E. coli Lawyer

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Utah public health officials are investigating an increase in Shiga toxin-producing Escherichia coli (STEC) infections across the state. While the source of these infections has not been identified, several ill individuals reported visiting petting zoos, corn mazes, and farms.

Since October 1, 2018, 20 cases of STEC have been reported along the Wasatch Front and in the Central and Southwestern regions of Utah. Cases range in age from 10 months to 71 years old. Eleven cases are younger than 18. Six people were hospitalized and no deaths have been reported. “For the past five years, Utah has averaged about 13 cases of STEC during the month of October,” said Kenneth Davis, epidemiologist with the Utah Department of Health (UDOH). “An average of 113 STEC cases and 25 hospitalizations are reported each year in Utah. This increase in October is higher than normally expected,” said Davis. UDOH is working with Utah’s local health departments to investigate the illnesses and determine the source of infection.

E. coli is a bacteria spread by consuming contaminated food or water, unpasteurized (raw) milk, contact with cattle, or contact with the feces of infected people. People visiting petting zoos and areas where cattle have been are at greater risk of contracting E. coli, especially if they are not practicing good hand hygiene. Symptoms usually appear 3–4 days after exposure and can vary, but often include severe stomach cramps, diarrhea (often bloody), and vomiting. Most people get better within 5–7 days, but some infections are severe or even life-threatening. Hemolytic uremic syndrome (HUS), a type of kidney failure, is a potentially life-threatening complication of E. coli infection. Very young children and the elderly are more likely to develop severe illness and kidney failure than others, but even healthy, older children and young adults can become seriously ill.

Practicing good hand hygiene is one of the best ways to reduce your chance of getting and spreading E. coli infection. Always wash your hands:

  • Before and after preparing or eating food
  • After using the bathroom or changing diapers
  • After touching or being around animals or places where animal feces may be present (e.g., farms, petting zoos, fairs, corn mazes, or even your own backyard)

Other protective measures include:

  • Stay home from school or work while you have diarrhea. Most people can return to work or school when they no longer have diarrhea, but special precautions are necessary for food handlers, healthcare workers, and childcare providers and attendees. Check with your employer before returning to work, and check with your child’s child care center before resuming child care.
  • Follow the four steps to food safety when preparing food: clean, separate, cook, and chill.
  • Avoid raw (unpasteurized) milk, unpasteurized dairy products, and unpasteurized juices (such as fresh apple cider).
  • Don’t swallow water when swimming and when playing in lakes, ponds, streams, swimming pools, backyard “kiddie” pools, and splash parks.

Contact your healthcare provider if you have diarrhea that lasts for more than three days, or is accompanied by high fever, blood in the stool, or so much vomiting that you cannot keep liquids down and you pass very little urine. Antibiotics should not be used to treat this infection. There is no evidence that treatment with antibiotics is helpful, and taking antibiotics may increase the risk of HUS. Antidiarrheal agents may also increase that risk.

As of September 19, 2018, 18 people infected with the outbreak strain of E. coli O26 were reported from 4 states – Colorado (10), Florida (15), Massachusetts (1) and Tennessee (1). Illnesses started on dates ranging from July 5, 2018 to July 25, 2018. Ill people ranged in age from one year to 75, with a median age of 16. Sixty-seven percent of ill people were male. Of 18 people with information available, 6 (33%) were hospitalized, including one person who died in Florida.

Epidemiologic, laboratory, and traceback evidence indicates that ground beef from Cargill Meat Solutions was a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Fourteen (100%) of 14 people interviewed reported eating ground beef. Ill people purchased ground beef from several different grocery stores, including Publix Super Markets, Inc.

USDA-FSIS conducted traceback investigations from stores where ill people reported buying ground beef. Initial information collected from ill people in Florida indicated that the ground beef was purchased from various Publix grocery stores. On August 30, 2018, Publix Super Markets, Inc. recalled ground chuck products sold in several Florida counties.

Further traceback investigation by USDA-FSIS identified Cargill Meat Solutions in Fort Morgan, Colorado as the source of the contaminated ground beef linked to illness, including the recalled ground beef sold at Publix stores in Florida. On September 19, 2018, Cargill Meat Solutions recalled ground beef products that were produced and packaged on June 21, 2018. Products are labeled with the establishment number “EST. 86R” inside the USDA mark of inspection. The products were shipped to retailers nationwide.

Laboratory testing identified the outbreak strain of E. coli O26 in leftover ground beef collected from the home of one ill person in Florida. WGS analysis showed that the E. coli O26 strain identified in the leftover ground beef was highly related genetically to the E. coli O26 strain isolated from ill people.

Prior E. coli outbreak in 2009 and recall in 2013.

The Department of Health cautioned consumers today to be aware of the risks of drinking raw milk especially for infants and young children, older adults, pregnant women, and people with weakened immune systems.

“Raw milk doesn’t go through the pasteurization process where harmful germs and bacteria are destroyed. This puts infants, young children, the elderly, pregnant women and those with a weakened immune system at a greater risk of illness when they drink it,” said Dr. Scott Lindquist, Washington state communicable disease epidemiologist.

Lab results recently confirmed a child under 5 years old from Island County and resident in their 70s of Clallam County became ill with an E. coli infection after drinking Dungeness Valley Creamery raw milk.

E. coli infections may cause severe diarrhea, stomach cramps and bloody stool. Symptoms generally appear three to four days after exposure, but can take up to nine days to appear. In some cases, the infection causes a serious disease resulting in kidney failure.

Individuals who have any of these symptoms after consuming raw milk should consult their health care provider and notify their local health departments.

In 2009 an outbreak was linked to the consumption of raw, unpasteurized, whole milk produced by the Dungeness Valley Creamery. There were a total of three cases. There were two E. coli strains implicated. One strain was confirmed and was E. coli O121. The other strain was suspected and was E. coli O157:H7. Raw milk was legal to sell and buy in Washington, provided the dairy underwent a series of inspections and was licensed. This dairy had been licensed since 2006.

