Criminal prosecutions in food cases have been quiet for the last few years.

Outbreak 2: The recent multistate investigation began on April 2, 2019, when CDC’s PulseNet identified the Salmonella Carrau outbreak. As of April 24, 2019, 117 people infected with the outbreak strain of Salmonella Carrau have been reported from 10 states – Minnesota, Iowa, Missouri, Michigan, Illinois, Wisconsin, Indiana, Ohio, Kentucky and Alabama.

Illnesses started on dates ranging from March 4, 2019, to April 8, 2019. Ill people range in age from less than one to 98 years, with a median age of 53. Fifty-eight percent are female. Of 88 people with information available, 32 (36%) have been hospitalized. No deaths have been reported.

Epidemiologic and traceback evidence indicate that pre-cut melon supplied by Caito Foods LLC of Indianapolis, Ind. is the likely source of this multistate outbreak.

Outbreak 1: Less than a year ago, on July 24, 2018, the CDC reported that 77 people infected with the outbreak strain of Salmonella Adelaide were reported from nine states – Arkansas, Florida, Illinois, Indiana, Kentucky, Michigan, Missouri, Ohio, Tennessee.

Illnesses started on dates ranging from April 30, 2018, to July 2, 2018. Ill people ranged in age from less than 1 year to 97, with a median age of 67. Among ill people, 67% were female. Out of 70 people with information available, 36 (51%) were hospitalized. No deaths were reported.

Epidemiologic and traceback evidence indicated that pre-cut melon supplied by the Caito Foods, LLC of Indianapolis, Indiana was the likely source of this multistate outbreak.

So, what about criminal sanctions? Could a person in a “position of responsibility or authority in a firm” above face criminal sanctions? Perhaps. Should they? That is a debate to have. It would make me nervous if I sat in a position of authority in one of the companies above or one of their suppliers.

By way of background, in 1938 Congress passed the Federal Food, Drug, and Cosmetic Act (FDCA) in reaction to growing public food safety demands.  The primary goal of the Act was to protect the health and safety of the public by preventing deleterious, adulterated or misbranded articles, including food, from entering interstate commerce.

Under section 402(a)(4) of the Act, a food product is deemed “adulterated” if the food was “prepared, packed, or held under insanitary conditions whereby it may have become contaminated with filth, or whereby it may have been rendered injurious to health.” A food product is also considered “adulterated” if it bears or contains any poisonous or deleterious substance, which may render it injurious to health. Chapter III of the Act addresses prohibited acts, subjecting violators to both civil and criminal liability.

Felony violations include adulterating or misbranding a food, drug, or device, and putting an adulterated or misbranded food, drug, or device into interstate commerce.  Any person who commits a prohibited act violates the FDCA.  A person committing a prohibited act “with the intent to defraud or mislead” is guilty of a felony punishable by years in jail and millions in fines or both. The key here is an intentional act.

A misdemeanor conviction under the FDCA, unlike a felony conviction, does not require proof of fraudulent intent, or even of knowing or willful conduct.  Rather, a person may be convicted if he or she held a position of responsibility or authority in a firm such that the person could have prevented the violation – prevented the tainted product from entering interstate commerce. Again, unlike a felony and misdemeanor charge is a crime with no intent.  Convictions under the misdemeanor provisions are punishable by not more than one year or fined not more than $250,000, or both.

The past as a guide? Here are four cases where prosecutors brought criminal charges – the first three are misdemeanor charges and the last a felony charge:

  • In 1998 in what was the first criminal conviction in a large-scale food-poisoning outbreak, Odwalla Inc. pleaded guilty to violating Federal food safety laws and agreed to pay a $1.5 million fine for selling tainted apple juice that killed a 16-month-old girl and sickened 70 other people in several states in 1996. Odwalla, based in Half Moon Bay, California pleaded guilty to 16 counts of unknowingly delivering ”adulterated food products for introduction into interstate commerce” in the October 1996 outbreak, in which a batch of its juice infected with the toxic bacteria E. coli O157:H7 sickened people in Colorado, California, Washington and Canada. Fourteen children developed a life-threatening disease (hemolytic uremic syndrome -HUS) that ravages kidneys. At the time, the $1.5 million penalty was the largest criminal penalty in a food poisoning case.  Odwalla also was on court-supervised probation for five years, meaning that it had to submit a detailed plan to the food and drug agency demonstrating its food safety precautions and that any subsequent violations could have resulted in more serious charges.
  • In 2012 Eric Jensen, age 37, and Ryan Jensen, age 33, brothers who owned and operated Jensen Farms, a fourth generation cantaloupe operation, located in Colorado, presented themselves to U.S. marshals in Denver and were taken into custody on federal charges brought by the U.S. Attorney’s Office with the Food and Drug Administration – Office of Criminal Investigation. According to the six-count indictment, Eric and Ryan Jensen unknowingly introduced adulterated (Listeria-tainted) cantaloupe into interstate commerce. The indictment further stated that the cantaloupe was prepared, packed and held under conditions, which rendered it injurious to health.  The outbreak sickened over 147, killing over 33 in 28 states in the fall of 2011.  The Jensen’s faced up to six years in jail and $1,500,000 in fines each. The eventually pleaded guilty and were sentenced to five years probation.
  • In 2013, Austin “Jack” DeCoster and his son, Peter DeCoster, both faced charges stemming from a Salmonella outbreak caused by their Iowa egg farms in 2010.  The Salmonella outbreak ran from May 1 to November 30, 2010, and prompted the recall of more than a half-billion eggs. And, while there were 1,939 confirmed infections, statistical models used to account for Salmonella illnesses in the U.S. suggested that the eggs might have sickened more than 62,000 people. The family business, known as Quality Egg LLC, pleaded guilty in 2015 to a federal felony count of bribing a USDA egg inspector and to two misdemeanors of unknowingly introducing adulterated food into interstate commerce. As part of the plea agreement, Quality Egg paid a $6.8-million fine and the DeCosters $100,000 each, for a total of $7 million.  Both DeCosters were sentenced to three months in jail. They are appealing the jail sentence.
  • In 2015 ConAgra Foods agreed to plead guilty and pay $11.2 million in connection with the shipment of Salmonella contaminated peanut butter linked to a 2006 through 2007 nationwide outbreak of that sickened over 700. ConAgra signed a plea agreement admitting that it unknowingly introduced Peter Pan and private label peanut butter contaminated with Salmonella into interstate commerce during the 2006 through 2007 outbreak.
  • In 2014 former Peanut Corporation of America owner Stewart Parnell, his brother and one-time peanut broker, Michael Parnell, and Mary Wilkerson, former quality control manager at the company’s Blakely, Georgia, plant, faced a federal jury in Albany, Georgia. The 12-member jury found Stewart Parnell guilty on 67 federal felony counts, Michael Parnell was found guilty on 30 counts, and Wilkerson was found guilty of one of the two counts of obstruction of justice charged against her. Two other PCA employees earlier pleaded guilty. The felony charges of introducing adulterated food into interstate commerce, “with the intent to defraud or mislead,” stemmed from a 2008 to 2009 Salmonella outbreak that sickened 714 and left nine dead. Stewart Parnell is now spending 28 years in prison and Michael 20. Mary Wilkerson is going to jail for 5 years.

If I was Caito, I would be nervous.

Bill Marler, food safety advocate and foodborne attorney since 1993, whose Seattle law firm, Marler Clark, has been contacted by victims of the recent E. coli O103 ground meat outbreak, and recent Salmonella outbreaks linked cut fruit and ground tuna, called today on those companies responsible to pay the medical bills and lost wages of all individuals who became ill.

