The CDC is MIA in Listeria and Salmonella Outbreaks

“Two multi-state foodborne illnesses outbreaks have been reported by the FDA since the beginning of the year,” William “Bill” Marler, owner of Marler Clark, Inc., PS, The Food Safety Law Firm. “However, contrary to how outbreaks have been publicly announced  and posted on line for decades, the CDC has remained silent,” added Marler.

Last month, the FDA announced that they were investigating illnesses in a multistate outbreak of Salmonella Enteritidislinked to Sweet Cream-brand mini pastries made in Italy and exported to the United States through a Canadian company. 

One January 21, 2025, the FDA was notified by Canadian Food Inspection, that the same strain of Salmonella linked to Sweet Cream-brand mini pastries, was responsible for a United States Salmonella outbreak.  A recall of this product was initiated with the two distributors in the United States. The FDA conducted a traceback investigation that indicated the Sweet Cream-brand pastries were consumed by one of those sickened at a restaurant which received product from one of the U.S. distributors.  

Facts of Salmonella Outbreak (as of January 29, 2025)

  • Case count: 18 people infected with the outbreak strain, one person hospitalized, no deaths. 69 victims in five Canadian provinces
  • 7 States reported cases – California, Illinois, Massachusetts North Carolina, New Jersey, New York, and Pennsylvania
  • 60% of those sickened reported eating the pastries

On November 25, 2024, FDA was notified about an outbreak of Listeria monocytogenes in the United States, with many ill people residing in long-term care facilities (LTCF) prior to illness onset. FDA’s traceback investigation identified that each of the LTCF who supplied invoice information for review from 2024 to present received a frozen supplemental shake of either Lyons ReadyCare or Sysco Imperial brand. As part of this investigation, FDA collected environmental samples and found the outbreak strain of Listeria.

Facts about Listeria Outbreak

  • Case Count: 38 Sick – 37 Hospitalized – 11 Deaths
  • Illness Range: 2018 to the present
  • 21 States with Cases: Alabama, California, Colorado, Connecticut, Florida, Illinois, Indiana, Maryland, Michigan, Minnesota, Missouri, North Carolina, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Washington and West Virginia
  • Who is sick: 34 victims (89%) reported living in long term care facilities or were hospitalized prior to becoming sick

According to the FDA, this outbreak includes cases dating back to 2018, with 20 cases across 2024 and 2025, and is currently ongoing. Epidemiologic evidence in previous investigations were unable to identify a source of the outbreak. Certain Lyons ReadyCare and Sysco Imperial Frozen Supplemental Shakes are being voluntarily recalled.  

“The CDC site has not published anything about these two outbreaks or made an announcement of the recalls.  It is imperative to have active reporting on recalls by our government officials to help prevent more illnesses.  This is in the interest of public safety,” said Marler.  

William “Bill” Marler has been a food safety lawyer and advocate since the 1993 Jack-in-the-Box E. coli Outbreak which was chronicled in the book, “Poisoned” and in the recent Emmy Award winning Netflix documentary by the same name. Bill work has been profiled in the New Yorker, “A Bug in the System;” the Seattle Times, “30 years after the deadly E. coli outbreak, A Seattle attorney still fights for food safety;” the Washington Post, “He helped make burgers safer, Now he is fighting food poisoning again;” and several others. 

Dozens of times a year Bill speaks to industry and government throughout the United States, Canada, Europe, Africa, China and Australia on why it is important to prevent foodborne illnesses.  He is also a frequent commentator on food litigation and food safety on Marler Blog. Bill is also the publisher of Food Safety News.

For all media inquiries, please contact Julie Dueck, Media Relations Director, Marler Clark Inc., PS: jdueck@marlerclark.com.

Two multi-state foodborne illnesses outbreaks have been reported by the FDA since the beginning of the year. However, against how it has been done for decades, the CDC has remained silent. Why?

Last month, the FDA announced that it, the CDC, in collaboration with state, local, and international partners, were investigating illnesses in a multistate outbreak of Salmonella Enteritidis infections linked to Sweet Cream-brand mini pastries manufactured in Italy and exported into the United States by Importations Piu Che Dolci Inc. of Quebec, Canada.

