Not  to be confused with the Seven Deadly Sins: pride, greed, lust, envy, gluttony, wrath and sloth, although, perhaps some of these outbreaks were sinful.  I had the honor to represent many of the ill and the families of those who died.

Jack-in-the- Box E. coli Outbreak – 1992 – 1993

708 ill, 171 hospitalized and 4 dead

An outbreak of E. coli O157:H7 was linked to the consumption of hamburgers from the Jack-in-the-Box Restaurant chain. Cases were reported from the states of Washington (602 cases/144 hospitalizations/3 deaths), Idaho (14 cases/4 hospitalizations/no deaths), California (34 cases/14 hospitalizations/1 death), and Nevada (58 cases/9 hospitalizations/no deaths). A case control study implicated the chain’s hamburgers resulting in a multistate recall of the remaining hamburgers. Only 20 percent of the product remained at the time of the recall; this amounted to 272,672 hamburger patties. Subsequent testing of the hamburger patties showed the presence of E. coli O157:H7. The strain of E. coli O157:H7 found in ill people matched the strain isolated from uncooked hamburger patties. The outbreak illustrated the potential for large, foodborne illness outbreaks associated with restaurant chains receiving shipments of contaminated food. At the time, many clinical laboratories in the United States were not routinely culturing patients’ stool for E. coli O157:H7 by using the correct culture medium. Additionally, many local and state health departments were not actively tracking and investigating E. coli O157:H7 cases.


Chi Chi’s Green Onion Hepatitis A Outbreak – 2003

565 ill, 130 hospitalized and 3 dead

Pennsylvania State health officials first learned of a hepatitis A outbreak when unusually high numbers of hepatitis A cases were reported in late October 2003. All but one of the initial cases had eaten at the Chi Chi’s restaurant at the Beaver Valley Mall, in Monaca, PA. Ultimately, at least 565 cases were confirmed. The victims included at least 13 employees of the Chi Chi’s restaurant, and residents of six other states. Three people died as a consequence of their hepatitis A illnesses. More than 9,000 people who had eaten at the restaurant, or who had been exposed to ill people, were given a post-exposure injection as a prevention against developing hepatitis A. Preliminary analysis of a case-control study indicated fresh, green onions were the probable source of this outbreak. The investigation and tracebacks by the state health department, the CDC, and the FDA, confirmed that the green onions had been grown in Mexico.


Dole Baby Spinach E. coli Outbreak – 2006

238 ill, 103 hospitalized and 5 dead

On Sept. 13, 2006, public health officials in Wisconsin, Oregon and New Mexico noted E. coli O157:H7 infections with matching pulsed-field gel electrophoresis (PFGE) patterns. These illnesses were associated with eating fresh, bagged spinach produced by Dole Brand Natural Selection Foods. By Sept. 26 that year, infections involving the same strain of E. coli O157:H7 had been reported from 26 states with one case in Canada. A voluntary recall was issued by the company on Sept. 15. E. coli O157: H7 was isolated from 13 packages of spinach supplied by patients in 10 states. Eleven of the packages had lot codes consistent with a single manufacturing facility on a particular day. The PFGE pattern of all tested packages matched the PFGE pattern of the outbreak strain. The spinach had been grown in three California counties – Monterey, San Benito and Santa Clara. E. coli O157:H7 was found in environmental samples collected near each of the four fields that provided spinach for the product, as designated by the lot code. However, E. coli O157:H7 isolates associated with only one of the four fields, located on the Paicines Ranch in San Benito County, had a PFGE pattern indistinguishable from the outbreak strain. The PFGE pattern was identified in river water, cattle feces and wild pig feces on the Paicines Ranch, the closest of which was less than one mile from the spinach field.


Peanut Corporation of America Salmonella Outbreak – 2008 – 2009

714 ill, 171 hospitalized and 9 dead

Beginning in November 2008, CDC’s PulseNet staff noted a small and highly dispersed, multistate cluster of Salmonella Typhimurium isolates. The outbreak consisted of two pulsed-field gel electrophoresis (PFGE) defined clusters of illness. Illnesses continued to be revealed through April 2009, when the last CDC report on the outbreak was published. Peanut butter and products containing peanut butted produced at the Peanut Corporation of America plant in Blakely, GA, were implicated. King Nut brand peanut butter was sold to institutional settings. Peanut paste was sold to many food companies for use as an ingredient. Implicated peanut products were sold widely throughout the USA, 23 countries and non-U.S. territories. Criminal sanctions were brought against the owners of PCA.