In 2013, the Washington State Department of Agriculture (WSDA) is warned consumers not to drink Dungeness Valley Creamery brand raw Jersey whole milk, raw Jersey skim milk, and raw Jersey cream because the products may be contaminated with Escherichia coli bacteria (E. coli) that can cause serious illness.

Dungeness Valley Creamery raw Jersey cream, raw Jersey whole milk and raw Jersey skim milk with any Best Buy dates of 03/02 or later may be contaminated. The firm sells its products in gallon, half gallon, quart and pint containers. Today’s health alert includes all container sizes of the unpasteurized milk products.

The health alert is being initiated after routine sampling by WSDA found toxin-producing E. coli in a sample of raw cream. Based in Sequim, the Dungeness Valley Creamery and WSDA are continuing their investigation into the source of the problem. Currently, no human illnesses have been linked with these products.

Some strains of E. coli produce a toxin called Shiga toxin that can lead to severe illness. Shiga toxin-producing E. coli infections may cause severe diarrhea, stomach cramps, and bloody stool. Symptoms generally appear three to four days after exposure, but can take as long as nine days to appear. Anyone experiencing these symptoms should contact a health care provider.

The infection sometimes causes hemolytic uremic syndrome, a serious disease in which red blood cells are destroyed and the kidneys fail. Infants, children, pregnant women, the elderly and those with compromised immune systems are especially at risk.

According to the Dungeness Valley Creamery website, the firm’s products are sold at the following retail locations:
• Bainbridge Island: Real Foods; Pan D’Amore; Walt’s Lynwood Center Market
• Bothell: Tru Health
• Bremerton: CJ’s Evergreen General Store; Fresh Local
• Federal Way: Marlene’s Market & Deli
• Issaquah: Front Street Red Apple
• Longview: Country village Nutrition Shoppe
• Olympia: Olympia Food Co-op East; Olympia Food Co-op West
• Port Angeles: Country Aire; Good To Go
• Port Townsend: Port Townsend Food Co-op
• Poulsbo: Abundantly Green
• Seattle: Madison Market; My Asia’s Essentials; Pike Place Market Creamery
• Sequim: Sequim Prairie Grange; Red Rooster Grocery; Sunny Farms Farm Store
• Tacoma: Marlene’s Market & Deli
• Vancouver: Chuck’s Produce; Neighbors Market

On Aug. 16, 2018, FSIS was notified of an investigation of E. coli O26 illnesses. FSIS, the Centers for Disease Control and Prevention, and state public health and agriculture partners determined that raw ground chuck was the probable source of the reported illnesses. The epidemiological investigation identified 18 case-patients, predominantly from Florida, with illness onset dates ranging from July 5 to July 25, 2018. Traceback information indicated that case-patients consumed ground chuck products purchased at various Publix Super Markets that was supplied by a yet-to-be determined source.

2018 Outbreak of E. Coli O26 Linked to Homegrown Restaurants, King County, Washington

  • Organism:
  • Non-O157 STEC
  • Vehicle:
  • Chicken pesto sandwich

On May 25, 2018 Public Health Seattle King County (PHSKC) announced an outbreak of E. Coli O26 associated with Homegrown Restaurants. Four cases were reported. Three were laboratory confirmed with a genetically indistinguishable strain of E. Coli …Read More »

2017 E. coli O157:H7 and E. coli O26 outbreak among Marine recruits, California

  • Organism:
  • coli O157:H7, Non-O157 STEC
  • Vehicle:
  • beef

In October 2017 an outbreak of E. coli O157:H7 and E. coli O26 occurred among recruits at the Marine Corps Recruit Depot in San Diego and the command’s field training facilities at Edson Range, Camp Pendleton, California. Investigators identified 62 …Read More »

2017 Outbreak of E. coli O26 in Multiple Counties, Colorado

  • Organism:
  • Non-O157 STEC
  • Vehicle:
  • Unknown

Six people residing in Adams, Arapahoe, Denver and Douglas counties, Colorado were laboratory confirmed with E. coli O26 between September 1, 2017 and October 15, 2017. One person was hospitalized. No one died. Three out of 6 cases consumed raw spina…Read More »

2015 Outbreak of E. coli O26 Linked to Chipotle Mexican Grill, Washington and Oregon

  • Organism:
  • Non-O157 STEC
  • Vehicle:
  • unknown

The CDC, FDA, USDA FSIS and public health officials in several states investigated two outbreaks of E. coli O26 linked to food sold at Chipotle Mexican Grill restaurants. Public health investigators used PulseNet to identify illnesses that were part …Read More »

2013 Multi-state Outbreak of E. coli O26 Suspected to be Caused by Iceberg Lettuce

  • Organism:
  • Non-O157 STEC
  • Vehicle:
  • Iceberg lettuce

In the spring of 2013 twenty six cases of E. coli O26 were reported by 13 states: Illinois (6), Minnesota (5), Wisconsin (3), Michigan (2), California (2) and Kentucky, Missouri, Mississippi, New Jersey, new York, Ohio, Washington and West Virginia, …Read More »

2011 Outbreak of E. coli O26 at Jimmy John’s Restaurants Linked to Raw Clover Sprouts

  • Organism:
  • Non-O157 STEC
  • Vehicle:
  • Vegetables, Sprouts, Clover Sprouts

On February 15, 2012, the Centers for Disease Control first announced an ongoing investigation into illnesses linked to the consumption of raw clover sprouts consumed at Jimmy John’s Restaurants in several states. The illnesses were caused by E. co…Read More »

Cargill Meat Solutions/BJ’s Wholesale Club Ground Beef 2010

  • Organism:
  • Non-O157 STEC
  • Vehicle:
  • Beef, Ground Beef

A recall of ground beef was issued on August 28 when three people developed illnesses caused by rare strain of E. coli O26 after they had eaten the product. The ground beef produced by Cargill Meat Solutions, of Pennsylvania and was distributed to B…Read More »

Thanks for Outbreak Database Dot Com.

And, there is some history to consider:

Last year (2010), the USDA’s Food Safety and Inspection Service (FSIS) was petitioned to declare six additional disease-causing and potentially life-threatening strains of E. coli, those referred to as non-O157 Shiga-toxin producing E. coli (STECs) or more succinctly, “the big six,”  as adulterants.Specifically, those six strains include E. coli O26, O11, O103, O121, O45 and O145. Those strains of the E. coli bacteria were targeted because of their capacity to produce the same deadly Shiga toxins as E. coli O157.

