The Minnesota Departments of Health and Agriculture are working with the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration on a multi-state outbreak of listeriosis linked to eating caramel apples.

Four people in Minnesota have become ill as part of this outbreak. All were adults ages 59 to 90 years. They became ill in late October and November. All were hospitalized and two died.

Health officials are warning consumers who may have purchased any pre-packaged, commercially-produced caramel apples, including caramel apples with other toppings such as nuts, chocolate, and sprinkles, to not eat them until more information from the investigation becomes available.

Minnesota cases purchased caramel apples from Cub Foods, Kwik Trip, and Mike’s Discount Foods, which carried Carnival brand and Kitchen Cravings brand caramel apples. These two brands are no longer available for purchase at retail locations; however, health officials are concerned that persons who purchased them may still have them in their homes. The investigation is evolving, and other caramel apple brands and locations may also be impacted. Minnesota officials are working with national partners to determine the scope of products impacted. Consumers should not eat any brands of commercially-produced pre-packaged caramel apples until additional information is available. At this time, no illnesses related to this outbreak have been linked to apples that are not caramel-coated and not pre-packaged.

Listeriosis is a serious infection caused by eating food contaminated with the bacterium Listeria monocytogenes. The disease affects primarily older adults, pregnant women, newborns, and persons with weakened immune systems. On average, seven cases of listeriosis are reported in Minnesota each year. Symptoms of listeriosis include fever, muscle aches, headache, stiff neck, confusion, loss of balance, and convulsions. Infected pregnant women may experience only a mild, flu-like illness; however, infections during pregnancy can lead to miscarriage or stillbirth, premature delivery, or infection of the newborn. Symptoms begin from 3 to 70 days after consuming the bacteria.

I tend to focus on my job, and when your focus is on bacteria, the focus can be a bit narrow and small – some would say, microscopic.  I have said often that I pay attention to the things that can kill you quickly, not the broader issues around food, like the environment, worker safety and sustainability.

That is why when I picked up Ted Genoways’s new book: “The Chain: Farm, Factory, and the Fate of Our Food,” my small focus was both disturbed and enlightened, which is what a good – very good – book tends to do.  I was struck by many things in the book, but this phrase towards the end in many ways sums up my failure to look up from my work:

“… today, it seems that we are not so much concerned with safety as promoting an illusion of safety. We feel assured that we are protected from illness, when, in fact, the real illness is the pretense we, as Americans, must collectively agree upon— in order to maintain the mirage of safe food, a safe workplace, well- treated livestock, a healthy environment, a strong economy, and a cohesive and equitable culture.”

This is a book all consumers of food – which is all of us – should read.  I would send special copies to all farm state politicians – with a special audio copy to the Governor of Iowa.  We all need to lift our focus on making our food safe, plentiful and affordable, but not at the expense massive environmental degradation, worker – especially migrate worker abuse, and risks of zoonotic disease.

Thank you Ted for writing this book.  You honored agriculture – especially those who risk their health and lives to feed us.

Bleating Heart Cheese (BHC) is conducting a voluntary recall of a few of its sheep milk and cow’s milk cheese produced in late May, late June and early July of 2014, based on sampling by the US Food & Drug Administration (FDA) that found the presence of Listeria monocytogenes in at least one sample of the following cheeses. At this time, no illnesses have been reported, but to reduce possible health risks and ensure that all suspect product is removed from the marketplace, BHC is initiating this voluntary recall in cooperation with the California Departments of Food & Agriculture and Public Health.

  1. “Ewelicious Blue” – natural rind, aged 2 – 3 months, identifying code 14-0618 on the bottom side of the label
  2. “Fat Bottom Girl” – natural rind, aged 2 – 3 months, identifying code 14-0702 on the bottom side of the label
  3. “Goldette Tommette” – natural rind, aged 2 – 3 months, identifying code 14-0527 on the bottom side of the label

These specific cheeses and lot numbers were distributed or sold beginning on October, 2014 to distributors servicing the San Francisco Bay area retail food shops, restaurants and stores.

AP reports that our clients, Melissa and Andrew Kay, whose 8-year-old son Joshua died after eating ground beef contaminated with E. coli O157:H7 filed suit against Whole Foods Market and Doniphan, Missouri-based Rain Crow Ranch, according to court documents. The couple is seeking unspecified damages.

The couple bought the grass-fed ground beef at a Whole Foods in South Weymouth, Mass., according to the lawsuit which was filed in US District Court in Boston. Two other individuals also became sick. On Aug. 15, Whole Foods Markets in South Weymouth and Newton, Mass. recalled 368 lbs. of ground-beef products on concerns of E. coli O157:H7 contamination.