Jensen Farms Cantaloupe Listeria Outbreak – 2011

147 ill, 143 hospitalized and 33 dead

A multistate outbreak of Listeria monocytogenes involving five distinct strains was associated with consumption of cantaloupe grown at Jensen Farms’ production fields near Granada, CO. A total of 147 ill people were reported to the CDC. Thirty-three people died, and one pregnant woman miscarried. Seven of the illnesses were related to pregnancy – three newborns and four pregnant women. Among 145 ill people with available information, 143 – 99 percent – were hospitalized. Source tracing of the cantaloupes indicated that they came from Jensen Farms, and were marketed as being from the Rocky Ford region. The cantaloupes were shipped from July 29 through Sept. 10, 2011, to at least 24 states, and possibly distributed elsewhere. Laboratory testing by the Colorado Department of Public Health and Environment identified Listeria monocytogenes bacteria on cantaloupes collected from grocery stores and from ill persons’ homes. Laboratory testing by FDA identified Listeria monocytogenes matching outbreak strains in samples from equipment and cantaloupe at the Jensen Farms’ packing facility in Granada, Colorado.  Criminal sanctions were brought against the two owners of Jensen Farms.


Bidart Caramel Apple Listeria Outbreak

35 ill, 34 hospitalized and 7 deaths

On December 19, 2014, the CDC announced a multistate outbreak of Listeria monocytogenes linked to commercially produced, prepackaged caramel apples. A total of 35 people infected with the outbreak strains of Listeria monocytogenes were reported from 12 states. Of these, 34 were hospitalized. Listeriosis contributed to at least 3 of the 7 deaths reported. Eleven illnesses were pregnancy-related with one illness resulting in a fetal loss. here invasive illnesses were among otherwise healthy children aged 5-15 years. Twenty-eight (905) of the 31 ill persons interviewed reported eating commercially produced, prepackaged caramel apples before becoming ill. The Public Health Agency of Canada identified one case of listeriosis that was genetically related to the US outbreak. The investigation was assigned Cluster ID #1411MNGX6-1. On December 24, 2014, Happy Apples issued a voluntary recall of Happy Apple brand caramel apples with best use by date between August 25th and November 23rd, 2014 due to a connection between the apples and outbreak associated cases. California Snack Foods brand caramel apples issued a similar recall on December 27th. Both companies used apples supplied by Bidart Brothers. On December 29 Merb’s Candies recalled Bionic Apples and Double Dipped Apples. On January 6, 2105 Bidart Bros. of Bakersfield, California recalled Granny Smith and Gala apples because environmental testing revealed contamination with Listeria monocytogenes at the firm’s apple-packing facility. On January 8, 2015 FDA laboratory analyses using PFGE showed that environmental Listeria isolates from the Bidart Bros. facility were indistinguishable from the outbreak strains.


Andrew and Williamson Cucumber Salmonella Outbreak – 2015

907 ill, 204 hospitalized and 6 dead

On September 4, 2015 the CDC announced an outbreak of Salmonella Poona linked to consumption of cucumbers grown in Mexico and imported by Andrew & Williamson Fresh Produce. On March 18, 2016 the outbreak was declared to be over. A total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states. Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Two hundred four ill people were hospitalized and six deaths were reported. Salmonella infection was not considered to be a contributing factor in two of the 6 deaths. Epidemiologic, laboratory, and traceback investigations identified imported cucumbers from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.

blue-bell-icecreamPress Release from Blue Bell:

As we complete our final phase of distribution, we wanted to update our loyal customers on what has been going on in our production facilities. We continue to strictly adhere to our enhanced operations, policies, employee training and cleaning procedures to help give regulatory agencies and the public assurance that all aspects of our facilities and operations are resulting in a safe product.

We continually reinforce to our employees that eliminating all potential sources of contamination is our number one priority so that we can stay committed to producing safe and high quality products for customers to enjoy.

Because Listeria is commonly found in the natural environment, no manufacturer can ever assume it can be entirely eradicated. We have worked closely with our expert team of microbiologists to develop an enhanced, robust testing system specifically designed for each facility to identify any possible presence of Listeria in the production environment, including extensive environmental testing and testing every single batch of ice cream we make before it is sold to customers.