Today, despite much controversy and debate and after many months of waiting, those six dangerous strains of E. coli will now be banned from the nation’s meat supply and take their place with E. coli O157 to be classified as adulterants. Accordingly, it will be illegal for meat packers to sell meat contaminated with those pathogens.

William Neuman of The New York Times explained that in his report:

Under the rule, any meat that is found to contain the Big Six E. coli, in tests by government or industry, will have to be diverted for use in cooked products. The bacteria is killed by heating the meat to 160 degrees.

Previously, in 1994, FSIS declared E. coli O157 to be an adulterant an outbreak linked to tainted hamburger patties sold at Jack in the Box restaurants sickened more than 700 people in four states and led to 171 hospitalizations and four deaths. In 2010, in support of the petition to label “the big six” as adulterants, Bill Marler wrote: “the people of this nation do not deserve another Jack in the Box-sized catastrophe as a pre-requisite for currently needed agency action.”

According to a news story by MSNBC health reporter JoNel Aleccia:

The move was hailed as a long-sought victory by food safety advocates, who said they wondered why it took so long to require testing for bacteria that last year collectively caused more infections in the U.S. than E. coli 0157.

“I think what consumers can expect is less contaminated product making it into commerce,” said Nancy Donley, president of the agency STOP Foodborne Illness. “It’s fantastic news.”

Bill Marler, seasoned attorney and food safety advocate, also applauded the move by FSIS as a step in the right direction. In an interview with Aleccia, Marler said, “I am more than pleased. It’s a big recognition that there are other pathogens out there that cause human disease.”

As Aleccia noted in her report:

In 2010, for the first time, those rarer strains of E. coli were responsible for more infections in the U.S. than E. coli O157, according to a June study released by the Centers for Disease Control and Prevention. The non-STECs caused 451 confirmed infections last year, including 69 people who were hospitalized and one death. E. coli O157 caused 442 infections, 184 hospitalizations and two deaths.

However, CDC officials say many infections are never detected. The agency estimates that overall, as many as 265,000 STEC infections occur each year in the United States, with the non-0157 strains causing up to 113,000 illnesses and 300 hospitalizations annually.

Today’s decision will hopefully serve to better protect the public from foodborne illness. As Elisabeth Hagen, the head of food safety for the Department of Agriculture, told William Neuman, “This is one of the biggest steps forward in the protection of the beef supply in some time.” She added, “We’re doing this to prevent illness and to save lives.”

I have been thinking today about what growers in Yuma are going to do next season?  With the FDA and CDC fingering the water from an irrigation canal that flowed by a feedlot with some 100,000 cows, you have to wonder what is going to happen next season if nothing changes?  What are grocery stores and restaurants going to do?  What will consumers demand?

This Years Outbreak

In April 2018 local, state and federal public health and agriculture agencies announced an outbreak of E. coli O157:H7 linked to romaine lettuce from the Yuma, Arizona growing area. On June 28, 2018 the Centers for Disease Control and Prevention (CDC) declared the outbreak over.

The outbreak strain was identified as PulseNet strain EXHX01.0047/EXHA26.0626. A total of 210 people in the United States infected with the outbreak strain of E. coli O157:H7 were reported from 36 states.

States reporting outbreak associated case patients

Illnesses started on dates ranging from March 13, 2018 to June 6, 2018. Ill people ranged in age from 1 to 88 years, with a median age of 28 years. Sixty-seven percent of ill people were female. Of 201 people with information available, 96 (48%) were hospitalized, including 27 people who developed hemolytic uremic syndrome (HUS), a type of kidney failure. Five deaths were reported from Arkansas, California, Minnesota (2), and New York.

WGS analysis of isolates from 184 ill people identified antibiotic resistance to chloramphenicol, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole. Standard antibiotic resistance testing of eight clinical isolates by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory confirmed these findings. Isolates from four of those ill people also contained genes for resistance to ampicillin and ceftriaxone.

In Canada there were eight illnesses of E. coli O157:H7 with a similar genetic fingerprint to illnesses reported in the U.S. investigation. The eight Canadian illnesses were reported in five provinces:  British Columbia (1), Alberta (1), Saskatchewan (2), Ontario (3), and Quebec (1). Individuals in Canada became sick between March and April 2018. One patient was hospitalized and no one died. Based on the evidence from the U.S. outbreak investigation and information provided by individuals who became sick, Canadian investigators concluded that the likely source of illness in Canada was contaminated romaine lettuce. All of the individuals reported having eaten romaine lettuce at home or in prepared salads purchased at grocery stores, restaurants and fast food chains before their illnesses occurred. Two Canadians did report traveling to the U.S. before getting sick and eating romaine lettuce while they were there.[1]

The FDA and state and local regulatory officials traced the romaine lettuce to many farms in the Yuma growing region. The FDA, along with CDC and state partners, started an environmental assessment in the Yuma growing region and collected samples of water, soil, and manure. CDC laboratory testing identified the outbreak strain of E. coli O157:H7 in water samples taken from a canal in the Yuma growing region. WGS showed that the E. coli O157:H7 found in the canal water was closely related genetically to the E. coli O157:H7 isolated in ill people. Investigators believe this finding suggests that contaminated water coming into contact with produce, either through direct irrigation or other means, is a viable explanation for transmission of the bacteria to romaine lettuce. The FDA also notes that the canal is close to a Concentrated Animal Feeding Operation (CAFO), a facility that can hold in excess of 100,000 head of cattle at any one time. FDA traceback information showed a clustering of romaine lettuce farms nearby. The Environmental Assessment report will be made publicly when complete.[2]  

