From Food Safety News:

By Dan Flynn on September 24, 2018

A new edition of “Poisoned: The True Story of the Deadly E. Coli Outbreak That Changed the Way Americans Eat” by Jeff Benedict has been shipped to distributors by book publishers Thomson-Shore.

In the new edition, Benedict catches up with America’s best-known food safety lawyer in South Africa where the world’s largest ever listeriosis outbreak was underway with eerie parallels to America’s 1993 E. coli outbreak, which “Poisoned”explores in detail.

Twenty-five years after that game-changing E. coli O157: H7 outbreak, Benedict finds food safety lawyer Bill Marler older and grayer, but still going from one food safety crisis to another. And South Africa’s listeriosis outbreak is the worst of its kind ever, according to the World Health Organization.

The new edition of “Poisoned” is the first since the original hardback came out in 2011, followed by the paperback in 2014. Its release comes as Benedict, one of America’s top nonfiction writers, finds his book, “Tiger Woods,” riding atop the New York Times Best Seller list.

In the new second edition of “Poisoned,” he reports on Marler teaming up with South African human rights lawyer Richard Spoor to seek justice for more than 1,000 Listeria victims, including the more than 200 that died. “Nearly half of the victims were newborns that had been infected during gestation,” Benedict reports.

Benedict took some time out of one of his increasingly busy days to answer a few questions from Food Safety News (FSN). Here’s what we learned:

FSN: Jeff, we did not know just how busy you’ve been. Congratulations sir, on your new book, “Tiger Woods.” It’s a No. 1 New York Times bestseller with stunning reviews. How does that feel?

JB: “It was a privilege to write the biography of the world’s greatest golfer. Tiger is a Shakespearian figure whose popularity transcends sport. The great thing is that his comeback is a triumphant tale that has captured the attention of the world.”

FSN: About half of your books involve the world of sports. In addition to golf, you’ve authored serious works about college and pro football, the NBA, Indian gaming, and domestic violence involving athletes. How do you follow so many sports and still get anything done?

JB: “It’s not so much about following so many sports. When I write a book, I do full immersion into the subject matter, whether it’s a biography about a famous athlete or an exposé on a phony Indian tribe that built the world’s largest casino. Once I’m into a book, I pretty much block out everything else.”

FSN: You also made famous action on the Supreme Court with “Little Pink House,” the takings case out of New London, CT. Your book was made into a movie that was in theaters earlier this year. What was your role in that?

JB: “I was an executive producer on the film, which starred Catherine Keener and Jeanne Tripplehorn. One of my responsibilities was to persuade David Crosby to compose an original theme song, which turned out to be one of my favorite aspects of working on the film.”

FSN: In returning to “Poisoned” to write for the new edition, were you surprised to find so many instances of foodborne illness still occurring 25 years after the events your first wrote about?

JB: “Not really. What’s interesting is the diversity of foods that are now responsible for E. coli outbreaks. When the Jack in the Box outbreak, which is the subject of “Poisoned,” happened 25 years ago, E. coli poisoning was traced to contaminated ground beef. That used to be the norm. Now E. coli is found in leafy greens and other foods. It shows, in part, how complex our food system has become.”

FSN: Poisoned is a must read for anyone in the food safety community and many will likely want to read the updated version. Beyond this professional community, do you know who makes up the audience for a book like “Poisoned” with it’s behind the scenes look at food safety?

JB “I chose a narrative style that I thought would appeal to parents, especially mothers. I also tried to write the story in a cinematic way. It’s a very visual story. And I remain hopeful that one day it will find its way to the screen.

FSN: Jeff, you’ve been highly productive as an author and producer during the past decade and longer. What’s next for you?

JB:   “The biography of LeBron James.”

Editor’s notes: Jeff Benedict is licensed to practice law in Connecticut. He’s a distinguished professor of writing and mass media at Southern Virginia University. He is represented by Richard Pine at InkWell Management in New York City.