On January 21, 2025, FDA was notified about an outbreak of Salmonella in the United States, which is the same strain investigated in Canada. Canadian Food Inspection Agency (CFIA) informed FDA that their investigation linked their outbreak to Sweet Cream-brand mini pastries, and Importations Piu Che Dolci Inc. initiated a recall of all Sweet Cream-brand mini pastry products with best by dates from 2025/06/17 through 2025/11/15 (June 17- November 15, 2025).

The recalled products were imported by two distributors in the U.S. who were contacted about the recall. One distributor had no product on hand, and the second distributor quarantined all product on hand and informed all of their downstream customers of the recall. As part of this investigation, FDA conducted traceback for one of the U.S. cases and identified that they were served recalled Sweet Cream-brand mini pastries at a restaurant prior to becoming sick. The restaurant received the pastries from one of the U.S. distributors.

The FDA reported as of January 29, 2025, a total of 18 people infected with the outbreak strain of Salmonella have been reported from seven states – California, Illinois, Massachusetts North Carolina, New Jersey, New York, and Pennsylvania. Of the 18 people for whom information is available, one person has been hospitalized. No deaths have been reported. Of the 5 people interviewed, 3 (60%) reported eating pastries.

In Canada there are 69 ill in the following provinces: British Columbia (4), Alberta (3) , Ontario (24), Quebec (37) and New Brunswick (1). Twenty-two have been hospitalized.

Yesterday, the FDA announced that it the CDC, in collaboration with state and local partners, are investigating illnesses in a multistate outbreak of Listeria monocytogenes infections linked to Lyons ReadyCare and Sysco Imperial Frozen Supplemental Shakes.

On November 25, 2024, FDA was notified about an outbreak of Listeria monocytogenes in the United States, with many ill people residing in long-term care facilities (LTCF) prior to illness onset. FDA’s traceback investigation identified that each of the LTCF who supplied invoice information for review from 2024 to present received a frozen supplemental shake of either Lyons ReadyCare or Sysco Imperial brand. As part of this investigation, FDA collected environmental samples and found the outbreak strain of Listeria.

According to FDA, this outbreak includes cases dating back to 2018, with 20 cases across 2024 and 2025, and is currently ongoing. Epidemiologic evidence in previous investigations were unable to identify a source of the outbreak. As of February 21, 2025, a total of 38 people infected with the outbreak strain of Listeria monocytogenes have been reported from 21 States – Alabama, California, Colorado, Connecticut, Florida, Illinois, Indiana, Maryland, Michigan, Minnesota, Missouri, North Carolina, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Washington and West Virginia.. Of the 38 people for whom information is available, 37 people have been hospitalized. Eleven deaths have been reported. Of the 38 people for whom information is available, 34 (89%) reported living in long term care facilities or were hospitalized prior to becoming sick. Records reviewed from facilities indicated nutritional shakes were available to residents.

FDA has been informed that certain Lyons ReadyCare and Sysco Imperial Frozen Supplemental Shakes are being voluntarily recalled. FDA is working with the recalling firms. FDA’s investigation is ongoing, and more information will be provided as it becomes available.

Here is what is on the CDC website about these two outbreaks as of this morning:

I cannot think of a worse places to serve Listeria-tainted food.

Case Count: 38 Sick – 37 Hospitalized – 11 Deaths

Illness Range: 2018 to the present.

States with Cases: Alabama, California, Colorado, Connecticut, Florida, Illinois, Indiana, Maryland, Michigan, Minnesota, Missouri, North Carolina, Nevada, New York, Ohio, Oklahoma, Pennsylvania, Tennessee, Texas, Washington and West Virginia.

Who is sick: (89%) reported living in long term care facilities or were hospitalized prior to becoming sick.

The FDA and CDC, in collaboration with state and local partners, are investigating illnesses in a multistate outbreak of Listeria monocytogenes infections linked to Lyons ReadyCare and Sysco Imperial Frozen Supplemental Shakes.

On November 25, 2024, FDA was notified about an outbreak of Listeria monocytogenes in the United States, with many ill people residing in long-term care facilities (LTCF) prior to illness onset. FDA’s traceback investigation identified that each of the LTCF who supplied invoice information for review from 2024 to present received a frozen supplemental shake of either Lyons ReadyCare or Sysco Imperial brand. As part of this investigation, FDA collected environmental samples and found the outbreak strain of Listeria.