And a Bit(e) of Lettuce History

Date Vehicle Etiology Confirmed
Cases		 States/Provinces
July 1995 Leafy Greens E. coli O157:H7 74 1:MT
Sept. 1995 Romaine E. coli O157:H7 20 1:ID
Sept. 1995 Iceberg E. coli O157:H7 30 1:ME
Oct. 1995 Iceberg E. coli O157:H7 11 1:OH
May-June 1996 Mesclun Mix E. coli O157:H7 61 3:CT, IL, NY
May 1998 Salad Mix E. coli O157:H7 2 1:CA
Feb.-Mar. 1999 Iceberg E. coli O157:H7 72 1:NE
Oct. 1999 Salad E. coli O157:H7 92 3:OR, PA, OH
Oct. 2000 Lettuce E. coli O157:H7 6 1:IN
Nov. 2001 Lettuce E. coli O157:H7 20 1:TX
July-Aug. 2002 Romaine E. coli O157:H7 29 2:WA, ID
Nov. 2002 Lettuce E. coli O157:H7 13 1:Il
Dec. 2002 Lettuce E. coli O157:H7 3 1:MN
Oct. 2003-May 2004 Salad Mix E. coli O157:H7 57 1:CA
Apr. 2004 Spinach E. coli O157:H7 16 1:CA
Nov. 2004 Lettuce E. coli O157:H7 6 1:NJ
Sept. 2005 Romaine E. coli O157:H7 32 3:MN, WI, OR
Sept. 2006 Spinach E. coli O157:H7 and other serotypes 205 Multistate and Canada
Nov./Dec. 2006 Lettuce E. coli O157:H7 71 4:NY, NJ, PA, DE
Nov./Dec. 2006 Lettuce E. coli O157:H7 81 3:IA, MN, WI
July 2007 Lettuce E. coli O157:H7 26 1:AL
May 2008 Romaine E. coli O157:H7 9 1:WA
Oct. 2008 Lettuce E. coli O157:H7 59 Multistate and Canada
Nov. 2008 Lettuce E. coli O157:H7 130 Canada
Sept. 2009 Lettuce: Romaine or Iceberg E. coli O157:H7 29 Multistate
Sept. 2009 Lettuce E. coli O157:H7 10 Multistate
April 2010 Romaine E. coli O145 33 5:MI, NY, OH, PA, TN
Oct. 2011 Romaine E. coli O157:H7 58 Multistate
April 2012 Romaine E. coli O157:H7 28

1:CA

Canada
June 2012 Romaine E. coli O157:H7 52 Multistate
Sept. 2012 Romaine E. coli O157:H7 9 1:PA
Oct. 2012 Spinach and Spring Mix Blend E. coli O157:H7 33 Multistate
Apr. 2013 Leafy Greens E. coli O157:H7 14 Multistate
Aug. 2013 Leafy Greens E. coli O157:H7 15 1:PA
Oct. 2013 Ready-To-Eat Salads E. coli O157:H7 33 Multistate
Apr. 2014 Romaine E. coli O126 4 1:MN
Apr. 2015 Leafy Greens E. coli O145 7 3:MD, SC, VA
June 2016 Mesclun Mix E. coli O157:H7 11 3:IL, MI, WI
Nov. 2017 Leafy Greens E. coli O157:H7 67 Multistate and Canada
Mar. 2018 Romaine E. coli O157:H7 219 Multistate and Canada

 

[1] https://www.canada.ca/en/public-health/services/public-health-notices/2018/public-health-notice-outbreak-e-coli-infections-linked-romaine-lettuce.html

[2] https://www.cdc.gov/ecoli/2018/o157h7-04-18/0; and https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm604254.htm

Surprised?  I did not think so.  Cattle feces from a CAFO gets into the water supply that is used to irrigate romaine lettuce – what possibly could go wrong?

Of note, the FDA still has not been transparent (except that “romaine [lettuce] from the Yuma growing region as the likely source of contamination”) as to where the romaine was consumed (except for the “Alaskan correctional facility back to a single farm – [Harrison]”).  Nor, has the FDA been transparent what farms grew the romaine, where and who processed it and who shipped it.  The FDA in fact knows most, if not all, of this, but refuses to release the information citing, “trade secrets.”

As the CDC reported in its final assessment of the outbreak on June 28, 2018, there are 210 cases in 36 states: Alabama (3) Alaska (8), Arkansas (1), Arizona (9), California (49), Colorado (3), Connecticut (2), Florida (3), Georgia (5), Idaho (12), Illinois (2), Iowa (1), Kentucky (1), Louisiana (1), Massachusetts (4), Michigan (5), Minnesota (12), Mississippi (1), Missouri (1), Montana (9), Nebraska (1), New Jersey (8), New York (11), North Carolina (1), North Dakota (3), Ohio (7), Oklahoma (1), Oregon (1), Pennsylvania (24), South Dakota (1), Tennessee (3), Texas (4), Utah (1), Virginia (1), Washington (8), and Wisconsin (3). 5 deaths were reported from Arkansas, California, Minnesota (2), and New York.  8 illnesses were reported in Canada linked to the same outbreak.

On August 6, 2018, the FDA posted an update on the status of its ongoing environmental assessment on the likely, what used to be called the “root cause.” The FDA’s update was as follows:

On July 31 and August 1, 2018, the FDA participated in a meeting of the Leafy Greens Food Safety Task Force that was formed in response to the serious outbreak of E. coli O157:H7 associated with romaine lettuce that occurred earlier this year. During the meeting FDA shared preliminary hypotheses from the Environmental Assessment in Yuma to facilitate conversations with state and local officials, industry and local growers on the hypotheses and associated actions necessary to prevent such an outbreak from occurring again.

As FDA has previously stated, samples of canal water have tested positive for the outbreak strain of E. coli. FDA continues to consider that contaminated water coming into contact with produce, either through direct irrigation or other means, is a viable explanation for the pattern of contamination. But other hypotheses were discussed as well. FDA notes that the canal is close to a Concentrated Animal Feeding Operation (CAFO), a facility with a large number of cattle on the premises. The CAFO can hold in excess of 100,000 head of cattle at any one time and the FDA traceback information showed a clustering of romaine lettuce farms nearby.

Our experts continue to work on examining potential links between the CAFO, adjacent water, and geologic and other factors that may explain the contamination and its relationship to the outbreak. Additional sampling activities will be conducted to further explore and narrow down hypotheses in the near future. Our findings will be detailed in a finalized environmental assessment report.