Poisoned FOREWARD 6-29-18

I have been a frequent advocate for more transparency at the FDA when it comes to outbreaks and recalls – especially of Class I Recalls – and a frequent critic of its failure to disclose retailers – where the recalled product was sold – and its failure to disclose manufacturers – where the product was produced.  Commissioner Gottlieb seems to be taking a major leap forward in allowing consumers more information on at lease where tainted product has been sold.

I had just finished by speech at the South American IAFP Conference, when the FDA Alert fell into my in box – Statement from FDA Commissioner Scott Gottlieb, M.D., on new FDA commitment to disclose retailer information for certain food recalls to improve consumer safety.

So, here is Commissioner Gottlieb’s press statement in part.

A bit of History –The agency has not traditionally released lists of specific retailers where recalled foods may have been purchased. This is because certain supply chain information is confidential between the supplier and retailer…. But there are some cases where additional information about the retailers selling potentially harmful product may be key to protecting consumers such as when the food is not easily identified as being subject to a recall from its retail packaging and the food is likely to be available for consumption. It is particularly important in situations where the product has already been linked to foodborne illness.

Retail Disclosure –… That’s why today the FDA issued new draft guidance that describes situations when disclosing retail information for products undergoing recalls is appropriate. The draft guidance outlines the circumstances when the FDA intends to make public the retail locations that may have sold or distributed a recalled human or animal food. These circumstances will particularly apply in situations associated with the most serious recalls, where consumption of the food has a reasonable probability of causing serious adverse health consequences or death to humans or animals.

Retail Disclosure continued –… Based on this new policy, moving forward the FDA intends to publicize retail consignee lists for food recalls when the food is not easily identified as being subject to a recall from its retail packaging, or lack thereof, and if the food is likely to be available for consumption…. The new draft guidance also states that the FDA may disclose retail consignee lists in certain recall situations, including when a recalled food is related to a foodborne illness outbreak and where the information is most useful to consumers….

Perhaps, this says it all? –… I remain committed to investing in the FDA’s food program, building on our successes, and to applying the FDA’s food safety expertise to protect American families and keep our Nation safe.

Cargill Ground Beef 2018 – 17 Ill, 1 Death – E. coli O26

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 beef was the probable source of the reported illnesses. The epidemiological investigation identified 17 illnesses and one death with illness onset dates ranging from July 5 to July 25, 2018.  On August 30thPublix Super Markets Inc., a Lakeland, Fla., retail grocery store chain recalled an undetermined amount of ground beef products made from chuck that may be contaminated with Escherichia coli O26.  On September 19th, Cargill Meat Solutions, a Fort Morgan, Colorado establishment, recalled approximately 132,606 pounds of ground beef products made from the chuck portion of the carcass that may be contaminated with Escherichia coli O26,

A bit of History:

Cargill Ground Beef 2012 – 40 Ill – Salmonella

On July 22, 2012 Cargill Meat Solutions announced a recall of 29,339 pounds of fresh ground beef products due to possible contamination with Salmonella Enteritidis. Using epidemiologic and traceback data public health investigators in 8 states (MA, ME, NH, NY, RI, VA, VT, and WV) and the CDC linked 40 patients diagnosed with S. Enteritidis to consumption of Cargill ground beef sold at Hannaford grocery stores in Massachusetts, Maine, New Hampshire, New York and Vermont. Among 40 persons for whom information is available, illness onset dates ranged from June 6, 2012 to July 9, 2012. Eleven patients were hospitalized. The Vermont Department of Health isolated the outbreak strain in leftover product.