According to CDC, this outbreak includes cases dating back to 2018, with 20 cases across 2024 and 2025, and is currently ongoing. Epidemiologic evidence in previous investigations were unable to identify a source of the outbreak. As of February 21, 2025, a total of 38 people infected with the outbreak strain of Listeria monocytogenes have been reported from 21 states. Of the 38 people for whom information is available, 37 people have been hospitalized. Eleven deaths have been reported. Of the 38 people for whom information is available, 34 (89%) reported living in long term care facilities or were hospitalized prior to becoming sick. Records reviewed from facilities indicated nutritional shakes were available to residents.

FDA has been informed that certain Lyons ReadyCare and Sysco Imperial Frozen Supplemental Shakes are being voluntarily recalled.  FDA is working with the recalling firms. FDA’s investigation is ongoing, and more information will be provided as it becomes available.

Boar’s Head Brand® is reinforcing its unwavering commitment to food safety with a company-wide initiative: “Boar’s Head Food Safety Promise Day.” Today, operations at all Boar’s Head facilities will pause for employees to come together to focus on the new and enhanced food safety and sanitation controls and processes that have been implemented across the organization. This initiative underscores Boar’s Head’s dedication to providing consumers with high-quality, safe products and cements that food safety is an integral part of the Company’s culture.

“From sourcing to production to delivery, Boar’s Head is implementing proactive safety measures at every step in making safe, high-quality food, and today everyone at Boar’s Head is doubling down on this promise to consumers,” said Frank Yiannas, MPH, former Deputy Commissioner for Food Policy & Response at the U.S. Food and Drug Administration (FDA) and Chief Food Safety Advisor to Boar’s Head. “Since last year’s recall and the examination into its cause, Boar’s Head has employed a series of leading-edge interventions and programs to further strengthen food safety protocols and to maintain the trusted quality that customers expect from the Boar’s Head brand. These enhancements build upon the Company’s 120-year commitment to quality and care, and position Boar’s Head to be at the forefront of food safety standards.”

Over the past several months, the Company has made significant progress in safety and quality, with several interventions and innovations implemented across the organization, including:

  • Upgraded to Processes that Provide Additional Layers of Protection as Part of its Transition to USDA’s Alternative 2 ListeriaControl Requirements 
    • Boar’s Head now utilizes high-pressure pasteurization, water pasteurization, and, in some cases, the addition of natural ingredients proven to inhibit the growth of food-borne pathogens. These processes bring the company to a higher food safety standard and are very effective in controlling microorganisms without compromising the quality or taste you expect.
  • Intensified Environmental Monitoring and Analysis Technologies
    • Boar’s Head has increased Listeria sampling across all its facilities and invested in cutting-edge laboratory testing and analysis technologies. These advancements allow for rapid detection and swift response to help maintain high sanitation standards.
  • Strengthened Sanitation Protocols
    • The Boar’s Head sanitation team has undergone additional third-party training, and daily cleaning and sanitation procedures have been bolstered. This includes hours each day dedicated to top-to-bottom cleaning and sanitizing of all manufacturing equipment, surfaces, and plant environments. Regular audits ensure the effectiveness of these practices.
  • Retrained Teams 
    • Starting last summer, Boar’s Head retrained team members at all facilities on updated and comprehensive food safety procedures and protocols to ensure employees are equipped to operate with the utmost care and attention to detail.
  • Piloting Advanced Supply Chain Visibility 
    • Boar’s Head is piloting battery-free smart tags that transmit critical safety and compliance information such as temperature, location, and product sequencing throughout the supply chain.
  • Established the independent Food Safety Advisory Council
    • Boar’s Head benefits from the expertise of an independent Food Safety Advisory Council. Led by Frank Yiannas, MPH, as Chief Food Safety Advisor, the Council includes three other distinguished food safety experts who provide a wealth of collective expertise.
  • Fostering a Strong Food Safety Culture 
    • The entire Boar’s Head team at all levels continues to promote a culture of safety and respect for the brand and each other. The Company embraces the high standards and values that have driven Boar’s Head for 120 years.

Boar’s Head is working every day to set a new industry standard in food safety. The Company has taken significant actions to ensure consumers can trust and enjoy Boar’s Head products.