We urge other government and non-government entities, produce growers in the region, and those engaged in managing the canal systems to work with FDA and marshal and deploy resources to achieve our collective food safety goal. Broad engagement from the surrounding community is critical to developing and implementing remediation measures to reduce the potential for another outbreak. We believe local in-depth knowledge and actions are critical in helping resolve this issue in order to protect public health.

The Environmental Assessment report will be made publicly available when complete.

And, then there is this – for those “geographically challenged,” Yuma is near the dark purple in the lower left corner:

To date, we have filed 10 lawsuits and are making great progress tracing back from restaurants and grocery stores that sold the E. coli-tainted romaine in the spring.  And, once the “points of sale” flip the supply chain of the romaine, we are making great progress finding out who brokered the sale and who processed the romaine.  We are making slower process identifying specific farms, but that information is coming. Once we have the names of more farms, we will move back up other chains of distribution identifying additional shippers, brokers, processors and eventually more restaurants and grocery stores.

Having discovery and subpoena power is a great tool for truth.

As of June 27, 2018, the CDC reported 210 people infected with the outbreak strain of E. coli O157:H7 were reported from 36 states.  Canada reported 8 sickened.

Illnesses started on dates ranging from March 13, 2018 to June 6, 2018. Ill people ranged in age from 1 to 88 years, with a median age of 28.

Sixty-seven percent of ill people were female.

Of 201 people with information available, 96 (48%) were hospitalized, including 27 people who developed hemolytic uremic syndrome, a type of kidney failure.

Five deaths were reported from Arkansas, California, Minnesota (2), and New York.

Here is what the FDA has told us all as of May 31, 2018:

Epidemiologic, laboratory, and traceback evidence indicated that romaine lettuce from the Yuma growing region was the likely source of this outbreak.

The FDA and state and local regulatory officials traced the romaine lettuce to many farms in the Yuma growing region. The FDA, along with CDC and state partners, started an environmental assessment in the Yuma growing region and collected samples of water, soil, and manure. CDC laboratory testing identified the outbreak strain of E. coli O157:H7 in water samples taken from a canal in the Yuma growing region.

Here is what we have figured out through litigation to date.  More information will be added in the coming weeks:

We are now investigating the following outbreak that seemed to fall a bit below the radar.

Authors: Amelia Keaton, R. Hassan, S. Luna, I. Lee, R. Magalhaes, M. Bidlack, L. Smith, R. Maves, D. Freer, K. Flinn, G. Monk, P. Graf, K. Trinh, J. Crandall, D. Noveroske, G. Fortenberry, L. Ramos, R. Recio, C. Peak, E. McDonald, T. Waltz, K. Patel, D. Wagner, J. Espiritu, L. Christensen, L. Gieraltowski

Background: Shiga toxin-producing Escherichia coli (STEC) infections are a substantial cause of foodborne illness and a cause of hemolytic-uremic syndrome (HUS). In November 2017, CDC assisted the US Navy in a response to an outbreak of STEC illnesses in recruits at a Marine Corps Recruit Depot in San Diego (MCRD). We investigated to determine the source of this outbreak and identify prevention and mitigation measures.

Methods: In October 2017, medical providers identified a high number of gastrointestinal (GI) illnesses at MCRD. Recruits with diarrhea submitted stool specimens for culture and/or culture-independent diagnostic testing (CIDT) for GI pathogens. We performed pulsed-field gel electrophoresis (PFGE) on culture isolates. Case-patients were then defined as follows: confirmed (PFGE-confirmed STEC infection matching outbreak strains), probable (diagnosis of HUS and/or CIDT evidence of STEC), and suspected (bloody diarrhea). We conducted environmental evaluations of facilities, training areas, and barracks. A case-control study was performed using PFGE-confirmed case-patients and platoon-matched controls. We performed product traceback for foods identified as exposure risks by interview or case-control study.

Results: We identified 62 confirmed, 62 probable, and 120 suspected case-patients. Thirty case-patients required hospitalization and 15 had HUS. Case-patient ages ranged from 17-28 years (median: 18 years). Poor hygiene practices among recruits and inconsistent cooking temperatures within dining facilities were noted. Forty-three case-patients and 135 controls were interviewed about food, hygiene, and environmental exposures. Consumption of undercooked beef was found to be significantly associated with illness, (mOR 2.40, CI 1.04-5.72, p=0.04). We identified a single ground beef supplier for MCRD, but MCRD records did not document which specific lots of ground beef were used.

Conclusions: Case-control analysis and environmental observations suggested undercooked ground beef as a potential source for this outbreak. We recommended the Navy and Marine Corps retain lot information, address food handling concerns, and improve hygiene among recruits.

REF:  https://www.cdc.gov/eis/downloads/eis-conference-2018-508.pdf, page 117

Here is what the FDA has told the public thus far about the source of the 2018 Yuma Romaine Lettuce Outbreak that has sickened over 200 in the US and Canada and killed 5 in the US:

Eventually, at least for the 105 people who have hired us, we will fill in all the blanks.  I must admit as someone interested in food safety and transparency, having a lawyer in Seattle fill in the blanks that the FDA should is not how it should be.  The time has come for the FDA to reassess what are considered “trade secrets” or “confidential.”  FSIS did it a decade ago and the sky did not fall.

Thanks to my great clients for being willing to tell their stories.  It put what the FDA does – and does not do – in context.

Victims blame FDA for food-recall failures

‘If I had heard about the problem even one week earlier … life today would be very different.’

By CHRISTINE HAUGHNEY

Peter Ebb holds get-well cards he received in 2017 following a food-related illness. Ebb was critically sickened after consuming I.M. Healthy SoyNut Butter, surviving a food illness that sent his kidneys into failure. | M. Scott Mahaskey/POLITICO

People had been getting sick from eating I.M. Healthy Original Creamy SoyNut Butter for more than two months when Peter Ebb, a 59-year-old Boston lawyer and health enthusiast, went for a run and then ate his usual gluten-free English muffin smeared with soy nut butter.