Court documents state that traceback investigation indicated all three individuals consumed ground beef purchased from two Whole Foods locations before betting sick. Joshua Kaye was later admitted to Boston Children’s Hospital. He had developed hemolytic uremic syndrome, a complication of E. coli O157:H7 infection. Joshua Kaye died on July 7.

A stool sample taken from Joshua Kaye resulted in an E. coli 0157:H7 positive culture that identically matched the Whole Foods Market E. coli 0157:H7 outbreak strain, court documents said.

The CDC reports as of December 15, 2014, a total of 111 people infected with the outbreak strains of Salmonella Enteritidis have been reported from 12 states. Connecticut (8), Maine (4), Maryland (5), Massachusetts (35), Montana (1), New Hampshire (6), New York (21), Ohio (3), Pennsylvania (17), Rhode Island (7), Vermont (3) and Virginia (1).  Twenty-six percent of ill persons have been hospitalized. No deaths have been reported.

Collaborative investigation efforts of state, local, and federal public health and regulatory agencies indicate that bean sprouts produced by Wonton Foods, Inc. are the likely source of this outbreak.   On November 21, 2014, Wonton Foods Inc. agreed to destroy any remaining products while they conducted a thorough cleaning and sanitation and implemented other Salmonella control measures. On November 24, the firm completed the cleaning and sanitation and resumed production of bean sprouts. The firm resumed shipment on November 29, 2014.

CDC recommends that consumers, restaurants, and other retailers always practice food safety for sprouts.  Children, older adults, pregnant women, and persons with weakened immune systems should avoid eating raw sprouts of any kind (including alfalfa, clover, radish, and mung bean sprouts).  Cook sprouts thoroughly to reduce the risk of illness. Cooking sprouts thoroughly kills any harmful bacteria

A new study finds that between 2010 and 2012, five percent of all U.S. food-borne outbreaks with a known source were tied to raw milk.  The research is in the CDC journal Emerging Infectious Diseases. [Elisabeth A. Mungai, Casey Barton Behravesh and L. Hannah Gould, Increased Outbreaks Associated with Nonpasteurized Milk, United States, 2007–2012].  Also, see downloadable infographic.

Microbes in raw milk—including salmonella, E. coli, campylobacter and Listeria—caused an average of three outbreaks per year between 1993 and 2006. But the new study finds an average of 13 such outbreaks annually from 2007 through 2012.

During that time raw milk consumption resulted in 979 illnesses and 73 hospitalizations. And more than 80 percent of such cases occurred in states where selling raw milk is legal.

More information from the CDC can be found here.

Also, for additional information about raw milk risks, see Real Raw Milk Facts.

Flat Creek Farm & Dairy of Swainsboro, GA has recalled 3 lots of cheese with lot codes 140802XAZ (Aztec Cheddar), 140702XAZ (Low Country Gouda voluntary recall) and 140725XGO (Aztec Cheddar voluntary recall) because of potential to be contaminated with Salmonella. Salmonella is an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy individuals may suffer only short-term symptoms such as high fever, severe headache, vomiting, nausea, abdominal pain and diarrhea. Long-term complications can include severe arthritis. The lot codes can be found on the front of the packages.

As of November 25, 2014 at 11:00am, according to Flat Creek records, all of the purchasers have been notified and all but 1.5 pounds of the cheese has been recovered. Two of the batches of raw milk cheese (lot codes 140702XAZ and 140725XGO) have been tested by an independent lab. The results were negative for contamination, but they are being voluntarily recalled and destroyed by Flat Creek.

Aztec Cheddar and Low Country Gouda was distributed in certain parts of Georgia via Flat Creek delivery and (1) online order (www.flatcreekdairy.com), which have all been notified. The product is packed in clear plastic and ranges in sizes from ½ pound to whole wheels. The results were negative for contamination, but they are being voluntarily recalled and destroyed by Flat Creek.

All of the raw milk cheese has been destroyed. Flat Creek Dairy is no longer producing raw milk cheese and has begun gently pasteurizing its artisanal cheeses.

The recall was the result of a routine sampling program conducted by the Georgia Department of Agriculture, which revealed that the finished products were contaminated. The company has identified the source of the problem and has eliminated it from future batches.

No illnesses have been reported to date.

The Morbidity and Mortality Weekly Report (MMWR) series is prepared by the Centers for Disease Control and Prevention (CDC).  Often called “the voice of CDC,” the MMWR series is the agency’s primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations.

MMWR readership predominantly consists of physicians, nurses, public health practitioners, epidemiologists and other scientists, researchers, educators, and laboratorians – and, at least one lawyer.  The data in the weekly MMWR are provisional, based on weekly reports to CDC by state health departments.

Botulism – 13 foodborne cases thus far in 2014 – not broken down by state.