Additional Information

The Company also noted that the CDC declared last year’s outbreak over in November 2024. All Boar’s Head products offered for sale are not affected by any recalls, and customers can continue to enjoy Boar’s Head products confidently.

As part of its normal course practices, the USDA maintains a daily presence in all Boar’s Head meat and poultry plants, conducting routine inspections. Furthermore, the USDA recently completed thorough reviews of all Boar’s Head meat and poultry plants, confirming their continued compliance with safety standards.

More details about Boar’s Head’s commitment to food safety can be found at boarshead.com/FoodSafety.

About Boar’s Head

Founded in 1905, Boar’s Head Brand has a deep commitment to upholding the highest standards for quality, refusing to take shortcuts that compromise the integrity of its products for the sake of convenience or economy. What started with just a few products has grown to over 500, ranging from premium delicatessen meats, cheeses and condiments to an array of Italian and Old World specialties, hummus, snacking and foodservice items.

WASHINGTON, Feb. 19, 2025—In response to a reduction in workforce at the U.S. Food and Drug Administration (FDA), a coalition of consumer, industry, and public health stakeholder groups issues the following statement: 

“Ensuring the safety of our nation’s food supply is a shared responsibility,” the coalition stated. “Food companies are committed to producing safe products. Maintaining safe, accessible, and affordable food is a fundamental public health priority and a key component of the Make America Healthy Again platform. An under-resourced food safety agency could jeopardize Secretary Kennedy’s stated objectives to improve nutrition and ingredient safety for children and adults. Adequate resources are critical not only for outbreak response but also for developing and updating food safety standards, providing science-based industry guidance, and ensuring a well-trained federal-state inspection force to protect the integrity of our food system.“

American Frozen Food Institute

Association of Food and Drug Officials

Association of Public Health Laboratories

Center for Science in the Public Interest

Consumer Brands Association

Consumer Federation of America

Consumer Reports

Council for Responsible Nutrition 

Global Cold Chain Alliance

Institute for Food Safety and Nutrition Security, George Washington University

International Dairy Foods Association

STOP Foodborne Illness

Darin Detwiler

Bill Marler

Jennifer McEntire

More people in the United States got sick from contaminated food in 2024 than the year before, and the number of people who were hospitalized or died doubled, according to U.S. PIRG Education Fund’s new report, Food for Thought 2025.

Of the people who were sickened by food in 2024, 98 percent of their illnesses came from just 13 outbreaks. This fact shows the consequences of companies producing or selling contaminated food. All but one of the outbreaks involved Listeria, Salmonella or E. coli, according to research done by PIRG. 

“This indicates that some companies just aren’t doing enough to keep bacteria from contaminating our food,” said Teresa Murray, Consumer Watchdog Director for U.S. PIRG Education Fund and co-author of Food For Thought 2025. “And, when contamination does happen, companies often don’t conduct proper testing to catch it before it makes us sick.” 

The statistics gathered by PIRG support the recurrent message that a lot of food was unsafe in 2024. Several high-profile recalls, from Boar’s Head deli meats to McDonald’s Quarter Pounders, punctuated the headlines. 

Meat and poultry recalls through the U.S. Department of Agriculture declined, while recalls by the U.S. Food and Drug Administration of everything else from produce to snacks increased.

Other key findings in the PIRG report:

                  •               More than 500 people were hospitalized or died in 2024 from contaminated food, up from about 240 in 2023.

                  •               The number of recalls because of Listeria, Salmonella or E. coli increased significantly and comprised 39 percent of all recalls.

                  •               One-third of recalls in 2024 stemmed from undeclared allergens or other ingredients that can make people sick.

                  •               Recalls of pet food increased, from seven in 2023 to 11 in 2024.

“Once again, everything from soup to nuts threatened our health in 2024,” Murray said. “If food producers and packagers just focused more on being sanitary and labeling packages for allergens, our food would be so much safer.”

Clearly a perfect time to gut FDA, FSIS and CDC?

So says Forbes this morning following reporting of yesterday in Reuters. As one good friend in public health said:

“The damage they are doing will take years or generations to repair.  It reminds me of giving somebody a haircut while blindfolded and wildly swinging a straight razor.”

Here is the full post on Forbes:

Over a thousand (1300) probationary workers at the Center for Disease Control are being let go by the Trump administration, representing about 45% of all probationary workers at the CDC.