Cargill Meat Solutions Ground Turkey 2011 – 181 Ill – Salmonella

The U.S. Department of Agriculture’s Food Safety and Inspection Service(FSIS) issued a public health alert, on July 29, due to concerns about illnesses caused by Salmonella Heidelberg that associated with the use and the consumption of ground turkey. The alert was initiated after continuous medical reports, ongoing investigations and testing conducted by various departments of health across the nation determined an association between consumption of ground turkey products and illness. On August 3, Cargill Meat Solutions issued a recall of ground turkey products. The products subject to recall bear the establishment number “P-963” inside the USDA mark of inspection. On August 4, the Centers for Disease Control published their first outbreak summary. The Salmonella Heidelberg was multi-drug resistant, resistant to ampicillin, streptomycin, tetracycline, and gentamycin. The CDC began their investigation on May 23, after recognizing an “unusual clustering” of Salmonella Heidelberg cases. About the same time, routine surveillance by a federal food monitoring system found the same strain of Salmonella Heidelberg in ground turkey in stores. On July 29, the initial outbreak strain and a second, closely related, strain of Salmonella Heidelberg was isolated from a sample of leftover unlabeled frozen ground turkey from the home of an outbreak case in Ohio. Since February 27, 2011, a total of 23 ill persons were reported to Pulse Net with this second, closely related, strain. Eighty-four ill persons were infected with the initial strain. The consumer product sample originated from the Cargill Meat Solutions Corporation establishment in Springdale, Arkansas. On September 11, Cargill Meat Solutions recalled an additional, approximately 185,000 pounds, of ground turkey contaminated with an identical strain of Salmonella Heidelberg that had led to the earlier recall on August 3. As of September 27, no illnesses had been linked to the additionally recalled, ground turkey products.

Cargill Meat Solutions/BJ’s Wholesale Club Ground Beef 2010 – 3 Ill – E. coli O26

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 BJ’s Wholesale Clubs in New York, Maine, Connecticut, Virginia, New Jersey, New Hampshire, Massachusetts, and Maryland.

Beef Packers, Inc., Cargill, Ground Beef 2009 – 2 Ill – Salmonella

In December, Beef Packers, Inc., owned by Cargill, recalled over 20,000 pounds of ground beef contaminated with a drug-resistant strain of Salmonella Newport. The company issued an earlier recall in August 2009, due to contamination of ground beef with the same strain of Salmonella Newport. This contaminated ground beef was produced in September and was distributed to Safeway grocery stores in Arizona and New Mexico. The Arizona Department of Health linked two illnesses to the ground beef.

Beef Packers, Inc., Cargill, Ground Beef 2009 – 68 Ill – Salmonella

A Beef Packers, Inc. plant in California owned by Cargill, distributed approximately 830,000 pounds of ground beef that was likely contaminated with Salmonella Newport. The beef was shipped to distribution centers in Arizona, California, Colorado, and Utah where it was repackaged into consumer-sized packages and sold under different retail brand names. The contaminated beef contained a strain of Salmonella resistant to several commonly used antibiotics (called MDR-AmpC resistance). Sixty-eight outbreak associated cases were reported by 15 states. Most of the ill in Colorado had purchased the ground beef at Safeway grocery stores.

Cargill Ground Beef Sold at Sam’s Club Stores 2007 – 46 Ill – E. coli O157:H7

A multistate outbreak of E. coli O157:H7 began in August and led to the eventual recall of 845,000 pounds of Cargill ground beef. Forty-six cases were reported by 15 states. Interviews with the case-patients found a common exposure of Cargill hamburger.

Emmpak/Cargill Ground Beef 2002 – 57 Ill – E. coli O157:H7

Wisconsin epidemiologists noted a cluster of E. coli O157:H7 cases. The health department interviewed case-patients and found a common exposure. All victims had eaten ground beef from Emmpak, a meat producer. The same strain of E.coli O157:H7 was isolated from the ground beef. The case investigation resulted in a 2.8-million-pound recall of Emmpak meat and resulted in related illnesses in at least six states. The responsible Emmpak plant was closed for inadequate sampling and testing procedures.

Cargill Deli Turkey 2000  – 29 Ill – Listeria

A case-control study implicated sliced, processed, turkey deli meat in a multistate (11 state) outbreak. A traceback investigation identified a single processing plant in Texas as the likely source of the outbreak. The company recalled 16 million pounds of processed meat. The same plant had been implicated in a Listeria contamination involving the same strain of Listeria more than a decade previously.