“We know that at least 156 people became ill with E. coli infections after eating tainted beef and 130 became ill from eating either cut fruit or ground tuna. Unfortunately, those numbers will like rise in the coming week,”  Marler said.  “The cost of treating victims of E. coli and Salmonella infections can run in the tens of thousands of dollars, or in a severe case, even in the hundreds of thousands of dollars,” Marler continued. “These families need these companies to do more than promise to cooperate in the investigation into these outbreaks. They need to know that these companies intend to fulfill their corporate responsibility by looking out for their customers,” Marler added.

Marler noted that over the last two decades in other outbreak-situations, companies such as Chi-Chi’s, Dole, Jack in the Box, Con Agra, Odwalla and Sheetz advanced medical costs for outbreak victims whose illnesses were traced to their food products.

Since the Jack in the Box E. coli outbreak in 1993, where Bill recovered $15,600,000 for one of its victims, Bill has represented thousands of E. coli, Salmonella, Listeria, Hepatitis A and other foodborne illness victims against the largest corporations in the US and around the world. Total recoveries on behalf of victims are in excess of $650,000,000.

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.

Campylobacter, with poultry as a major source, is still the most commonly identified foodborne illness since FoodNet tracking began in 2013. Also, the incident of Salmonella Enteritidis, the most common Salmonella subtype for which poultry and eggs are often the source, has not declined over the last 10 years. Compared with 2015-2017 levels, incidence significantly increased in 2018 for Cyclospora (399%), Vibrio (109%), Yersinia (58%), STEC E. coli (26%), Campylobacter (12%), and Salmonella (9%).

Not much of a surprise to those who follow my blog.  Looks like biggest culprits are Chicken and Leafy Greens.

The CDC reported today that the incidence of three major foodborne pathogens Campylobacter, Salmonella  Enteritidis  and STEC E. coli has increased in 2018.

The Bug – Campylobacter: Campylobacter continues to be the most commonly identified infection in FoodNet since 2013.

What is the Government and Industry doing about it: Poultry is a major source of Campylobacter. In August 2018, FSIS began using a new testing method; in a study of that method, Campylobacter was isolated from 18% of chicken carcasses and 16% of chicken parts sampled. FSIS currently makes aggregated test results available and intends to update performance standards for Campylobacter contamination.

The Bug – Salmonella:  The incidence of infections with Salmonella Enteritidis has not declined in over 10 years.

What is the Government and Industry doing about it: Salmonella Enteritidis is adapted to live in poultry, and eggs are an important source of infections. By 2012, FDA had implemented the Egg Safety Rule, which requires preventive measures during the production of eggs in poultry houses and requires subsequent refrigeration during storage and transportation, for all farms with ≥3,000 hens. In December 2018, FSIS reported that 22% of establishments that produce chicken parts failed to meet the Salmonella performance standard. The percentage of samples of chicken meat and intestinal contents that yielded Enteritidis were similar in 2018 to those during 2015–2017.

The Bug – E. coli:  STEC E. coli has increased in 2018.

What is the Government and Industry doing about it: Produce is a major source of foodborne illnesses. During 2018, romaine lettuce was linked to two multistate outbreaks of STEC O157 infections. FDA is implementing the Produce Safety Rule, with routine inspections of large produce farms planned this spring. Because produce is a major component of a healthy diet and is often consumed raw, making it safer is important for improving human health.

Full Report:

 

Link between two producers of meat and the recalls unclear (How are the two connected?  Presumably a common supplier?) except that both recalls were prompted by positive E. coli O103 tests on “Unopened, intact, packages of ground beef collected as part of the ongoing investigation tested positive for E. coli O103 at an FSIS laboratory.”

Recall No. 2 landed in my inbox about 9PM Wednesday night on the ongoing E. coli O103 outbreak that has now sickened a total of 156 people infected with the outbreak strain of E. coli O103 from 10 states. Twenty people have been hospitalized.  This 2nd recall states:

Grant Park Packing, a Franklin Park, Ill. establishment, is recalling approximately 53,200 pounds of raw ground beef products that may be contaminated with E. coli O103, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.