The CDC employs 12,000 individuals, with thousands of probationary workers, most of whom work a year or less for the center. The layoffs occur amidst the massive cuts and cost savings President Trump attempts to implement to curb inflation and increase government efficiency.

Among those laid off include all 50 first-year officers of the CDC’s Epidemic Intelligence Service, and perhaps some second-year officers. The EIS, established in 1951, recruits some of the brightest public health leaders into a two-year program to train healthcare professionals to identify and respond to disease outbreaks.

EIS personnel are among the brightest frontline public health workers, many with masters and doctorate degrees that safeguard health in America and globally. Historically, these workers have responded to public health threats such as E. coli and cholera outbreaks, helped contained the Ebola Nigeria outbreak from 2014-216 as well as investigate the source of many food-borne illnesses and outbreaks in America and throughout the world.

Here are some ways these layoffs threaten science and public health:

Hinders Disease Surveillance

EIS officers have historically identified and controlled important health threats like COVID-19 and Zika. Their expertise allows for rapid response to emerging infectious diseases, which ultimately prevents widespread transmission. Firing frontline workers will have devastating consequences for public and global health, and will hinder the CDC’s ability to respond to outbreaks in a timely fashion.

This comes at a time where there is no shortage of public health threats. Currently, the flu is surging in America, with up to 23 million hospital visits for the flu and at least 370,000 hospitalizations, according to the CDC. In addition, the bird flu is spreading uncontrollably in animals and has killed one man in Louisiana. An Ebola outbreak has also been reported in Africa. America and the world are in desperate need of qualified public health practitioners who can manage all of these public health threats.

Impedes Development of Public Health Leaders

The EIS fellowship is widely considered an elite public health program that develops leaders, many of whom serve in the CDC itself or go on to become leaders in state health departments. The type of expertise required to handle public health emergencies and threats cannot be developed on “the fly”. We do not just expect people to wake up and become doctors, lawyers or engineers. These types of vocations take skill, time and often require years of advanced schooling. Without formal training in important fellowship programs like the EIS, the United States may encounter a long-term deficit of qualified public health professionals who are specifically trained in investigating diseases.

Compromises Data Analysis

EIS personnel play a vital role in gathering and interpreting scientific data, which often informs public health policy and the allocation of life-saving resources. With fewer manpower and resources, the quality and timeliness of data may be hindered, resulting in suboptimal responses to health threats. Science thrives through evidence-based data and evidence-based interventions.

We live in an era where misinformation and disinformation run rampant, particularly with the ease at which it spreads through social media. It is critical now, more than ever, that EIS officers have the support of the U.S. government to gather, interpret and make important decisions based on scientific data.

Increased Healthcare Costs

Despite the intention for these layoffs to reduce costs, firing CDC workers and particularly EIS personnel can actually paradoxically increase costs.

What happens when there is a potential infectious disease outbreak that results in significant transmission across the population? This may necessitate more emergency room visits, more physicians working long hours to care for patients and more life-saving interventions that would need to be implemented. All of this costs money due to hospitalizations and treatments. Keeping the CDC and EIS personnel fully staffed can actually reduce costs in the long-run by early detection and prevention of many potential public health threats.

Since President Trump has taken office, the entire landscape for public and global health has drastically changed. These cuts to healthcare personnel do not merely reflect cost savings, they are a threat to science and public health. The expertise of CDC workers and EIS personnel are indispensable in protecting and safeguarding the health for people all around the world. Without them, humanity is less prepared against future global health threats and progress in science and health will remain guarded.

Omer Awan Senior Contributor Dr. Omer Awan is a practicing physician who covers public health.

Although making sure that Salmonella contaminates chicken is bad for consumers and their families, U.S. Representative Tracey Mann (KS-01), Chairman of the House Agriculture Committee’s Subcommittee on Livestock, Dairy, and Poultry and Representative Steve Womack (AR-03), Chairman of the Congressional Chicken Caucus, seem content to allow more to get sick, so I have more work to do – thanks Tracy and Steve.