As some of the readers might know, in my spare time I am the managing partner at Marler Clark in Seattle.  Our long-time Epidemiologist, Patti Waller, has moved into semi-retirement and is running www.outbreakdatabase.com for us.  Katrina Deardorff, who has been with us for a nearly two years, has decided to take a job back in the public sector, and we wish her well.

So, I am working here on a Saturday (not that uncommon), thinking about how to replace the irreplaceable, but knowing how important this job is to the quality of work we do at Marler Clark.

Minimum requirements are a Masters in Public Health or Epidemiology and some experience in foodborne disease investigations and willingness to live in Seattle.

Please send your resume and salary requirements to me at bmarler@marlerclark.com.  Also, take a chance to see the below.  I think it helps understand the job and its importance.

SPEAKER: William Marler, Managing Partner, Marler Clark, The Food Safety Law Firm
TIME: 4:30 – 5:30 pm
LOCATION: Wynne Courtroom and atrium, Inlow Hall, 530 W. New York Street, Indianapolis, IN
CONTACT: Hall Center for Law and Health at centerlh@iupui.edu

Please join the Indiana University Robert H. McKinney School of Law Hall Center for Law and Health Grand Rounds on Thursday, September 13th at 4:30pm.

William Marler, Managing Partner, Marler Clark, The Food Safety Law Firm

This is a free event, but registration is required.

Bio:

An accomplished attorney and national expert in food safety, William (Bill) Marler has become the most prominent foodborne illness lawyer in America and a major force in food policy in the U.S. and around the world.  Marler Clark, The Food Safety Law Firm, has represented thousands of individuals in claims against food companies whose contaminated products have caused life altering injury and even death.

He began litigating foodborne illness cases in 1993, when he represented Brianne Kiner, the most seriously injured survivor of the historic Jack in the Box E. coli O157:H7 outbreak, in her landmark $15.6 million settlement with the company.  The 2011 book, Poisoned: The True Story of the Deadly E. coli Outbreak that Changed the Way Americans Eat, by best-selling author Jeff Benedict, chronicles the Jack in the Box outbreak and the rise of Bill Marler as a food safety attorney.

For the last 25 years, he has represented victims of nearly every large foodborne illness outbreak in the United States.  He has filed lawsuits against such companies as Chili’s, Chi-Chi’s, Cargill, ConAgra, Dole, Excel, Golden Corral, KFC, McDonald’s, Odwalla, Peanut Corporation of America, Sheetz, Sizzler, Supervalu, Taco Bell and Wendy’s, securing over $600,000,000 for victims of E. coli, Salmonella, and other foodborne illnesses.

Among the most notable cases he has litigated, Bill counts those of nineteen-year-old dancer Stephanie Smith, who was sickened by an E. coli-contaminated hamburger that left her brain damaged and paralyzed, and Linda Rivera, a fifty-seven-year-old mother of six from Nevada, who was hospitalized for over 2 years after she was stricken with what her doctor described as “the most severe multi-organ [bowel, kidney, brain, lung, gall bladder, and pancreas] case of E. coli mediated HUS I have seen in my extensive experience.”

New York Times reporter Michael Moss won a Pulitzer Prize for his coverage of Smith’s case, which was settled by Cargill in 2010 for an amount “to care for her throughout her life.” Linda’s story hit the front page of the Washington Post and became Senate Majority Leader Harry Reid’s touchstone for successfully moving forward the Food Safety Modernization Act in 2010.

Bill Marler’s advocacy for a safer food supply includes petitioning the United States Department of Agriculture to better regulate pathogenic E. coli, working with nonprofit food safety and foodborne illness victims’ organizations, and helping spur the passage of the 2010-2011 FDA Food Safety Modernization Act.  His work has led to invitations to address local, national, and international gatherings on food safety, including testimony before the U.S. House of Representatives Committee on Energy and Commerce.

At little or no cost to event organizers, Bill travels widely and frequently to speak to food industry groups, fair associations, and public health groups about the litigation of claims resulting from outbreaks of pathogenic bacteria and viruses and the issues surrounding it.  He gives frequent donations to industry groups for the promotion of improved food safety and has established numerous collegiate science scholarships across the nation.

