut broker.

Wilkerson’s offense was a “process crime” over misleading federal agents during the investigation. The government acknowledged she was not part of the conspiracy that led to the Salmonella poisonings that sickened thousands and killed nine. She was not responsible for making restitution to any of the victims.

Samuel Lightsey, who managed the PCA plant in Blakely, GA, at the time of the deadly outbreak, was the government’s star witness at trial and served less than three years.

Another former PCA plant manager, Daniel Kilgore, also made a deal with the government for his testimony for a six-year sentence. He’s next up for release, now set for Jan 30, 2021. He is at a minimum-security federal prison in Oakdale, LA.

Doing the most time for the PCA-related convictions, however, are the Parnell brothers. The Albany, GA, federal jury found Stewart guilty on 67 federal felony counts and Michael guilty on 30. The second generation of his family to run PCA, which spanned three southern states, Stewart was sentenced to 28 years in prison, and his brother to 20.