In ground beef, dangerous forms of E. coli are legally prohibited, and because of that legal fees from those cases have dropped to nearly zero. However, there is no USDA regulatory limit on Salmonella in chicken.  Every day, Salmonella-contaminated chicken leaves processing plants with USDA’s stamp of approval visible on the label.  Astounding, but true.  And consequential.  Some 125,000 people get sick and too many are hospitalized and die every year from Salmonella in chicken.  The stories of their experiences are excruciating.

In January 2021, a coalition of illness victims and consumer advocacy groups petitioned USDA to set enforceable standards for Salmonella in chicken and turkey.  Industry appeared to agree.  In September 2021, the scientists who lead the food safety programs at Purdue Farms, Tyson Foods, Wayne Farms, and Butterball joined the consumer groups and leading academic experts in a coalition letter to Secretary Vilsack calling on him to set such standards.  

But, Tracy and Steve seem intent on letting consumers get sick while stuffing money in my pockets. Here is their press statement.

January 23, 2025  Press Release

WASHINGTON, D.C. – Today, U.S. Representative Tracey Mann (KS-01), Chairman of the House Agriculture Committee’s Subcommittee on Livestock, Dairy, and Poultry and Representative Steve Womack (AR-03), Chairman of the Congressional Chicken Caucus, introduced legislation to protect poultry producers and consumers from a President Biden-era regulation that could put producers out of business and drive-up costs for consumers. The legislation prevents the U.S. Department of Agriculture (USDA) from using federal funds to carry out its proposed rule regarding Salmonella, which is not based in science nor indicates a major impact on consumer health. The Biden-era proposed rule disregards data from USDA that found Salmonella outbreaks have decreased 60% since 2020 and that more than 97% of whole chickens tested negative for Salmonella as recently as 2022. 

“American families have been clear about the weight that skyrocketing food prices and inflation have had on their ability to put food on their tables.” said Rep. Mann. “Rather than coming up with real solutions to drive down costs and make life easier for Americans, President Biden dug his heels deeper in his war on rural America with costly, burdensome regulations. My bill blocks USDA from using taxpayer dollars to implement arbitrary science to burden American families, and it protects America’s livestock producers who work day in and day out to feed a hungry world. I look forward to working with President Trump to end bad, Biden-era nonsense like this.” 

“The Biden Administration’s proposed Salmonella Framework places burdensome, unnecessary testing requirements on our nation’s poultry producers,” said Rep. Womack. “This leads to higher costs at the grocery store for consumers. I’m proud to help Congressman Mann introduce this bill to prevent federal funding from being used to implement this ludicrous regulatory requirement. I look forward to working with President Trump’s USDA to support America’s farmers and producers—the backbone of our great nation.

The National Chicken Council supports this bill.

Go figure.

Here we go again.

From the New York Health Department:

Anyone Who Ate Food From ilili Restaurant During January 31 – February 9, 2025 Should Get Hepatitis A Vaccine as a Precautionary Measure

Hepatitis A is an Extremely Contagious Liver Disease; It is Rarely Fatal

February 14, 2025 — The New York City Health Department was recently notified about a case of hepatitis A in a food handler at ilili Restaurant (236 Fifth Avenue, New York, NY 10001). No additional cases of illness have been identified to date.

As a precautionary measure, the NYC Health Department is urging patrons who dined at, or ordered take out from, ilili Restaurant between January 31 and February 9 to get a hepatitis A vaccination, if not previously vaccinated. In addition, all patrons who ate food from the restaurant between January 17 to February 9 should monitor for symptoms of hepatitis A for seven weeks following their meal.

“We are urging these restaurant patrons to consult with their providers and get the hepatitis A vaccine as a precautionary measure,” said Acting Health Commissioner Dr. Michelle Morse. “If people experience symptoms like yellowing of eyes and skin, fatigue, abdominal pain, nausea, and diarrhea, they should see a doctor immediately, especially if you have not had two doses of the hepatitis A vaccine. This incident serves as an important reminder to stay up to date with current vaccination recommendations, and to always wash your hands thoroughly to prevent the spread of disease.”

Hepatitis A can be spread by eating food that was touched by a person with the disease. People should get the vaccine within 14 days of exposure (the date they ate food from the restaurant) for the vaccine to be most effective at protecting against hepatitis A. The earlier the vaccine is given, the more effective it is in preventing the disease. In some cases, a dose of immune globulin (antibodies) is also needed, depending on the person’s age and health. People who ate food from the restaurant and have previously received two doses of hepatitis A vaccine or have already had hepatitis A infection, do not need another dose of the vaccine. People who were exposed but only received one dose in the past should get a second dose.

