Where’s the leafy greens lobby? Feds to seek listeria, leafy green connections after Dole outbreak

Mike Hornick of The Packer writes that health officials will begin routinely asking listeria outbreak victims if they consumed leafy greens, according to the Centers for Disease Control and Prevention.

lettuce.skull.noroThe addition of leafy greens to the standard federal questionnaire on listeria comes in response to last winter’s outbreak linked to a Dole Fresh Vegetables salad plant in Springfield, Ohio. That outbreak sickened 33 in the U.S. and Canada and was tied to at least one death. Dole stopped production in January and reopened the plant in April.

It was the first reported listeria outbreak in the U.S. associated with leafy greens, and the eighth with fresh produce. All occurred since 2008, according to an Aug. 26 report by the CDC.

“It is unclear whether the appearance of these outbreaks might be attributed to improved outbreak detection, changes in consumer behavior, or changes in production and distribution,” the report says. “Fresh produce processors are advised to review food safety plans and consider incorporating measures to avoid the growth and persistence of listeria.”

In the Ohio centered outbreak, the older questionnaire failed to identify a common source for seven infections reported by Nov. 30.

Then in December and January, eight new or previously interviewed patients or their representatives took part in open-ended interviews or provided shopper card records.

That revealed the connection. All reported consuming leafy greens in the month before the onset of illness.

Among these, seven reported romaine and six reported spinach, higher than national food consumption estimates of 47% and 24%, respectively. Six patients recalled consuming packaged salad, according to the report.

Dole Fresh Vegetables denied responsibility in two foodborne illness lawsuits that followed the outbreak.

More STEC found: Multistate outbreak of Shiga toxin-producing Escherichia coli infections linked to flour

On July 25, 2016, General Mills expanded its recall to include more production dates. A list of all the recalled flours and how to identify them is available on the Advice to Consumers page.

sorenne.doug.usa.today.jun.11Four more ill people have been reported from two states. The most recent illness started on June 25, 2016.

An infection with another serotype, Shiga toxin-producing Escherichia coli (STEC O26), has been added to this outbreak investigation. STEC O26 was isolated from a sample of General Mills flour (pic, left, from 2011; Sorenne did not eat the flour and awareness of cross-contamination was robust).

One person has developed hemolytic uremic syndrome, a type of kidney failure.

The U.S. Centers for Disease Control, multiple states, and the U.S. Food and Drug Administration(FDA) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) infections.

46 people infected with the outbreak strains of STEC O121 or STEC O26 have been reported from 21 states.

Thirteen ill people have been hospitalized. One person developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

Epidemiologic, laboratory, and traceback evidence indicate that flour produced at the General Mills facility in Kansas City, Missouri is a likely source of this outbreak.

Several recalls and recall expansions have been announced as a result of this investigation.

In July 2016, laboratory testing by General Mills and FDA isolated STEC O26 from a sample of General Mills flour. Whole genome sequencing (WGS) showed that the STEC O26 isolated from the flour sample was closely related genetically to isolates from an ill person. The flour tested was not included in the earlier General Mills recalls.

On July 25, 2016, General Mills further expanded its flour recall to include additional lots.

CDC recommends that consumers, restaurants, and retailers do not use, serve, or sell the recalled flours.

Do not eat raw dough or batter, whether made from recalled flour or any other flour. Flour or other ingredients used to make raw dough or batter can be contaminated with STEC and other pathogens.

Consumers should bake all items made with raw dough or batter before eating them. Do not taste raw dough or batter.

Restaurants and retailers should not serve raw dough to customers or allow children and other guests to play with raw dough.

This investigation is ongoing, and we will update the public when more information becomes available.

 

 

Parents hate my food safety stories, so just a face palm: 611 sick with Salmonella from backyard chicks

Sorenne rode her bike to school on Friday for the first time.

After months of angst, probably because she saw daddy wipe out and get 23 stiches a couple of years ago when she was on training wheels, she rode her bike.

Today (Wed) they had a bike-to-school day to play-bicycle-polo-on-the-tennis courts, and the number of kids and bikes was a bit much to handle.