The bulk raw ground beef was produced on October 30-31, 2018 and November 1, 2018.  The following products are subject to recall:

  • 40-lb. bulk cardboard boxes of “North Star Imports & Sales, LLC. 100% GROUND BEEF BULK 80% LEAN/ 20% FAT” marked “FOR INSTITUTIONAL USE ONLY” with lot code GP.1051.18 and pack dates 10/30/2018, 10/31/2018, and 11/01/2018.

The products subject to recall bear establishment number “EST. 21781” inside the USDA mark of inspection. These items were shipped to Minnesota for further distribution and Kentucky for institutional use.

FSIS and its public health partners, including the Centers for Disease Control and Prevention (CDC) and the Kentucky Department for Public Health, have been investigating an outbreak of E. coli O103. Unopened, intact, packages of ground beef collected as part of the ongoing investigation tested positive for E. coli O103 at an FSIS laboratory. The sample was collected at a point of service where multiple case patients ate. At this time, there is no definitive link between this positive product and the ongoing E. coli O103 outbreak. Further traceback and product analysis continues to determine if the recalled products are related to the E. coli O103 outbreak.

The first recall hit my inbox abut 10PM on Tuesday.  That recall states:

FSIS reported moments ago, K2D Foods, doing business as (DBA) Colorado Premium Foods, a Carrolton, Ga. establishment, is recalling approximately 113,424 pounds of raw ground beef products that may be contaminated with E. coli O103, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.  This is a Class I Recall.

The raw ground beef items were produced on March 26, March 29, April 2, April 5, April 10, and April 12, 2019.  The following products are subject to recall:

  • Two 24-lb. vacuum-packed packages in cardboard boxes containing raw “GROUND BEEF PUCK” with “Use Thru” dates of 4/14/19, 4/17/19, 4/20/19, 4/23/19, 4/28/19, and 4/30/19.

The products subject to recall bear establishment number “EST. 51308” inside the USDA mark of inspection on the boxes. These items were shipped to distributors in Ft. Orange, Fla. and Norcross, Ga. for further distribution to restaurants.

FSIS and its public health partners, including the Centers for Disease Control and Prevention (CDC) and the Tennessee Department of Health, have been investigating an outbreak of E. coli O103. Unopened, intact ground beef collected as part of the ongoing investigation from a restaurant location, where multiple case-patients reported dining, tested positive for E. coli O103. At this time, there is no definitive link between this positive product and the ongoing E. coli O103 outbreak. Further traceback and product analysis continues to determine if the recalled products are related to the E. coli O103 outbreak.

The CDC, public health and regulatory officials in several states, and the U.S. Food and Drug AdministrationExternal are investigating a multistate outbreak of Salmonella Carrau infections.

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting is performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE. WGS showed that isolates from ill people were closely relatedly genetically. This means that people in this outbreak are more likely to share a common source of infection.

The multistate investigation began on April 2, 2019, when PulseNet identified the outbreak. As of April 24, 2019, 117 people infected with the outbreak strain of Salmonella Carrau have been reported from 10 states – Minnesota, Iowa, Missouri, Michigan, Illinois, Wisconsin, Indiana, Ohio, Kentucky and Alabama.

Illnesses started on dates ranging from March 4, 2019, to April 8, 2019. Ill people range in age from less than one to 98 years, with a median age of 53. Fifty-eight percent are female. Of 88 people with information available, 32 (36%) have been hospitalized. 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 4 weeks.

Epidemiologic and traceback evidence indicate that pre-cut melon supplied by Caito Foods LLC of Indianapolis, Ind. is the likely source of this multistate outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Forty-six (73%) of 63 people interviewed reported eating pre-cut melons purchased at grocery stores, including pre-cut cantaloupe, watermelon, honeydew, or a fruit salad mix or fruit tray with melon. Five additional people reported eating pre-cut melon outside the home.