We are pleased that our enhanced environmental and product testing procedures are working. We have identified locations where suspected Listeria species may be present in our facility, and we continue to extensively clean and sanitize those areas and make additional enhancements to the facility and our procedures based on the environmental test results. To confirm that our robust environmental program is effective, and that our “seek and destroy” goals are being achieved, we expect to periodically find microbiological indications in our facilities. Since our plants reopened, we have tested and will continue to test every batch of ice cream produced, and no products produced have tested positive for Listeria.

According to an FDA Press Release, Queseria Bendita of Yakima, Wash., is recalling three types of cheese, Queso Fresco, Panela, and Requeson, because they have the potential to be contaminated with Listeria monocytogenes, an organism that can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

The Queso Fresco, Panela, and Requeson cheeses are sold at Queseria Bendita’s retail store and were distributed in Washington and Oregon, where they are sold in Hispanic markets.

The Queso Fresco is packaged in one- and three-pound vacuum packed wheels; the Panela is vacuum packed in one- and three- pound sizes; and the Requeson is packed in eight-ounce and one- pound clear plastic tubs.

Each cheese has a green label identifying the type of cheese, the Queseria Bendita brand name, and a date code up to and including "Apr 30 2010".

To date there is one confirmed illness in Washington related to the recalled product. Other illnesses in Washington and Oregon may also be related.

The public health investigation of the illnesses led to sampling and testing of the cheeses. The testing revealed the contamination of the product with Listeria monocytogenes.

The company has ceased production and distribution of the product while the Washington State Department of Agriculture, the U.S. Food and Drug Administration, and the firm investigate the source of the problem.

My wife and 16-year-old daughter spent the week at the Democratic National Convention.  Me, I took our other 13-year-old and 9-year-old daughters to Hawaii for a few days in the surf and sun.  Yes, we did go to a laua – picture below the main course.

OK, I get asked all the time what I eat and do not eat – yes, I ate it.  My kids, however, kept asking why they killed and cooked Wilbur?  So, a little bit of an experiment in food illness surveillance?  It has been 48 hours since I ate Wilbur, let’s see how it goes.  If the pig is contaminated with listeria, I have a long time to wait with the incubation period running up to a month. 

As the Canadian Public Health Agency says, 29 cases of listeriosis have been confirmed nationally, and another 31 suspected cases are being investigated.  Maple Leaf, the manufacturer of the contaminated product, has ordered the return of all products made at the plant from nursing homes, hospitals, restaurants and stores, in one of Canada’s biggest food recalls.  For more information on Listeria, see www.about-listeria.com.

And for more worries North of the border, Salmonella kills one, leaves 87 ill in Quebec
Cheese Recall.
  A salmonella outbreak in Quebec has left one person dead and 87 others sick, prompting the Ministry of Agriculture, Fisheries and Food to recall three cheeses manufactured by Fromages La Chaudiere Inc.  Blocks of hard cheese, as well as cheese curds labelled La Chaudiere, Polo and Tradition, manufactured between July 24 and Aug. 24, have been pulled off store shelves as they may be contaminated with salmonella.  The outbreak has centred in three regions of Quebec — Chaudiere Appalaches, Estrie and Mauricie Centre du Quebec — but the cheeses have a wide distribution throughout the province, Horacio Arruda, Quebec’s director of public health, said in a news conference yesterday in Montreal.  Over the past week, a total of six cheeses have been pulled from store shelves across the province. In addition to the three cheeses recalled on Thursday, three other cheeses were recalled earlier this week because they may contain listeria.  For more information on salmonella, see www.about-salmonella.com.

Three elderly men have died and at least one pregnant woman has miscarried since last June after drinking listeria-contaminated pasteurized milk from Whittier Farms in Shrewsbury, Massachusetts. At least two others have been sickened as well. According to the Massachusetts Department of Health, tests have found no problems with the pasteurization process at the Whittier Farms plant, so investigators have turned their attention to the cooling and bottling machinery. So, the question really becomes where in the process did the milk become contaminated? Assuming that it really was not a problem in under-pasteurization, where, after heating, was the listeria bacteria introduced?

The families of victims of this outbreak have recently contacted us. One of the questions asked is how listeria survived pasteurization or how it was contaminated after pasteurization. Historically, there have been bacteria outbreaks tied to pasteurized milk, but the outbreaks seem tied to under-pasteurization or post-pasteurization contamination.