Hepatitis A is an extremely contagious liver disease that can spread from person to person by putting something in the mouth that has been contaminated with traces of fecal matter from an infected person. There are no special medicines or antibiotics that can be used to treat a person once the symptoms appear. Symptoms include jaundice (yellowing of eyes and skin), fatigue, abdominal pain, nausea, and diarrhea. People at risk for severe hepatitis A infection include those experiencing chronic liver disease, people with a weakened immune system, and people who are pregnant. Hepatitis A is very rarely fatal (fewer than 1% of cases).

Reminds me of a letter I wrote:

ACIP Secretariat

Advisory Committee on Immunization Practices 

1600 Clifton Road, N.E., Mailstop H24-8

Atlanta, GA 30329-4027

acip@cdc.gov

Re:  Letter to the CDC’s Committee on Immunization Practices – It is time to deal with Hepatitis A and Food Service Workers

Dear ACIP Secretariat:

The Advisory Committee on Immunization Practices (ACIP) provides advice and guidance to the Director of the CDC regarding use of vaccines and related agents for control of vaccine-preventable diseases in the civilian population of the United States. Recommendations made by the ACIP are reviewed by the CDC Director and, if adopted, are published as official CDC/HHS recommendations in the Morbidity and Mortality Weekly Report (MMWR).

Presently, approximately 5% of all hepatitis A outbreaks are linked to infected food-handlers.

Here is what the CDC continues to say about vaccinating food-handlers:

Why does CDC not recommend all food handlers be vaccinated if an infected food handler can spread disease during outbreaks?

CDC does not recommend vaccinating all food handlers because doing so would not prevent or stop the ongoing outbreaks primarily affecting individuals who report using or injecting drugs and people experiencing homelessness. Food handlers are not at increased risk for hepatitis A because of their occupation. During ongoing outbreaks, transmission from food handlers to restaurant patrons has been extremely rare because standard sanitation practices of food handlers help prevent the spread of the virus. Individuals who live in a household with an infected person or who participate in risk behaviors previously described are at greater risk for hepatitis A infection.

The CDC misses the point; granted, food service workers are not more at risk of getting hepatitis A because of their occupation, but they are a risk for spreading it to customers. Food service positions are typically low paying, and certainly have the likelihood of being filled by people who are immigrants from countries where hepatitis A might be endemic or by people who have been recently experienced homelessness.

Over the past several years, there has been an ongoing outbreak of hepatitis A in the United States. As of February 2, 2023, there have been a total of 44,779 cases with a 61% hospitalization rate (approximately 27,342 hospitalizations). The death toll stands at 421. Since the outbreak started in 2016, 37 states have reported cases to the CDC.

The CDC recommends to the public that the best way to prevent hepatitis A is through vaccination, but the CDC has not explicitly stated that food service workers should be administered the vaccination. While food service workers are not traditionally designated as having an increased risk of hepatitis A transmission, they are not free from risk. 

24% of hepatitis A cases are asymptomatic, which means a food-handler carrying the virus can unknowingly transmit the disease to consumers. Historically, when an outbreak occurs, local health departments start administering the vaccine for free or at a reduced cost. The funding from these vaccinations is through taxpayer dollars. 

A mandatory vaccination policy for all food service workers was shown to be effective at reducing infections and economic burden in St. Louis County, Missouri.

From 1996 to 2003, Clark Country, Nevada had 1,523 confirmed cases of hepatitis A, which was higher than the national average. Due to these alarming rates, Clark County implemented a mandatory vaccination policy for food service workers. As a result, in 2000, the hepatitis A rates significantly dropped and reached historic lows in 2010. The county removed the mandatory vaccine rule in 2012 and are now part of the ongoing hepatitis A outbreak. 

According to the CDC, the vaccinations cost anywhere from $30 to $120 to administer, compared to thousands of dollars in hospital bills, and offer a 95% efficacy rate after the first dose and a 99% efficacy after the second dose. Furthermore, the vaccine retains its efficacy for 15-20 years.  