Information collected from stores where ill people shopped indicates that Caito Foods LLC supplied pre-cut melon to these stores. On April 12, 2019, Caito Foods, Inc. recalledExternal pre-cut watermelon, honeydew melon, cantaloupe, and pre-cut fruit medley products containing one of these melons produced at the Caito Foods LLC facility in Indianapolis, Ind.

  • FDA inspectors found Listeria in 19 of the plants (21 percent) and Salmonella in one
  • More than half of the facilities (45) had 39 objectionable and 39 insanitary practices
  • Six facilities were selected for extremely unsanitary practices
  • The findings prompted three voluntary recalls,

According to an FDA Press Release today:

 

“Inspecting food facilities and collecting and testing samples from the environment where foods are produced are two of the many ways the FDA works to better understand microbial hazards and to help prevent contaminated products from reaching consumers. These activities help the FDA gather data and information necessary to develop prevention-based systems and, when contamination does occur, to respond swiftly to these hazards. Following a string of safety issues related to a number of U.S. ice cream distributors, the FDA engaged a team to inspect and obtain environmental samples from 89 ice cream production facilities in 32 states to test for Listeria monocytogenes and Salmonella. Although many of these facilities were adhering to good manufacturing practices, we did find that some were in violation of the law,” said Frank Yiannas, FDA Deputy Commissioner for Food Policy and Response. “Findings from our inspections resulted in three voluntary recalls that were conducted in 2017 and 2018 to protect public health. We also collaborated with inspected companies to help them make needed corrections and implement food safety plans designed to keep harmful bacteria out of their products and protect American consumers. These results serve as an important reminder to all food facilities distributing products in the U.S. of the importance of complying with rules set forth to mitigate safety issues. Ultimately, we must work together to ensure all necessary protective steps are taken so that Americans can continue having confidence that the foods available for purchase in the U.S. are safe and wholesome.”

 

The U.S. Food and Drug Administration today released a report on its findings from inspections and environmental sampling for Listeria monocytogenes and Salmonella at 89 ice cream production facilities in 32 states from Sept. 12, 2016 to Aug. 30, 2017. The agency began the sampling assignment following 16 recalls of ice cream products that occurred from 2013 to 2015 due to the presence of pathogens, and an outbreak of listeriosis linked to an ice cream maker in 2015 that involved three deaths. The sampling was designed to gain insights into the extent to which Listeria monocytogenes and Salmonella may be in the manufacturing environment, and to evaluate each establishment’s ability to identify, prevent, reduce, and/or eliminate microbial hazards of public health concern. No objectionable conditions or practices were observed in nearly half of the ice cream production facilities inspected. The FDA did detect Listeria monocytogenes in 19 of the facilities; however, only one of them was found to have the pathogen on a food-contact surface. The FDA also detected Salmonella in one facility.

As a result of these findings, three voluntary recalls were conducted in 2017 and 2018. These include two voluntary recalls of Working Cow Homemade Inc. ice creams due to potential contamination with Listeria monocytogenes, and a Nelson’s Creamery LLC recall due to undeclared soy lecithin in one of their products. The FDA also suspended Working Cow Homemade Inc.’s food facility registration in 2018. The FDA lifted the suspension earlier this year after the firm changed its business model to cease making ice cream and only distribute product made by other manufacturers.

The findings affirm the need for commercial ice cream makers to ensure that they are controlling hazards in accordance with the Preventive Controls for Human Food rule established by the FDA Food Safety Modernization Act. Companies that follow the rule and employ robust environmental monitoring programs will likely occasionally detect environmental pathogens, but how an establishment responds to a pathogen finding is critical.

For some reason it reminded me of a song my dad used to sing me.

FSIS reported moments ago, K2D Foods, doing business as (DBA) Colorado Premium Foods, a Carrolton, Ga. establishment, is recalling approximately 113,424 pounds of raw ground beef products that may be contaminated with E. coli O103, the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS) announced today.  This is a Class I Recall.