But that’s a good problem.

picard.face.palmI was chatting with a parent after school, while the kids retrieved their bikes that were stored at the swimming pool due to overload, and I said it was a nice problem to have, and then we chatted about the weather – depths of winter, 24C in Brisbane – and he said I guess spring has sprung, our backyard chickens laid two eggs yesterday, so I guess spring is here.

I smiled but inside I was doing my best Jean-Luc.

The U.S. Centers for Disease Control and Prevention reports there are now eight multistate outbreaks of human Salmonella infections linked to contact with live poultry in backyard flocks.

In the eight outbreaks, 611 people infected with the outbreak strains of Salmonella were reported from 45 states.

Illnesses started on dates ranging from January 4, 2016 to June 25, 2016.

138 ill people were hospitalized, and one death was reported. Salmonella infection was not considered to be a cause of death.

195 (32%) ill people were children 5 years of age or younger.

Epidemiologic, traceback, and laboratory findings have linked the eight outbreaks to contact with live poultry such as chicks and ducklings sourced from multiple hatcheries.

Regardless of where they were purchased, all live poultry can carry Salmonella bacteria, even if they look healthy and clean.

These outbreaks are a reminder to follow steps to enjoy your backyard flock and keep your family healthy.

Always wash hands thoroughly with soap and water right after touching live poultry or anything in the area where the birds live and roam.

baby.chickDo not let live poultry inside the house.

Do not let children younger than 5 years of age handle or touch chicks, ducklings, or other live poultry without adult supervision.

These outbreaks are expected to continue for the next several months since flock owners might be unaware of the risk of Salmonella infection from live poultry or participate in risky behaviors that can result in infection.

Ill people reported purchasing live baby poultry from several suppliers, including feed supply stores, Internet sites, hatcheries, and friends in multiple states. Ill people reported purchasing live poultry to produce eggs, learn about agriculture, have as a hobby, enjoy for fun, keep as pets, or to give as Easter gifts. Some of the places ill people reported contact with live poultry include their home, someone else’s home, work, or school settings.

Public health officials collected samples from live poultry and the environments where the poultry live and roam from the homes of ill people in several states. Laboratory testing isolated four of the outbreak strains of Salmonella.

8 sickened, 1 dead: CDC says Listeria linked to frozen produce is over

The U.S. Centers for Disease Control and Prevention says the investigation into frozen fruits and vegetables produced at CRF Frozen Foods in Pasco, Washington.

veggierecallHowever, people could continue to get sick because recalled products may still be freezers and people who don’t know about the recalls could eat them. Retailers should not sell and consumers should not eat recalled products. Read the Recall and Advice to Consumers and Retailers.

CDC, several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Listeria monocytogenes infections (listeriosis).

Listeria can cause a serious, life-threatening illness.

Nine people infected with the outbreak strains of Listeria have been reported from four states since September 13, 2013.

All nine people were hospitalized, and three of them died. Listeriosis was considered to be a cause of death for one person in Connecticut. For the two deaths in Maryland and Washington, listeriosis was not considered to be a cause of death.

Epidemiologic and laboratory evidence indicated that frozen vegetables produced by CRF Frozen Foods of Pasco, Washington and sold under various brand names were a likely source of illness in this outbreak.

On April 23, 2016, CRF Frozen Foods recalled 11 frozen vegetable products because of potential Listeria contamination.

On May 2, 2016, CRF Frozen Foods expanded the initial recall to include all organic and traditional frozen vegetable and fruit products processed in its Pasco, Washington facility since May 1, 2014. More than 350 consumer products sold under 42 separate brands were recalled, as well as at least 100 other products prepared by other companies that contained recalled ingredients from CRF Frozen Foods.

CDC recommends that consumers do not eat, and restaurants and retailers do not serve or sell, recalled organic and traditional frozen vegetables and fruit products and recalled products containing these items.

Recalled items were sold nationwide and in Canada.

A complete list of recalled products is on the FoodSafety.gov website.