During an outbreak, if a food service worker is found to be hepatitis A positive, a local health department will initiate post-exposure treatment plans that must be administered within a two-week period to be effective. The economic burden also affects the health department in terms of personnel and other limited resources. Sometimes, the interventions implemented by the local health department may be ineffective. 

Though there are many examples of point-source outbreaks of hepatitis A that have occurred within the past few years around the country, a particularly egregious outbreak occurred in the early fall of 2021 in Roanoke, Virginia. The health department was notified about the outbreak on September 21, 2021, after the first case was reported by a local hospital. The Roanoke Health Department, along with the Virginia Department of Health, investigated this outbreak.

Three different locations of a local restaurant, Famous Anthony’s, were ultimately determined to be associated with this outbreak. The Virginia Department of Health published a community announcement on September 24, 2021, about the outbreak and the potential exposure risk. 

For purposes of the investigation, a case was defined as a “[p]erson with (a) discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels and (c) [who] tested positive for hepatitis A (IgM anti-HAV-positive), and frequented any of three Famous Anthony’s locations, or was a close contact to the index case patient, during the dates of August 10 through August 27, 2021.”

As of November 2021, a total of 49 primary cases (40 confirmed and 9 probable) were identified in this outbreak. Two secondary cases were also identified. Cases ranged from 30 to 82 years of age (median age of 63). In all, 57 percent of cases were male. Thirty-one cases included hospitalizations, and at least 4 case patients died. Illness onsets occurred between August 25 and October 15, 2021.

Ultimately, the outbreak investigation revealed that a cook, who also had risk factors associated with hepatitis A, had been infected with hepatitis A while working at multiple Famous Anthony’s restaurant locations. This index case’s mother and adult son also tested positive for hepatitis A. Following an inspection, the outbreak inspector noted, “due to the etiology of hepatitis A transmission, it is assumed the infectious food handler did not perform proper hand washing or follow glove use policy.” It was determined that person-to-person spread was the most likely mode of transmission in this outbreak. Environmental contamination was also considered a possible mode of transmission. 

Overwhelmed by the number of victims who pursued legal action for their injuries, Famous Anthony’s filed for bankruptcy and several of its locations have been closed.

The tragedy of this preventable hepatitis A outbreak cannot be overstated. Four people died. In one family, two of its members lost their lives. Most of the victims were hospitalized. Many risked acute liver failures. At least one person required both a liver and kidney transplants. Medical bills for the victims totaled over $6,000,000 in acute costs with millions of dollars in future expenses.[1] And this all because one employee did not receive a $30-$120 hepatitis A vaccine.

Affordable prevention of future tragedies like the Famous Anthony’s outbreak is possible and necessary. The time has come to at least recommend vaccinations to food service workers to reduce the spread of hepatitis A.

Sincerely,

Bill Marler

On behalf of 31 hepatitis A 

victims and families

[1] Privately, via mail, I am providing medical summaries for 31 of the victims so there can be a clear assessment of the impacts of hepatitis A on consumers of food at the hands of one unvaccinated food service worker.

With no fanfare after 89 reported sick, the FDA closes its E. coli investigation into a romaine lettuce E. coli outbreak without telling the public more and the CDC continues to remain mum.

What we do know. Outbreak posting was 12/4/2024 as an E. coli 
O157:H7 event now tied to Romaine 
Lettuce.* The FDA says that 89 were sick and that the investigation is no closed despite conducting 
Traceback
, 
Inspection
 and Sampling.

Earlier the FDA said: The FDA and CDC, in collaboration with state and local partners were investigating illnesses in a multistate outbreak of E. coli O157:H7 infections linked to an iceberg and romaine lettuce blend served at catering events, restaurants, and a school. At the time, based on epidemiological information collected by CDC, a total of 69 people infected with the same strain of E. coli O157 had been reported from 10 states. FDA’s traceback investigation identified an iceberg and romaine lettuce blend from a common supplier as the source of this outbreak; however, impacted product identified to date appeared to be past shelf life and no longer on the market. Te FDA continued to work with the supplier to determine if any additional product could be impacted. At this time, there does not appear to be any ongoing risk to public health and there is no recommendation for consumers to avoid iceberg or romaine lettuce. FDA’s investigation was ongoing, and more information will be provided as it becomes available. 

Well, I guess not.