The raw ground beef items were produced on March 26, March 29, April 2, April 5, April 10, and April 12, 2019.  The following products are subject to recall:

  • Two 24-lb. vacuum-packed packages in cardboard boxes containing raw “GROUND BEEF PUCK” with “Use Thru” dates of 4/14/19, 4/17/19, 4/20/19, 4/23/19, 4/28/19, and 4/30/19.

The products subject to recall bear establishment number “EST. 51308” inside the USDA mark of inspection on the boxes. These items were shipped to distributors in Ft. Orange, Fla. and Norcross, Ga. for further distribution to restaurants.

FSIS and its public health partners, including the Centers for Disease Control and Prevention (CDC) and the Tennessee Department of Health, have been investigating an outbreak of E. coli O103. Unopened, intact ground beef collected as part of the ongoing investigation from a restaurant location, where multiple case-patients reported dining, tested positive for E. coli O103. At this time, there is no definitive link between this positive product and the ongoing E. coli O103 outbreak. Further traceback and product analysis continues to determine if the recalled products are related to the E. coli O103 outbreak.

According to the CDC, a total of 156 people infected with the outbreak strain of E. coli O103 have been reported from 10 states – Minnesota, Illinois, Indiana, Ohio, Kentucky, Tennessee, Virginia, Mississippi, Georgia and Florida.

Many clinical laboratories do not test for non-O157 STEC, such as O103 because it is harder to identify than STEC O157:H7. People can become ill from STECs 2–8 days (average of 3–4 days) after exposure to the organism.

Most people infected with STEC O103 develop diarrhea (often bloody) and vomiting. Some illnesses last longer and can be more severe. Infection is usually diagnosed by testing of a stool sample. Vigorous rehydration and other supportive care is the usual treatment; antibiotic treatment is generally not recommended. Most people recover within a week, but, rarely, some develop a more severe infection. Hemolytic uremic syndrome (HUS), a type of kidney failure, is uncommon with STEC O103 infection. HUS can occur in people of any age but is most common in children under 5 years old, older adults and persons with weakened immune systems. It is marked by easy bruising, pallor and decreased urine output. Persons who experience these symptoms should seek emergency medical care immediately.

FSIS is concerned that some product may be in refrigerators or freezers of restaurants. Restaurants that have purchased these products are urged not to serve them.

Now available for purchase from Amazon.com and the University of Chicago Press (receive a 20% discount with the following promo code: UCPNEW)

Foodborne illness is a big problem. Wash those chicken breasts, and you’re likely to spread Salmonella to your countertops, kitchen towels, and other foods nearby. Even salad greens can become biohazards when toxic strains of E. coli inhabit the water used to irrigate crops. All told, contaminated food causes 48 million illnesses, 128,000 hospitalizations, and 3,000 deaths each year in the United States.

With Outbreak, Timothy D. Lytton provides an up-to-date history and analysis of the US food safety system.

He pays particular attention to important but frequently overlooked elements of the system, including private audits and liability insurance.Lytton chronicles efforts dating back to the 1800s to combat widespread contamination by pathogens such as E. coli and salmonella that have become frighteningly familiar to consumers. Over time, deadly foodborne illness outbreaks caused by infected milk, poison hamburgers, and tainted spinach have spurred steady scientific and technological advances in food safety. Nevertheless, problems persist. Inadequate agency budgets restrict the reach of government regulation. Pressure from consumers to keep prices down constrains industry investments in safety. The limits of scientific knowledge leave experts unable to assess policies’ effectiveness and whether measures designed to reduce contamination have actually improved public health. Outbreak offers practical reforms that will strengthen the food safety system’s capacity to learn from its mistakes and identify cost-effective food safety efforts capable of producing measurable public health benefits.