42 now sickened from E. coli O121 linked to flour

The U.S. Centers for Disease Control reports that as of June 28, 2016, 42 people infected with the outbreak strain of Shiga-toxin producing E. coli O121 have been reported from 21 states.

wondraOn July 1, 2016, General Mills expanded its recall to include additional lots of Gold Medal Flour, Signature Kitchens Flour, and Gold Medal Wondra Flour.

STEC O121 was isolated from samples of General Mills flour collected from the homes of ill people in Arizona, Colorado, and Oklahoma.

Four more ill people have been reported from four states. The most recent illness started on June 8, 2016. One new state, Indiana, has been added to the list of states with ill people.

Illnesses started on dates ranging from December 21, 2015 to June 8, 2016. Ill people range in age from 1 year to 95, with a median age of 18. Eighty-one percent of ill people are female. Eleven ill people have been hospitalized. No one has developed hemolytic uremic syndrome, a type of kidney failure, and no deaths have been reported.

gold-medal-all-purpose5LBGuidance from the Food and Drug Administration (FDA) and CDC continues to warn that consumers should refrain from consuming any raw products made with flour. E. coli O121 is eliminated by heat through baking, frying, sautéing or boiling products made with flour. All surfaces, hands and utensils should be properly cleaned after contact with flour or dough.

Always the kids: Stop kissing turtles, and stop buying them at flea markets: Outbreaks of Salmonella in US

In August 2015, the U.S. Food and Drug Administration (FDA) notified the U.S. Center for Disease Control of a consumer complaint involving Salmonella Sandiego infection in a child (the index patient), who had acquired a small turtle (shell length <4 inches [<10 cm]) at an Alabama flea market. The subsequent investigation, which included examining data from PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified four multistate Salmonella outbreaks: two involving Salmonella Sandiego and two involving Salmonella Poona. These turtle.kissserotypes have been linked to small turtles in previous outbreaks (1,2).

Although selling small turtles as pets in the United States has been banned since 1975 (3), illegal sales still occur at discount stores and flea markets and by street vendors. CDC investigated to determine the extent of the outbreaks and prevent additional infections.

For this investigation, a case was defined as infection with Salmonella serotypes Sandiego or Poona with the pulse-field gel electrophoresis patterns XbaI JL6X01.0104, JL6X01.0544, JL6X01.0055, JLXX01.0030, or JLXX01.0053 in a person with illness onset January 1–December 31, 2015. A total of 124 cases from 22 states were identified. Median patient age was 7 years (range <1–82 years); 51 patients (41%) were aged <5 years, and 59 (49%) were female. Among 108 patients with available information, 36 (33%) were hospitalized. Thirteen (36%) of the 36 hospitalized patients were aged <5 years. No deaths were reported. Fifty-eight (70%) of 83 patients with ethnicity information were Hispanic.

A total of 104 patients or their caregivers were interviewed; 50 patients (48%) had turtle exposure. Among the 50 patients with reported turtle exposure, the median age was 3 years (range <1–77 years), 30 (60%) were aged <5 years, and 25 (50%) were female. Of the 50 patients with turtle exposure, 48 had information on hospitalization; 18 of the 48 (38%) were hospitalized. Nine of those hospitalized were aged <5 years. Twenty-eight (72%) of 39 patients with ethnicity information were Hispanic. Turtle and turtle environment samples were collected from nine patients’ homes. Of these, 21 isolates of Salmonella were culture-positive: 17 matched the outbreak strains, two were Salmonella Paratyphi B var L-tartrate+, and two were Salmonella Pomona (Table).

An FDA consumer safety officer investigating the flea market where the index patient’s turtle was obtained traced the turtle’s origin to farm A (FDA’s Center for Veterinary Medicine did not pursue legal action regarding the sale by farm A of small turtles to the flea market vendor). Pond water samples from farm A yielded cultures of Salmonella (Table). Although the samples from turtle farm A did not yield the 2015 outbreak strains, two of the three Salmonella Pomona isolates from pond water matched isolates from a patient’s pet turtle’s environment.