Later that morning — March 6, 2017 — Ebb saw a message from Amazon, which had sold him the nut butter, that the manufacturer had recalled it for contamination by E. coli bacteria. Ebb threw away a protein drink he had made with the soy nut butter, but didn’t worry too much. The Food and Drug Administration warning that was linked to the email was worded very cautiously: Though serious illnesses might result, even potentially leading to death, “most healthy adults can recover completely within a week.”

Six days later, Ebb was hospitalized and developed a deadly type of kidney failure. Within days, doctors told his wife to send for their children in case they needed to bid him a last goodbye. He survived, but remains unable to work full time and has trouble climbing the stairs. Now, he’s joining with 18 other victims to file claims against the companies responsible and call attention to the inadequacy of the nation’s recall system.

“If I had heard about the problem even one week earlier and stopped then, I might have been able to avoid the disease completely, and life today would be very different,” Ebb said.

A POLITICO investigation found that the I.M. Healthy SoyNut Butter case — which officials at the FDA and the Centers for Disease Control and Prevention have hailed as an improvement over past failures — was nonetheless emblematic of persistent weaknesses in the nation’s food-safety system, some of which haven’t been corrected for two years after being flagged by the agency’s inspector general.

Two months elapsed between the first person sickened by eating I.M. Healthy SoyNut Butter on Jan. 4 and the recall orders that began on March 3 and expanded three more times until March 10. The FDA, working through a national network of labs that identifies outbreaks, pinpointed the contamination on Feb. 22. The nine-day lag time in persuading the manufacturer to begin recalling the tainted products was a significant improvement over previous lag times — which were as high as 165 days in one infamous case, according to the inspector general. But victims maintain that the FDA should have ordered a recall on its own authority, given that a few days or even hours can make a difference in a deadly outbreak.

“They have the authority to mandate a recall and, in theory, that would go more quickly than a voluntary recall,” said Sandra Eskin, who directs food safety at the Pew Charitable Trust. The FDA has used its authority to order recalls only three times since 2011. Instead, it usually waits to give companies time to decide whether to pull a product from shelves voluntarily.

There were complications, as well, in alerting customers to the fact of the recall. The FDA did not identify which retailers sold the contaminated batches of products. (The agency has traditionally considered this information to be trade secrets, and left it to manufacturers to alert retailers.) Thus, customers who saw only the FDA’s recall notice had no way of knowing whether the products they bought were among those that were contaminated.

“They just did not effectively execute the recall,” said Eskin. “You really have to monitor where the product is sold and reach out to the sellers online.”

Indeed, the contaminated products remained available for months afterward. Linda Harris, a food-safety microbiologist for the University of California at Davis who researched the case for the victims, said she was able to buy a three-pack of I.M. Healthy Original Creamy SoyNut Butter on Amazon in September, five months after the recall. In addition, some stores either missed or ignored the recall and kept the product on the shelves, Harris discovered.

Part of the problem, critics contend, was a lack of urgency: The cautious language of the FDA’s warning didn’t mention potential illnesses until the third paragraph, and the only instruction offered was to return the product to the place it was bought to receive “a full refund.”

“Amazon didn’t provide the information about the seriousness of the recall and the reason,” contended Sarah Sorscher, deputy director of regulatory affairs for the Center for Science in the Public Interest. “You should not have to click through to a government website while you’re eating breakfast to find out that you have a deadly product in your kitchen.”

The weaknesses in the soy nut butter case were all the more notable because they came 8½ months after the FDA’s inspector general declared that it lacked adequate procedures for handling food outbreaks.

“We found that the FDA did not have an efficient and effective food recall initiation process that helps ensure the safety of the Nation’s food supply,” Inspector General Daniel Levinson wrote on June 8, 2016. “This issue is a significant matter and requires the FDA’s immediate attention.”

Now, more than two years after the IG’s warning, the agency is still updating its procedures. In congressional hearings and blog posts earlier this year, FDA officials have pledged to take specific steps to improve the recall system, including a proposed rule to alert the public to dangers before recalls are announced. Among the other changes promised include revealing which retailers sold the tainted products “in certain cases,” developing a database to help the agency identify contaminated products and requiring companies to issue public warnings more quickly.

Meanwhile, the Trump administration, seeking to improve safety standards, proposed in mid-June consolidating all food-safety functions in a new agency within the U.S. Department of Agriculture as part of a broader reorganization that would require congressional approval. But few observers expect any congressional action in the near term.

In a statement to POLITICO, FDA Commissioner Scott Gottlieb, who took over the agency in May 2017, just after the soy nut butter recall, stressed his commitment to improving the current system.

“When the FDA learns about potentially unsafe foods in the marketplace, we must act quickly to keep people from getting sick or being harmed,” Gottlieb wrote. “The FDA is taking several policy steps this year as part of a broader action plan to further improve our oversight of food safety, and ensure that all food recalls are initiated, overseen, and completed quickly and effectively to best protect consumers. These and other efforts will increase transparency, empower consumers and ultimately lead to fewer potential recall situations with less people getting sick from contaminated food.”

Ten-year-old Mason Stoll began showing digestive symptoms suggestive of a food-borne illness on Jan. 7, 2017. Within four days, the boy was admitted to Johns Hopkins University Hospital, where his father, Bob, works as a project manager in the Applied Physics Laboratory.

Pretty soon, Mason was clinging to life with complications so severe that he coded four times. As he fought for his life, his parents began speaking with Maryland State Department of Health officials, trying to locate the cause of the contamination and passing on information about everything Mason had eaten, including the soy nut butter.

Like many of the families whose relatives were poisoned by contaminated I.M. Healthy Original Creamy SoyNut Butter, the Stolls were familiar with the threats posed by digestive illnesses: Many of the victims were eating soy nut butter because they had food-borne allergies or diseases like Crohn’s that left them unable to eat nuts or dairy products. For his part, Mason was allergic to peanuts, dairy and eggs. The Stolls were comfortable navigating the public-health bureaucracy. Like other families who spoke to POLITICO, they moved quickly on their own initiative to brief local officials and eventually the CDC, sharing receipts and providing detailed information about the foods they consumed.