He is a frequent writer on topics related to foodborne illness.  Bill’s articles include “Separating the Chaff from the Wheat: How to Determine the Strength of a Foodborne Illness Claim”, “Food Claims and Litigation”, “How to Keep Your Focus on Food Safety”, and “How to Document a Food Poisoning Case” (co-authored with David Babcock.)  He is the publisher of the online news site, Food Safety News and his award-winning blog, www.marlerblog.com is avidly read by the food safety and legal communities. He is frequent media guest on food safety issues and has been profiled in numerous publications.

In 2010 Bill was awarded the NSF Food Safety Leadership Award for Education and in 2008 earned the Outstanding Lawyer Award by the King County Bar Association.  He has also received the Public Justice Award from the Washington State Trial Lawyers Association.

Bill graduated from the Seattle University School of Law in 1987, and in 1998 was the Law School’s “Lawyer in Residence.”  In 2011 he was given Seattle University’s Professional Achievement Award.  He is a former board member of the Washington State Trial Lawyers, a member of the board of directors of Bainbridge Youth Services, former President of the Governor-appointed Board of Regents at Washington State University.

Parking:

Due to road construction on or near campus, we recommended parking at the IUPUI Sports Garage at 875 West New York Street.  Please note this is a change from previous years.

Parking is available for a nominal fee (credit/debit card) at the Sports Garage, as well as the Gateway Garage.

Special Accommodations:

Individuals with disabilities who need special assistance should call (317) 278-4789 no later than one week prior to the event. Special arrangements can be made to accommodate most needs.

The big takeaway is that this outbreak was caused by an environmental contaminate – a lot of cows in a feedlot near the water source used to irrigate crops.

So, if nothing changes environmentally and a similar E. coli outbreak happens, what is the responsibility of the growers, processors, shippers and “points of sale” – grocery stores and restaurants?

Perhaps we should take a look at Black’s Law Dictionary on punitive damages:

“Punitive damages are designed to not only discourage the defendant in question from engaging in similar behavior in the future, but are also meant to be a message sent to society at large. Civil courts that punish reckless or negligent behavior with punitive damages indicate to others that such behavior will not be tolerated and that that behavior can lead to monetary consequences.”

If next spring another E. coli outbreak happens in Yuma linked to the same cause and people get sick and/or die – count on punitive damages against against everyone – “Farm to Fork.”

When food makes people sick all around the country, an army of germ detectives jumps into action.

Listen here: https://one.npr.org/?sharedMediaId=641737545:641737661

On March 17, 2018, I penned the following: (Other than Tiger Brands admitting that its product tested positive for the exact same strain of Listeria that sickened now over 1,000 and killed 200), not much.  Lawrence, I’m still willing to write the check.

Imagine that the phone call comes or an email pops into your inbox – “Sir, we have been contacted by the health authorities and they say our product (polony) has been linked to illnesses and deaths. What do we do?”

So, what do you do?  Lawrence MacDougall received that call.  Now, what has he done and what will he do?

After being involved in every major (and a few minor) food poisoning outbreaks since the Jack in the Box E. coli Outbreak of 1993, I have seen it all. I have seen good CEOs act badly and make their and their company’s problems worse and I have seen bad CEOs handle the outbreak with such aplomb that they become associated with both food safety and good PR.

So, what do you do?

Of course, it is always best to avoid the outbreak to begin with. When I have spoken to CEOs or their Boards–generally, pre-outbreak and pre-lawsuit–I always pitch them on “why it is a bad idea to poison your customers.” Putting safe food as the primary goal–yes, alas, even before profits–will (absent an error) give you a very, very good chance of never seeing me on the other side of a courtroom.

But, what if despite your best efforts, or what if you simply did not care, and an outbreak happens.

So, what do you do?

First, have a pre-existing relationship with the folks that regulate you. If someone holds your business in the palm of his or her hand, you should at least be on a first name basis. No, I am not suggesting that you can influence your way out of the outbreak but knowing who is telling you that your company has a problem allows you the ability to get and understand the facts. Do regulators and their investigators make mistakes? Perhaps, but not very often and not often enough to waste time arguing that your company did not poison customers.