The high proportion of patients aged <5 years in these outbreaks emphasizes the risk for illness among young children with small turtles as pets. This finding indicates education is needed to address the risk to children for Salmonella infections from small turtles and other reptiles. Many patients in these outbreaks were Hispanic, which highlights the importance of multilingual messages for effective communication. During these outbreaks, the announcement and prevention messages regarding safe handling of pet reptiles and amphibians were translated into Spanish and posted on the “CDC en Español” website. To ensure wider dissemination, information was also provided to a major Spanish-language news agency.

Transient vendors continue to be a source of illegal sales of small turtles. Educational campaigns at schools, child care centers, carnivals, and flea markets regarding the risk for Salmonella from contact with turtles are important to prevent infections among children.

 

No, nature did: FDA ruins raw cookie dough for everybody

Rachel Rabkin Peachman writes in a New York Times blog that maybe you’ve swiped a bite of raw cookie dough while preparing a batch to bake. Or perhaps you’ve let your children lick the batter from the cake bowl, or use homemade “play dough” to make crafts. But even if the dough is free of raw raw.cookie.dough.e.colieggs, which you think might give you a pass, don’t eat it.

Yesterday, the Food and Drug Administration issued a message warning people not to eat raw dough because of a recent outbreak of E. coli linked to contaminated flour.

So far, a reported 38 people in 20 states have been infected by a strain of bacteria called Shiga toxin-producing E. coli O121 found in flour. The infections began last December, and 10 of those infected have been hospitalized.

Investigations by the Centers for Disease Control and Prevention and the F.D.A. traced the source of the outbreak to flour that was produced in November 2015 at the General Mills facility in Kansas City, Mo. General Mills has issued a voluntary recall of 10 million pounds of flour produced between Nov. 14 and Dec. 4, sold under three brand names: Gold Medal, Signature Kitchens and Gold Medal Wondra. Flour that is part of the recall should be thrown away.

Unlike other raw foods, like eggs or meat — which many people recognize as contamination risks — “flour is not the type of thing that we commonly associate with pathogens,” said Jenny Scott, a senior adviser in the F.D.A.’s Center for Food Safety and Applied Nutrition.

In this case, investigators believe that the grain became contaminated in the field, where it is exposed to manure, cattle, birds and other bacteria. “E. coli is a gut bug that can spread from a cow doing its business in the field, or it could live in the soil for a period of time; and if you think about it, flour comes from the ground, so it could be a risk,” said Adam Karcz, an infection preventionist at Indiana University Health in Indianapolis.

Normally, flour is cooked before it is consumed, destroying any pathogens. “For the most part, the risk from flour is pretty low, and most use of flour involves a ‘kill step’ — people bake with it,” Ms. Scott said. In commercial uses like “raw” cookie-dough ice cream, companies generally heat-treat it to eliminate bacteria, she said.

Consumers, then, need to be aware that they should follow food safety guidelines for flour. That means washing your hands thoroughly before and after handling raw flour. And Ms. Scott warned against letting children play with homemade play dough. “Kids are going to handle it and touch their faces, and they’re going to lick their fingers; it’s hard to supervise that,” she said.

20 years of PulseNet: The national molecular subtyping network for foodborne disease surveillance

The U.S. Centers for Disease Control reports PulseNet is celebrating 20 years of public health achievements in transforming the way foodborne disease outbreaks are detected and investigated.

pulse-net-20-200PulseNet is a national surveillance network of federal, state, and local public health laboratories that work together to detect foodborne disease outbreaks by connecting DNA fingerprints of bacteria that cause illness. The network facilitates the early identification of common sources of foodborne outbreaks and helps regulatory agencies identify areas where implementation of new measures are likely to improve the safety of the food supply.