Marion Nestle

“In Outbreak, Lytton gives us a legal scholar’s superb analysis of how government, lawyers, and civil society are struggling to prevent the tragic and unnecessary illnesses, hospitalizations, and deaths caused by microbial food contaminants. Foodborne illness may seem like an intractable problem, but Lytton’s suggestions for dealing with it are well worth attention, as is everything else in this beautifully written, thoughtful, and readable account. I couldn’t put it down.”

Stephen Sugarman, UC Berkeley School of Law

“A remarkable sweeping overview and evaluation of food safety practices that well serves both experts working in the field and members of the general public interested in the problem of food safety. Lytton shows how major outbreaks have prompted a variety of changes to reduce the risk of foodborne illness. Yet, as he argues persuasively, we don’t have firm scientific knowledge as to the degree to which—if at all—most of these measures have actually achieved their goal.”

William D. Marler, Esq., The Food Safety Law Firm

“From swill milk to HACCP to FSMA to Blockchain, Lytton weaves a compelling biological story of how we feed ourselves and the interplay between the supply chain, regulation, media, and civil litigation.”

Members of the California Leafy Greens Marketing Agreement have adopted new rules requiring them to sanitize “open source” used water for overhead irrigation following recent E. coli outbreaks that led investigators to suspect water as a cause.

The new rules, which passed in an April 19 vote, cover 99% of the leafy greens grown in California, according the California LGMA.

Arizona?

Vaccinating food service workers will not solve the entire problem – we need a nation-wide focus on homelessness and drug use as well.

According to a recent health warning, the CDC, multiple states across the country have reported outbreaks of hepatitis A (HAV), primarily among people who use drugs and people experiencing homelessness. Since the hepatitis A outbreaks were first identified in 2016, more than 15,000 cases, 8,500 hospitalizations, and 140 deaths as a result of HAV infection have been reported.

However, if state data is reviewed about 65% of the individuals sickened have been linked to drug use and homelessness, the remaining 35% have been Epi-Linked (people infected who are not drug users or homeless) or the cause of their infection is unknown.

In 2000, I said this:

“In the last six months Hepatitis A exposures have been linked to two Seattle-area Subways, a Carl’s Jr. in Spokane, WA, Hoggsbreath, a Minnesota restaurant, and three restaurants in Northwest Arkansas, IHOP, U.S. Pizza, and Belvedeers. Restaurants and food manufacturers must take action and voluntarily vaccinate all of their employees.”

Since then – especially recently – hardly a day goes by that the press does not report another food service worker possibly exposing thousands of patrons to HAV. Yet, neither the CDC nor any restaurant association has recommended HAV vaccination for such workers – until after the exposure.  This is not an acceptable public health response.

What is Hepatitis A?

Hepatitis A is one of the five Hepatitis viruses that are known to cause inflammation of the liver. The Centers for Disease Control and Prevention estimate that 150,000 people in the U.S. are infected each year by hepatitis. The illness is characterized by sudden onset of fever, malaise, nausea, anorexia, and abdominal pain, followed by jaundice. The incubation period for Hepatitis A, which varies from 10 to 50 days, is dependent upon the number of infectious particles consumed.

Where does Hepatitis A come from?

Hepatitis A spreads from the feces of infected people and can produce disease when individuals consume contaminated water or foods. Cold cuts, sandwiches, fruits, fruit juices, milk, milk products, vegetables, salads, shellfish, and iced drinks are also implicated in outbreaks. Water, shellfish, and salads are common sources. Contamination of foods by infected workers in food processing plants and restaurants is increasingly common.

How can a Hepatitis A infection be prevented?

Get vaccinated

If exposed, the illness can be prevented by a shot immune globulin within 2 weeks of exposure

Wash hands thoroughly with soap and warm water after using the bathroom, changing diapers, and before preparing/eating food.

Clean and disinfect bathrooms and diaper-changing surfaces frequently.

Never change diapers on eating or food preparing surfaces.

Cook shellfish before eating.

Drink water from approved source only.

For additional information see the Marler Clark sponsored Web sites about hepatitis A and about hepatitis A litigation.