More than three weeks after Mason began feeling sick, on Jan. 30, an 8-year-old boy named Trevor Simmons entered a hospital in Santa Clara, California, suffering from E. coli poisoning.

Trevor’s mother, Erin Parisi Simmons, said she spoke within two days to the Santa Clara Health Department and discussed possible sources of the illness. When his condition worsened, Trevor was moved to the intensive-care unit of the Stanford Medical Center. Erin Parisi Simmons recalled with chagrin that she unsuspectingly brought I.M. Healthy Original Creamy SoyNut Butter to the hospital on two different occasions to try to entice Trevor to eat, because it was his favorite food. Fortunately, he was too sick even to take a bite.

Mason Stoll, 10, was sickened for 14 months after eating tainted soy spread. He is now on a kidney transplant list. | John Shinkle/POLITICO

Around the same time, a Seattle woman named Nicole Cash purchased soy nut butter for her 11-year-old son, Oliver, and 8-year-old daughter, Hannah: Because of Oliver’s peanut allergy, the soy nut butter was a family staple. By Feb. 21, Hannah was experiencing diarrhea so severe that Nicole had to put her in diapers; when Hannah said she had blood in her stool and began vomiting uncontrollably, Nicole rushed her to the hospital.

Within a few days, Hannah was experiencing kidney failure and had to go on dialysis, and Nicole was talking to the CDC about what products might have made the girl so sick.

On March 2, Nicole had her answer, via an unlikely source: A closed group of people on Facebook who were posting reports about the E. coli outbreak said it was caused by soy nut butter, a day before I.M. Healthy began its first recalls.

At the same time, Maryland state officials told Mason Stoll’s family that his E. coli poisoning was caused by I.M. Healthy Original Creamy SoyNut Butter, which contained fecal matter. And California officials delivered the same news to Erin Parisi Simmons.

On March 3, the SoyNut Butter Company began its series of voluntary recalls. Even then, the recalls applied only to products with best-by dates of Aug. 30 and 31, 2018. More batches of soy nut butter were recalled the following day, March 4, and the recall was expanded again on March 7 and 10.

The FDA launched an inspection of the facility in which the soy nut butter was made by a food services company called Dixie Dew. Inspectors were at the Dixie Dew facility from March 3 through March 15, finding that it had rodent droppings, a sink that had not had hot water running in two years and an infestation of flies.

FDA records show that it wasn’t until March 28 that the agency finally suspended operations at the Dixie Dew facility.

Even though the FDA announced that the recall was completed by May 4, batches of the tainted products remained on sale through the fall. Over Labor Day weekend, Harris, the University of California at Davis food-safety microbiologist helping lawyer Bill Marler, who represents 19 victims, bought a three-pack on Amazon for $40. Once she received it, she notified Amazon and the state of California.

“It was a complicated recall, in part because it was a small company,” said Harris. “It still was a product that should not have been on the market.”

The vendor selling the nut butter contacted Harris to tell her that the specific jars she purchased were not affected. Harris had to explain that they were, indeed, part of the lot that was recalled. Amazon pulled the nut butter from its site by the Tuesday after Labor Day.

“They did not scroll to the bottom of the website and click to the link that said expanded recall,” Harris said. “When there are these complex recalls that happen in stages, you can’t have the notice of the expanded recall at the bottom of the page.”

Then, in October, Harris found another online retailer selling the nut butter and contacted FDA. The agency ensured that it was removed quickly. But it took until Oct. 13 for the FDA to issue a statement that read “FDA Reminds Public that All I.M. Healthy Soy Nut Butter Products are Recalled.” The notice added that “retailers cannot legally offer for sale” the product.

The FDA said it responded promptly once it learned that the recalled products were being offered for sale.

The FDA launched an inspection of the facility in which the soy nut butter was made by a food services company called Dixie Dew. Inspectors were at the facilities from March 3 through March 15, 2017, finding that it had rodent droppings, a sink that had not had hot water running in two years and an infestation of flies. | M. Scott Mahaskey/POLITICO

“The agency worked quickly to locate any remaining products to ensure they were no longer available to consumers and we put out a public notice to remind consumers of the dangers of these recalled products,” an FDA spokesman wrote in an email.

While the recall may be over, most of the victims are still dealing with long-term health effects and the trauma the experience left on their families.

After Peter Ebb left the hospital on March 30, his family had to reconfigure their house because he has trouble taking the stairs. He remains anemic and his kidneys have not returned to normal. “It’s definitely been a life-changing event, one of the worst,” said his wife, Fran Green.

Nicole Cash’s daughter Hannah has largely recovered, but she still has annual checkups to make sure there are no lingering complications. The Cashes, who are Australian, have reconsidered why they are living so far away from family.

Erin Parisi Simmons said her son is still being seen regularly by Stanford University’s nephrology department and is struggling with post-traumatic stress disorder. Her family is trying to stitch itself back together: She said she lost her tech job because her company was taken over while she was caring for her son. Her husband is trying to restore his stature within his company since some colleagues did not understand why he was off for so long. And their older son is still struggling with feelings of abandonment because his parents spent so much time caring for Trevor.

Bob Stoll reports that Mason’s 14 months of illness have depleted the family’s savings. Mason returned to school full time in April. On June 26, he had cervical spine surgery. And they’re preparing for a kidney transplant in their son’s future.

“It has had an emotional impact,” said Bob. “We’re just trying to piece together what normal looks like again.

In the months after the outbreak, Marler, the victims’ attorney, filed four lawsuits in federal court in Chicago, after which both the SoyNut Butter Company and Dixie Dew declared bankruptcy. Now, the 19 victims represented by Marler are applying to bankruptcy court to divide up $12 million in insurance and assets. After that, Marler said, he plans to file suit against the retailers and shippers who provided the products.

Terrence Guolee, the lawyer representing the SoyNut Butter Company, said that his client only handled marketing and that Dixie Dew handled the manufacturing.

“My client’s company shut down within a couple of weeks of being notified by the CDC as to what happened because they couldn’t survive any further,” Guolee explained.

Dixie Dew did not respond to requests for comment through its lawyer.