A recent economic evaluation of PulseNet activities suggests that the network prevents at least 270,000 illnesses from infection with Salmonella, E. coli, and Listeria and saves an estimated $500 million each year. In 2013, PulseNet began using whole genome sequencing (WGS) to detect outbreaks caused by Listeria, the most deadly foodborne pathogen. PulseNet is quickly expanding the use of WGS in state laboratories and has begun using WGS in investigations of other foodborne pathogens such as Campylobacter, E. coli, and Salmonella. With incorporation of WGS and other advanced molecular detection methods, PulseNet will continue to improve foodborne disease detection and identify outbreaks faster and with more accuracy.

Additional information regarding CDC’s Advanced Molecular Detection initiative is available at http://www.cdc.gov/amd/. Additional materials on the 20th anniversary of PulseNet, including success stories from state public health laboratories and fact sheets are available at the CDC PulseNet website.

Sporadic illnesses, outbreak illnesses, are similiar

Outbreak data have been used to estimate the proportion of illnesses attributable to different foods. Applying outbreak-based attribution estimates to non-outbreak foodborne illnesses requires an assumption of similar exposure pathways for outbreak and sporadic illnesses. This assumption cannot be tested, but other comparisons can assess its veracity.

vomit-FBOur study compares demographic, clinical, temporal, and geographic characteristics of outbreak and sporadic illnesses from Campylobacter, Escherichia coli O157, Listeria, and Salmonella bacteria ascertained by the Foodborne Diseases Active Surveillance Network (FoodNet). Differences among FoodNet sites in outbreak and sporadic illnesses might reflect differences in surveillance practices. For Campylobacter, Listeria, and Escherichia coli O157, outbreak and sporadic illnesses are similar for severity, sex, and age. For Salmonella, outbreak and sporadic illnesses are similar for severity and sex. Nevertheless, the percentage of outbreak illnesses in the youngest age category was lower.

Therefore, we do not reject the assumption that outbreak and sporadic illnesses are similar.

Comparing characteristics of sporadic and outbreak-associated foodborne illnesses, United States, 2004-2011

Emerging Infectious Diseases, Volume 22, Number 7, July 2016, DOI: 0.3201/eid2207.150833

E.D. Ebel, M.S. Williams, D. Cole, C.C. Travis, K.C. Klontz, N.J. Golden, R.M. Hoekstra

http://wwwnc.cdc.gov/eid/article/22/7/15-0833_article

Typhoid fever spread from asymptomatic restaurant worker in Colorado

On September 11, 2015, a single case of typhoid fever, caused by Salmonella Typhi infection, was reported to the Colorado Department of Public Health and Environment (CDPHE).

symptoms_of_typhoid_feverBecause the patient (patient A) had symptom onset September 2 and had traveled internationally for 4 days 60 days before symptom onset, the case initially was thought to be travel-associated* (1,2).

On October 1, a second case of S. Typhi infection was reported in patient B, with symptom onset September 20. Patient B reported no international travel or contact with ill persons or known carriers. Patients A and B resided approximately 6 miles (10 kilometers) apart and had no discernible epidemiologic connection. Family members of patients A and B tested negative for S. Typhi. CDPHE and the Weld County Department of Public Health and Environment (WCDPHE) investigated to 1) determine whether these cases represented a larger outbreak, 2) identify common exposure sources, and 3) stop transmission. Investigators determined that the typhoid fever in both patients and in a third patient (patient C) was associated with eating in the same restaurant during a 5-day period.

CDPHE defined a case of typhoid fever as clinically compatible illness with isolation of S. Typhi during July 1–October 15 and identification of an isolate with one of two pulsed-field gel electrophoresis (PFGE) outbreak patterns that differed by one band. A carrier was defined as a person who had contact with patients, reported no recent illness, and had S. Typhi with either of the PFGE outbreak patterns in an isolate from a rectal swab or stool specimen. Case finding included searching PulseNet for other isolates that might have been associated with the Colorado cases (3). On October 13, CDPHE issued a health alert notification to clinicians, local public health authorities, and laboratories to be vigilant for additional cases and to encourage reporting. During October 1–9, CDPHE and WCDPHE used the Salmonella National Hypothesis Generating Questionnaire (4), credit card receipts, food recall, shopper card records, and social media to identify potential exposures shared by patients A and B during the 60 days preceding symptom onset. Investigators found that the two patients had fresh produce purchases from the same grocery stores and had six common restaurant exposures.