Date – Location – Species – Cases

1966 – Florida – Shigella flexneri – 97

1975 – Louisiana – Salmonella Newport – 49

1976 – New York – Y. enterocolitica – 38

1978 – Arizona – S. Typhimurium – 23

1979 – UK – Campylobacter jejuni – 3,500

1982 – Tenn., Ark., Miss. – Y. enterocolitica – 172

1983 – Massachusetts – Listeria monocytogenes – 49

1984 – Kentucky – S. Typhimurium – 16

1985 – Illinois – S. Typhimurium – >150,000

1986 – Vermont – Campylobacter jejuni – 35

1992 – UK – Campylobacter jejuni – 23

1992 – UK – Campylobacter sp. – 110

1994 – Illinois – L. monocytogenes – 45

1995 – UK – Campylobacter sp. – 12

1995 – Vermont, New Hampshire – Y. enterocolitica – 10

1999 – UK – E. coli O157:H7 – 114

2000 – Pennsylvania, New Jersey – S. Typhimurium – 93

2004 – Denmark – E. coli O157:H7 – 25

2005 – Colorado – Campylobacter jejuni – 40

2006 – California – Campylobacter jejuni – 1,644

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

I have been following this tragic tale since right after Christmas in a series of three posts (1, 2, 3). I was somewhat surprised when Linda Bock of the Worcester Telegram wrote in yesterdays paper that Whittier Farms “voluntarily” stopped production of milk after it had learned that two men over 70 had died, one 87 year old man was still hospitalized and one young woman lost her baby. One wonders how “voluntary” the recall really was? Listeria monocytogenes is a very nasty bug in milk – it clearly can be deadly.

Cornell University, speaking specifically about milk, reported that Listeria monocytogenes can be found in soil and water and has been isolated from a large number of environmental sources. Listeria monocytogenes is destroyed by pasteurization, but if food products are contaminated after pasteurization, Listeria monocytogenes, can grow at refrigerator temperatures.

According to the FDA, Listeria typically causes illness in pregnant adults, newborns, the elderly, and patients with compromised immune systems, but healthy adults and children may also become infected. Symptoms of Listeriosis include flu-like symptoms, fever, muscle aches, stiff neck, headache, septicemia, meningitis, miscarriage, stillbirth, premature delivery, abortion, or death. The CDC reports that in the United States, an estimated 2,500 persons become seriously ill with listeriosis each year. Of these, 500 die. Unfortunatley, is doubtful that fetal deaths are counted in that number.

In June of 2006 researchers at the University of California at Berkeley published disturbing data on “Listeriosis’s path to miscarriage traced to placental infection.” Their research showed that the bacteria may invade the placenta, where – protected from the body’s immune system – they proliferate rapidly before pouring out to infect organs such as the liver and spleen. The illness they cause often results in miscarriage or infection of the fetus.

Listeria infections in the elderly are also common and can be deadly as well. Not surprisingly, inflammation and atrophy of the gastric mucosa escalates with age. Because stomach acids play an important role in limiting the number of bacteria that enter the small intestine, the low gastric acidity common in the elderly, especially those with gastric ulcer disease, increases the likelihood of infection when bacteria is ingested in food or drink. In addition, underlying (co-morbid) conditions contribute to the morbidity and mortality of infection in the elderly. These conditions make the elderly susceptible to certain complications of an infectious diarrheal illness like electrolyte imbalance, dehydration, and shock. And, finally, as people age the immune system is compromised. It leads to an inappropriate, inefficient, and sometimes detrimental immune response, and its effect on health often manifests most apparently during intense stress (e.g., surgery, sepsis, multiple organ failure, malnutrition, dehydration).

According to Stephen Smith of the Boston Globe Staff in his article, “State test points to dairy as germ source:”

Coffee-flavored milk taken from a cooler at a central Massachusetts dairy carried germs identical to bacteria that killed two elderly men and made two other people sick….

Genetic fingerprinting conducted at the state laboratory has indicated that a milk sample collected at Whittier Farms dairy two weeks ago, a sample taken in November from a bottle in a victim’s refrigerator, and blood drawn from the four patients all harbored exactly the same type of listeria.