Hepatitis A – 12 reported cases – Ohio (4), Maryland (1), North Carolina (1), California (1), Oregon (1), Washington (2) and Texas (2) – in the current week, bring the yearly total to 1,046.

Salmonella – 464 reported cases – Maine (1), Vermont (1), New York (14), Pennsylvania (12), Michigan (1), Ohio (21), Kansas (2), Missouri (9), Nebraska (3), Delaware (1), Florida (103), Georgia, (13), Maryland (20), North Carolina (43), South Carolina (8), Alabama (1), Tennessee (7), Arkansas (11), Oklahoma (8), Texas (104), Arizona, (4), Colorado (9), Idaho (4), Montana (1), California (44), Hawaii (2) and Washington (17) – in the current week, bring the yearly total to 44,651.  For Connecticut, Maine, Massachusetts, Montana, New Hampshire, New York, Ohio, Pennsylvania, Rhode Island, Vermont and Virginia you may well be seeing the tail end of an 11 state Salmonella sprout outbreak that has sickened 87.

Shiga toxin – Producing E. coli (O157:H7 and other STEC) – 50 reported cases – Maine (1), Vermont (1), New York (5), Pennsylvania (4), Ohio (4), Nebraska (3), Florida (4), Maryland (3), North Carolina (4), Tennessee (2) Oklahoma (2), Idaho (1), California (2), Oregon (2) and Washington (19)– in the current week, bring the yearly total to 4,758.  For what it is worth, 19 ill in one week in Washington seems a bit concerning.

Shigella – 215 reported cases – New Jersey (1), New York (22), Pennsylvania (2), Michigan (2), Ohio (12), Missouri (43), Nebraska (1), Delaware (1), D.C. (1), Florida (44), Georgia (18), Maryland (4), North Carolina (4), South Carolina (2), Virginia (3), Alabama (6), Kentucky (4), Mississippi (4), Tennessee (16), Arkansas (8), Louisiana (3), Oklahoma (1), Texas (45), Arizona (6), Colorado (1), Montana (4), California (9) and Washington (3) – in the current week, bring the yearly total to 16,942.

PDF Version of above data.

I had not noticed before that two-foodborne pathogens, Campylobacter and Listeria seem to be unaccounted for by MMWR although they are tracked by FoodNet. I would like to know why especially given that the CDC itself has noted that the number of outbreaks caused by Campylobacter increased from 15 outbreaks in 2009 to 25 in 2010, 30 in 2011, and 37 in 2012. During 2011 and 2012, 37 outbreaks were linked to foods with unpasteurized (raw) milk was responsible for the largest number of outbreaks.  For Listeria, the CDC has noted that Listeriosis (infection with Listeria monocytogenes) was added to the list of nationally notifiable diseases in 2001.  And, according to the CDC, Listeria monocytogenes is estimated to cause nearly 1,600 illnesses each year in the United States; more than 1,400 related hospitalizations and 250 related deaths occur.

I think some reader will help me with the missing bugs?

And, someone did – Hidden on the first page of the report was Listeria with nine for current week from Pennsylvania (2), Maryland  (1), Florida (1), Oklahoma (1), Texas  (1), Colorado (1), Washington (1) and Oregon (1) with a total of 609 2014.

Several recalls of cheese and dairy products produced by Oasis Brands, Inc. due to possible Listeria monocytogenes contamination have been announced by FDA.

  • On August 4, 2014, Oasis Brands, Inc. voluntarily recalled quesito casero (fresh curd) due to possible Listeria monocytogenes contamination after the pathogen was isolated from quesito casero produced by this firm.
  • On October 6, 2014, Oasis Brands, Inc. recalled cuajada en hoja (fresh curd) after U.S. Food and Drug Administration (FDA) isolated Listeria monocytogenes from environmental samples collected from the production facility.
  • On October 16, 2014, Oasis Brands, Inc. recalled various Lacteos Santa Martha and one HonduCrema brand cheese and dairy products.
  • At this time, Oasis Brands, Inc. has ceased manufacturing of all products, including the recalled products.

Whole-genome sequences of the Listeria monocytogenes strains isolated from recalled quesito casero cheese produced by Oasis Brands, Inc. were found to be highly related to sequences of Listeria strains isolated from one person who became ill in September 2013 and four persons who became ill during June through October 2014.

  • These five ill persons were reported from four states: Georgia (1), New York (1), Tennessee (2), and Texas (1).
  • Four of the five ill persons were hospitalized. One death was reported in Tennessee. Three illnesses were related to a pregnancy – one of these was diagnosed in a newborn.
  • All ill persons were reported to be of Hispanic ethnicity and reported consuming Hispanic-style soft cheese. Two persons who were able to answer questions about specific varieties of Hispanic-style soft cheeses reported consuming quesito casero, though neither could remember the brand.