Second, stop production of the implicated product and initiate a recall of all products at risk immediately. This procedure should have been practiced, and practiced, and practiced before. All possibly implicated suppliers should be alerted and all retailers should be offered assistance. Consumers need to be engaged too.  The goal now is to get poisoned product out of the marketplace and certainly out of the homes of consumers.

Third, launch your own investigation with two approaches, and at the same time. Are the regulators correct? And, what went wrong? Tell everyone to save all documents and electronic data. The goal here is to get things right. If it really is not your product, what has happened is bad, but survivable. If it really was your product, then learning what happened helps make sure it is likely to never happen again. More than anything, be transparent. Tell everyone what you find–good or bad.

According to the South African Minister of Public Health, Minister of Health Dr. Aaron Motsoaledi:

Listeria monocytogenes was isolated from stool collected from one of the ill children, and from both of the polony specimens collected from the crèche. These isolates were sent to the NICD Centre for Enteric Diseases and underwent whole genome sequencing and genomic analysis. The ST6 sequence type was confirmed on all three isolates on Saturday 27th January. Remember that in the last press conference I informed you that from clinical isolates obtained from patients (patient blood), 9 sequence types of Listeria monocytogenes were isolated and 91% were of sequence type 6 (ST6). We had then concluded that time that this outbreak is driven by ST6.

Following the lead from the tests performed on these children from Soweto and the food they had ingested, the EHPs (Environmental Health Practitioners), together with the NICD and DAFF representatives, accompanied by 3 technical advisors from the World Health Organization in Geneva, visited a food-production site in Polokwane and conducted an extensive food product and environmental sampling.

Listeria monocytogenes was isolated from over 30% of the environmental samples collected from this site, which happens to be the Enterprise factory in Polokwane.

To conclude the investigation, whole genome sequencing analysis was performed from this Enterprise factory and the results became available midnight or last night. The outbreak strain, ST6, was confirmed in at least 16 environmental samples collected from this Enterprise facility.

THE CONCLUSION FROM THIS IS THAT THE SOURCE OF THE PRESENT OUTBREAK CAN BE CONFIRMED TO BE THE ENTERPRISE FOOD-PRODUCTION FACILITY IN POLOKWANE

As of the March 14, 2018 update of Listeria monocytogenes Outbreak from the Centre for Enteric Diseases (CED) and Division of Public Health Surveillance and Response, Outbreak Response Unit (ORU), National Institute for Communicable Diseases (NICD)/National Health Laboratory Service (NHLS), a total of 978 cases has been reported since 2017. Since the last situational update (8 March 2018), 11 additional cases have been reported to the NICD. The death total remained at 183. Given the above work by NICD and the fact that the number of ill is failing post-recall, Tiger Brands – Enterprise has nothing to argue about the source of the outbreak.

Fourth, assuming that the outbreak is in fact your fault, publicly admit it. If it is not your fault, then fight it. However, pretending that you are innocent when you are actually at fault will get you nowhere. Asking for forgiveness is not a bad thing when you have something to be forgiven for. Saying you are sorry is not wrong when you are in fact wrong.

Mr. MacDougall, given the facts saying this was both heartless and stupid: “There is no direct link with the deaths to our products that we are aware of at this point. Nothing.”

Fifth, do not blame your customers.  If your food has a pathogen it is not your customers responsibility to handle it like it will likely kill them or a member of their family.  Hoping that the consumer will fix your mistake takes your eye off of avoiding the mistake in the first place.

Sixth, reach out to your customers and consumers who have been harmed. Offering to pay legitimate losses will save money and your company’s reputation in the long run.  The public with give you credit and it will be a reduction from the future award during litigation.

Seventh, teach all what you have learned. Do not hide what you have learned. Make your knowledge freely available so we all limit the risk that something similar will happen again.