Clearly, there was a failure in the pasteurization process or the contamination was introduced post-pasteurization.  Recent reports suggest the later.  Although outbreaks associated with mis-pasteurized milk have occurred, in nearly every instance it was a failure of the pasteurization process or post-pasteurization contamination that lead to illnesses. See by prior blog post, “More News on Massachusetts listeria Deaths Related to Whittier Farms Pasteurized Milk.”

So, before you go out and start buying raw milk because you are now worrying about mis-pasteurization, please take a hard look at the list of raw milk outbreaks put together by Barfblog and the below PowerPoint from the FDA:

Here is some interesting information on Raw Milk Production:  "Raw Milk Legal Status in Top 10 Milk Production States:"

1. California – 2903 million pounds in 2003 – Raw milk sales are legal in retail stores.

2. Wisconsin – 1852 million pounds in 2003 – In January, 2005, a raw milk bill was submitted to the Wisconsin legislature

3. New York – 1015 million pounds in 2003 – Raw milk sales are permitted on the farm.

4. Pennsylvania – 855 million pounds in 2003 – Raw milk sales are legal both on the farm and retail

5. Minnesota – 691 million pounds in 2003 – State Constitution stated in Article XIII, Section 7: Any person may sell or peddle the products of the farm or garden occupied and cultivated by him without obtaining a license therefor.

6. Idaho – 734 million pounds in 2003 – Raw milk sales are legal with a license

7. New Mexico – 565 million pounds in 2003 – Raw milk and raw milk products sales are legal both on the farm and in retail stores

8. Michigan – 511 million pounds in 2003 – Raw milk sales are illegal but the state condones cow sharing programs

9. Washington – 467 million pounds in 2003 – Grade A dairies may sell raw milk

10. Texas – 471 million pounds in 2003 – Raw milk sales are permitted

According to the Milford Daily News, the Massachusetts Department of Public Health (DPH) issued a warning today warning consumers not to drink any milk products from Whittier Farms in Shrewsbury because of listeria bacteria contamination, which has contributed to the death of two people. Four cases of listeriosis infection have been identified by DPH, according to a statement released by the state department late this afternoon. The cases occurred in June, October and two in November. The four cases involved three elderly residents and a pregnant woman from Worcester County. Two of the people have died. They have not been identified. DNA fingerprinting conducted by the State Laboratory Institute showed that the bacteria causing these infections came from a common source. Samples collected showed product contamination.

According the its website:

Whittier Farms is located in the historic and picturesque town of Sutton, Massachusetts. The farm is presently owned and operated by the fourth and fifth generation of the Whittier Family. The farm consists of two locations, which oversee each other from the tops of two hills with rolling fields nestled between them, depicting a true New England countryside.

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

FSIS announced today that the Maramont Corporation, a Brooklyn, N.Y, firm, is voluntarily recalling approximately 88 pounds of a beef patty product that may be contaminated with Listeria monocytogenes. The beef patty products were produced on December 18 and distributed on December 19 to schools in the Jersey City, N.J., area.  The following product is subject to recall:

2-oz packages of "BROILED BEEF PATTY (MICROWAVE)." The products were individually packaged and delivered from 17.25-pound cases. Each case label bears a lot code of "07352" and product number "2801." Each case label also bears the establishment number "EST. 5370" inside the USDA mark of inspection.

Listeria monocytogenes (Listeria) is a foodborne disease-causing bacteria; the disease is called listeriosis. Listeria can invade the body through a normal and intact gastrointestinal tract. Once in the body, Listeria can travel through the blood stream but the bacteria are often found inside cells. Listeria also produces toxins that damage cells. Listeria invades and grows best in the central nervous system among immune compromised persons, causing meningitis and/or encephalitis (brain infection). In pregnant women, the fetus can become infected, leading to spontaneous abortion, stillbirths, or sepsis (blood infection) in infancy.

Approximately 2,500 cases of listeriosis are estimated to occur in the U.S. each year. About 200 in every 1000 cases result in death. Certain groups of individuals are at greater risk for listeriosis, including pregnant women (and their unborn children) and immunocompromised persons. Among infants, listeriosis occurs when the infection is transmitted from the mother, either through the placenta or during the birthing process. These host factors, along with the amount of bacteria ingested and the virulence of the strain, determine the risk of disease. Human cases of listeriosis are, for the most part, sporadic and treatable. Nonetheless, Listeria remains an important threat to public health, especially among those most susceptible to this disease.