Let’s learn from history.

In January 2013, local, state, and federal public health officials, including the Centers for Disease Control and Prevention (CDC), announced an outbreak of Salmonella Typhimurium linked to consumption of ground beef produced by defendants Jouni Halal and Gab Halal.  Public health investigators used DNA “fingerprints” of Salmonella bacteria obtained through diagnostic testing with pulsed-field gel electrophoresis (PFGE) to identify patients considered to be part of the outbreak.  Collaborative investigative efforts indicated that ground beef produced by Jouni Meats, Inc. and Gab Halal Foods were the likely source of the outbreak.  See http://www.cdc.gov/salmonella/typhimurium-01-13/.  As set forth previously, the beef from which Gab Halal and Jouni Halal produced the ground beef was manufactured and distributed by AFG, Dakota Premium, and Saad Wholesale Meats.

A total of 22 persons infected with the outbreak strain were reported from six states:  Arizona, Illinois, Iowa, Michigan, Pennsylvania, and Wisconsin. Among persons for whom information was available, illness onset dates ranged from December 9, 2012 to February 20, 2013.  Ill persons ranged in age from 2 years to 87 years. Among 14 persons with available information, seven ill persons were hospitalized.  No deaths were reported.

Initial investigations focused on seven ill persons in Michigan (6) and Arizona (1) who reported eating at the same restaurant before their illness began.  This restaurant was Ike’s, located in Sterling Heights, Michigan.  The Arizona resident had traveled to Michigan, where he or she ate at Ike’s.  These seven individuals included Mary Ann Thomas and Sara Joseph.  By the end of the investigation, additional illnesses linked to the consumption of kibbeh at Ike’s were discovered, bringing the total number of people sickened in the potion of this outbreak linked to Ike’s restaurant to 12.  All seven of the initial ill persons reported eating raw ground beef kibbeh (a dish typically made of finely ground red meat, usually lamb, minced onions, and bulgur wheat) at this restaurant before becoming ill.  The other cases in the outbreak—i.e., those ill individuals not exposed to the beef at Ike’s—were exposed to the contaminated AFG/Dakota Premium beef at other retail locations nationally.

On January 24, 2013 Jouni Meats, Inc. recalled approximately 500 pounds of ground beef products.[1]  In the USDA recall news release announcing this recall, USDA stated that the investigation identified that raw ground beef was consumed at a restaurant. The products subject to recall are various size packages of ground beef. These products were produced by defendants AFG and Dakota Premium between December 4, 2012 and December 9, 2012, and were distributed to Ike’s restaurant, and also sold directly to consumers at Jouni Meats, Inc.  On January 25, 2013 Gab Halal Foods recalled approximately 550 pounds of ground beef products.[2]  The products subject to recall are various size packages of ground beef wrapped in clear plastic. These products were produced by defendants AFG and Dakota Premium between December 4, 2012, and December 10, 2012, and also distributed to Ike’s restaurant, and sold directly to consumers at Gab Halal Foods.

On March 15, 2013 the CDC issued a final notice declaring the outbreak to be over.[3]  The state of Michigan submitted its final report on the outbreak to the CDC in the form of a “National Outbreak Reporting System” form.  This NORS form sets forth the investigative conclusions for the portion of this multi-state outbreak that occurred at Ike’s restaurant in Michigan.  At the top of page 1 of the NORS Form, it is stated that the outbreak was linked to “Ike’s kibbeh nayeh.”  Page 2 of the form sets forth a section titled “Trace back,” where Jouni Halal and Gab Halal are identified as the “meat retailer/supplier” to Ike’s restaurant.  On the same page, in the section titled “Remarks,” Michigan Department of Agriculture states as follows:

Regarding traceback, additional traceback information was gathered, identifying the secondary and tertiary suppliers to the 2 firms [Gab Halal and Jouni Halal] involved in the recall.  The information was shared with USDA FSIS investigators for further traceback to the slaughter/processor [AFG and Dakota Premium].  This report includes only those cases in cluster 1212MIJPX-1 that were linked to the Ike’s restaurant cluster.

Finally, and quite notably with regard to the identification of the subject ground beef as the source of this outbreak, during random sampling by USDA at a beef slaughter/processing plant in Minnesota, a sample tested positive for Salmonella Typhimurium matching the outbreak strain by DNA testing.  USDA does not disclose the name of the beef plants where positive tests occur, but because traceback of the beef that was epidemiologically associated with the Ike’s cluster and this outbreak generally lead back to AFG/Dakota Premium, which is located in Minnesota, it is conclusive that the USDA sample was from AFG/Dakota Premium.