Mr. MacDougall, I will match you personally 1,000,000 Rand to donate to an Organization or University in South Africa to lead a review of both food processing standards and governmental regulations and oversight.  I will help find experts from around the world to assist.

Yes, you can do all of the above and still get sued. And, I might be the one to sue you, and in Mr. MacDougall’s case I am. Yet, companies who have followed the above find their passage through an outbreak, recall, and litigation temporary. The companies that struggle for unfounded reasons will seldom exist in the long run, or they will simply pay my clients more money.

Bill Marler is trial lawyer who spends a great deal of time trying to convince companies around the world why it is a bad idea to poison customers. Twitter @bmarler and Blog at www.marlerblog.com

As of Tuesday July 31, 2018, the Delaware General Health District has received a total of 683 inquiries related to a possible foodborne illness outbreak stemming from the Chipotle located at 9733 Sawmill Parkway. Of those inquiries, staff members have completed over 480 interviews.

The Ohio Department of Health returned initial stool sample results today – all have tested negative for Salmonella, Shigella, E. coli and Norovirus. Further stool testing will be conducted for other pathogens. The food samples are still in the process of being tested for Bacillus Cereus or Clostridium Perfringens in addition to the four diseases listed above that are tested in stool samples.

The Delaware General Health District suggests that you please contact your local health department to file food complaints. Posting on social media and/or a website is not an official complaint. The Health District has also received calls regarding medical attention. Please consult your doctor for all medical needs.

Fast Facts of CDC: Surveillance for Foodborne Disease Outbreaks — United States, 2009–2015 Surveillance Summaries / July 27, 2018 / 67(10);1–11:

2009–2015: 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths.

Among 2,953 outbreaks with a single confirmed etiology:

  1. Norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]).
  2. Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%).
  3. Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported.

Among 1,281 outbreaks in which the food reported could be classified into a single food category:

  1. Fish were the most commonly implicated category (222 outbreaks [17%]).
  2. Dairy (136 [11%]).
  3. Chicken (123 [10%]).

The food categories responsible for the most outbreak-associated illnesses were:

  1. Chicken (3,114 illnesses [12%]).
  2. Pork (2,670 [10%]).
  3. Seeded vegetables (2,572 [10%]).

Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Problem/Condition: Known foodborne disease agents are estimated to cause approximately 9.4 million illnesses each year in the United States. Although only a small subset of illnesses are associated with recognized outbreaks, data from outbreak investigations provide insight into the foods and pathogens that cause illnesses and the settings and conditions in which they occur.

Description of System: The Foodborne Disease Outbreak Surveillance System (FDOSS) collects data on foodborne disease outbreaks, which are defined as the occurrence of two or more cases of a similar illness resulting from the ingestion of a common food. Since the early 1960s, foodborne outbreaks have been reported voluntarily to CDC by state, local, and territorial health departments using a standard form. Beginning in 2009, FDOSS reporting was made through the National Outbreak Reporting System, a web-based platform launched that year.

Results: During 2009–2015, FDOSS received reports of 5,760 outbreaks that resulted in 100,939 illnesses, 5,699 hospitalizations, and 145 deaths. All 50 states, the District of Columbia, Puerto Rico, and CDC reported outbreaks. Among 2,953 outbreaks with a single confirmed etiology, norovirus was the most common cause of outbreaks (1,130 outbreaks [38%]) and outbreak-associated illnesses (27,623 illnesses [41%]), followed by Salmonella with 896 outbreaks (30%) and 23,662 illnesses (35%). Outbreaks caused by ListeriaSalmonella, and Shiga toxin-producing Escherichia coli (STEC) were responsible for 82% of all hospitalizations and 82% of deaths reported. Among 1,281 outbreaks in which the food reported could be classified into a single food category, fish were the most commonly implicated category (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Multistate outbreaks comprised only 3% of all outbreaks reported but accounted for 11% of illnesses, 34% of hospitalizations, and 54% of deaths.