An Amazon spokesperson said in an email that “Customer safety is our highest priority. Third-party sellers are required to comply with all relevant laws and regulations when listing items for sale on Amazon. When sellers don’t comply with our terms, we work quickly to take action on behalf of customers.”

The spokesperson noted that after FDA sent out its March recall, Amazon immediately stopped selling the soy nut butter. Then, six months later, when a third-party seller evaded Amazon’s systems and offered the item again for sale, Amazon took the item down, took action against the seller and notified customers.

While Marler is targeting the companies involved, he also has choice words for the FDA, particularly over its failure to publicize the retailers who sold the tainted products.

The FDA suspended Dixie Dew’s food facility registration on March 28, 2017, shutting down the company’s food processing plant in Erlanger, Ky., where it manufactured soy nut butter products. An office in the now-closed facility is pictured in April. | M. Scott Mahaskey/POLITICO

“This is, in my view, a classic failure of the FDA’s recall system,” he said. “When you don’t have full transparency, there’s confusion not only from consumers — retailers fall into the same trap. They either ignored the warnings or they simply didn’t understand the recall notice.”

In most cases, the FDA does not publicize the stores, restaurants or online retailers that sold contaminated food, a policy that has raised the ire of some members of Congress. “The primary goal of the FDA is to keep food safe,” declared Rep. Rosa DeLauro (D-Conn.). “FDA’s mission is not to protect the trade secrets of corporations.”

The FDA policy is especially perplexing since the U.S. Department of Agriculture, which is responsible for the safety of meat and poultry, changed its own policy against disclosing retailers nearly a decade ago.

Former USDA Under Secretary for Food Safety Richard Raymond recalls taking on the Grocery Manufacturers Association and other big food lobbies to get the policy changed. “Most of the people at USDA said ‘You won’t get this done. You’re wasting your time,’” said Raymond. “The FDA does not have to replow new ground. It was plowed by me.”

Gottlieb, the FDA commissioner, suggested in a statement that his agency is moving toward providing more information about retailers.

“Following on our commitment earlier this year to improve our oversight of food safety and how we implement our recall authorities, the FDA will soon issue guidance on additional information the FDA will now make available during certain recall notifications,” Gottlieb wrote. “Note that the agency recently released detailed distribution information by state for the outbreak linked to pre-cut melon so consumers could better know how to avoid the hazardous recalled food.”

As to lessons learned from the soy nut butter case, he wrote: “Anytime there’s a serious outbreak and consumers are hurt the answer is that we could always have done better. We won’t be able to prevent every outbreak and prevent every consumer from being at risk of a food-borne illness but our aim is a system that continues to reduce these risks and we strive toward that goal. I believe we’re heading in the right direction and over time we will see the benefits of our efforts.”

The Trump administration’s proposal to combine all the government’s food-safety functions into a new agency under USDA will continue to be debated. The notion of creating a new food-safety agency won the early support of key advocates and the House Agriculture Committee Chairman Mike Conaway (R-Texas), though even he suggested that it was just the start of a longer review process.

Changes cannot come quickly enough for the victims of the I.M. Healthy contamination, who remain convinced that tighter government oversight and earlier warnings might have spared themselves or their children.

“When it was happening, we felt helpless,” said Bob Stoll. “Now I don’t feel helpless. I feel angry.”

2017 soy nut butter outbreak

Jan. 4

First documented illness starts in Wisconsin.

Jan. 7

Mason Stoll gets sick.

Jan. 25

Trevor Simmons comes home sick with first symptoms.

Jan. 30

Trevor Simmons is admitted to hospital.

Early February

Cash family cannot find nut butter at Safeway. Unaware of any problems, they purchase it at Target.

Feb. 19

Hannah Cash starts having diarrhea.

Feb. 22

Hannah Cash is admitted to hospital. CDC identifies outbreak on PulseNet and calls FDA.

Feb. 23

A multistate conference call takes place with health departments and federal authorities about outbreak. Trevor Simmons is released from hospital.

Feb. 28

CDC asks states to do a more-focused questionnaire and ask victims whether they have consumed this nut butter.

March 1

Maryland and Arizona report to federal authorities that nut butter caused the illnesses.

March 2

Maryland Department of Health and Mental Hygiene picks up four jars from Bob Stoll’s house. FDA and CDC call the owners of the SoyNut Butter Company to advise the firm of the multistate outbreak linked to its SoyNut Butters.

March 3

The SoyNut Butter Company voluntarily recalls its I.M. Healthy Original Creamy SoyNut Butter with “best by” dates of Aug. 30 and 31, 2018. FDA has media blast and contacts school lunch programs and early childhood associations. Dixie Dew refuses to allow FDA investigators access to the facility’s environmental sampling and production records; the FDA subsequently issues a Demand for Records under section 414 of the Federal Food, Drug, and Cosmetic Act. After receiving the Demand for Records, Dixie Dew provides FDA investigators the necessary records.

March 3-15

FDA inspects Dixie Dew facility.

March 4

The SoyNut Butter Company expands the recall of its I.M. Healthy Original Creamy SoyNut Butter.

March 6

Peter Ebb and Bob Stoll both receive recall notices from Amazon.

March 7

Hannah Cash is released from hospital. Recall is expanded.

March 9

Peter Ebb gets sick.

March 10

Recall is expanded.

March 12

Peter Ebb is admitted to the hospital.

March 15

Facility inspection report is released.

March 24

Pro Sports Club recalls 20/20 Life Styles Yogurt Peanut Crunch bars because they were made with soy nut butter supplied by the SoyNut Butter Company.

March 28

FDA suspends company’s registration.

March 30

FDA announces company’s suspension in a notice. Peter Ebb leaves the hospital.

April 18

Last illness reported.

May 4

CDC declares outbreak is over.

May 9

Linda Harris visits the contaminated facility for lawyer Bill Marler.

May 11

Scott Gottlieb becomes FDA commissioner.

July 14

Mason Stoll released from Dupont Hospital.

Labor Day weekend

Linda Harris buys nut butter online.

Oct. 13

FDA announces they have learned that it’s still being sold.