Location: A location of preparation was provided for 5,022 outbreak reports (87%), with 4,696 (94%) indicating a single location. Among outbreaks reporting a single location of preparation, restaurants were the most common location (2,880 outbreaks [61%]), followed by catering or banquet facilities (636 [14%]) and private homes (561 [12%]). Sit-down dining style restaurants (2,239 [48%]) were the most commonly reported type of restaurant. The locations of food preparation with the most outbreak-associated illnesses were restaurants (33,465 illnesses [43%]), catering or banquet facilities (18,141 [24%]), and institutions, such as schools (9,806 [13%]). The preparation location with the largest average number of illnesses per outbreak was institutions (46.5), whereas restaurants had the smallest (11.6).

Outbreaks: Outbreak investigators identified a food in 2,442 outbreaks (42%). These outbreaks resulted in 51,341 illnesses (51%). The food reported belonged to a single food category in 1,281 outbreaks (22%). The food category most commonly implicated was fish (222 outbreaks [17%]), followed by dairy (136 [11%]) and chicken (123 [10%]). The food categories responsible for the most outbreak-associated illnesses were chicken (3,114 illnesses [12%]), pork (2,670 [10%]), and seeded vegetables (2,572 [10%]). Scombroid toxin in fish was the single confirmed etiology and food category pair responsible for the most outbreaks (85), followed by ciguatoxin in fish (72) and Campylobacter in dairy (60). The pathogen-food category pairs that caused the most outbreak-associated illnesses were Salmonella in eggs (2,422 illnesses), Salmonella in seeded vegetables (2,203), and Salmonella in chicken (1,941). In comparison, scombroid toxin and ciguatoxin outbreaks from fish resulted in 519 outbreak-associated illnesses, an average of three illnesses per outbreak. Outbreaks of Salmonella infections from seeded vegetables resulted in an average of 88 illnesses per outbreak, and outbreaks of Salmonella infections from eggs resulted in an average of 78 illnesses per outbreak.

Food Implicated: Several novel food vehicles caused outbreaks during the study period. In 2011, an outbreak of Salmonella serotype Enteritidis infections linked to pine nuts imported from Turkey resulted in 53 illnesses and two hospitalizations. In 2014, an outbreak of Salmonella serotypes Gaminara, Hartford, and Oranienburg in chia seed powder imported from Canada caused 45 illnesses and seven hospitalizations. An outbreak of STEC serogroups O26 and O121 infections that began in 2015 was linked to raw wheat flour produced in the United States; it resulted in 56 illnesses and 16 hospitalizations in 24 states. An outbreak of Salmonella serotype Virchow infections attributable to moringa leaf powder imported from South Africa began in 2015 and caused 35 illnesses and six hospitalizations in 24 states. It was an ingredient of an organic powdered shake mix branded to be used as a meal replacement.

Multistate Outbreaks: Multistate outbreaks comprised only 3% of outbreaks but were responsible for 11% of illnesses, 34% of hospitalizations, and 54% of deaths. Multistate outbreaks involved a median of seven states with a range of two to 45 states in which exposure occurred. The largest of the 177 multistate outbreaks was caused by Salmonella serotype Enteritidis and due to contaminated shell eggs. An estimated 1,939 persons were infected in 10 states beginning in 2010. An outbreak of Salmonella serotype Poona infections attributed to cucumbers in 2015 had the second highest number of illnesses (907 illnesses in 40 states). This outbreak also had the most outbreak-associated hospitalizations (204 [22% of cases]). An outbreak of Salmonella serotype Heidelberg infections attributed to chicken during 2013–2014 had the second most hospitalizations (200 [32% of cases]) and involved persons from 29 states and Puerto Rico. An outbreak of Listeria monocytogenes infections attributed to cantaloupes in 28 states in 2011 had the most deaths (33 [22% of cases]), followed in 2014 by an outbreak in 12 states of Listeria monocytogenes infections attributed to caramel apples, another novel food vehicle (9), in which seven persons (20% of cases) died.

Daniel Dewey-Mattia, MPH; Karunya Manikonda, MPH; Aron J. Hall, DVM; Matthew E. Wise, PhD; Samuel J. Crowe, PhD.

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