On October 19, CDPHE was notified of a third Weld Country resident who had tested positive for S. Typhi infection. Patient C had symptom onset September 15 and reported no recent travel or relation to patient A or B. Patient C was interviewed using the Salmonella questionnaire, and credit card receipts were reviewed. Patient C did not shop at the same grocery stores as patients A or B, but all three patients had eaten at restaurant A during August 16–20, 2015. Patients A and C were hospitalized. Isolates from patients B and C had indistinguishable PFGE patterns (pattern 2), and the isolate from patient A had a 1-band difference (pattern 1), which met the PFGE outbreak definition.

s.typhi.symptomsCDPHE hypothesized that a chronic S. Typhi carrier might be working in food service at restaurant A, where food is prepared using fresh ingredients. Possible transmission routes were investigated through environmental assessments and staff interviews; food service staff members were asked to be tested for S. Typhi. Environmental assessments performed on October 27 found no deficiencies in hand hygiene or other food handling issues. Administrators from restaurant A provided a list of all current and former employees who worked in food handling during August 10–August 20, 2015. These more conservative dates were chosen because food might have been served as many as 4 days after preparation, and because of concerns regarding the accuracy of credit card statement dates.

On October 28, current restaurant employees were confidentially interviewed at a local clinic by CDPHE and WCDPHE regarding international travel, symptoms, and work tasks. Because bacterial shedding can be intermittent, employees were requested to collect rectal swab specimens from themselves on October 28 and November 3 for culture and PFGE testing of isolates. All employees were allotted paid time to be interviewed and provide specimens. By October 29, a total of 28 (100%) current employees had responded and provided one or more rectal swab specimens. On October 30, CDPHE was notified by the state health laboratory that S. Typhi had been isolated from one employee. The isolate’s PFGE pattern was indistinguishable from outbreak pattern 1, the pattern of patient A.

Interviews with the infected restaurant worker revealed travel to a country with endemic typhoid fever 15 years earlier, but no recent symptoms, and no contact with any ill persons. The worker was excluded from food service work, treated with azithromycin for 28 days, and monitored with stool testing until three consecutive specimens obtained ≥1 month apart were negative for S. Typhi (2). Restaurant A agreed to keep the worker’s job open and allow him to return to work once he was no longer a carrier.

Typhi infection is a nationally notifiable condition; in Colorado, reporting is required within 24 hours of case detection. Notable clinical symptoms of typhoid fever include insidious onset of fever, and headache, constipation, chills, myalgia, and malaise (1). Unlike other Salmonella species, S. Typhi does not commonly cause diarrhea, and vomiting typically is not severe (1).

Typhi infection is endemic in many low-income countries; an estimated 22 million cases and 200,000 deaths occur each year (2). In the United States, approximately 5,700 cases of typhoid fever are reported annually; the majority occur among travelers (1). In Colorado during 2009–2014, on average, six cases of confirmed typhoid fever were reported annually; all cases were associated with international travel or attributed to a household member or close contact with a carrier. Humans are the only reservoir for S. Typhi; disease is transmitted via the fecal-oral route, typically by contaminated food or water. Chronic carriage occurs in 2%–5% of cases (1,2), and shedding of S. Typhi in chronic carrier stools can be intermittent.

This investigation highlights the potential for chronic S. Typhi carriers to cause illness in other persons, even years after infection. When cases of typhoid fever not associated with travel are detected, rapid and thorough interviewing is essential. Social media posts and credit card receipts to detect common exposures can be useful. The high cooperation rate among workers at the restaurant, which is rare in foodborne outbreak investigations, was attributed to the restaurant’s support and accommodation, demonstrating the importance of collaboration among local public health, state public health, public health laboratories, patients, and industry for successful investigations.

Typhoid fever outbreak associated with an asymptomatic carrier at a restaurant ― Weld County, Colorado, 2015

MMWR Morb Mortal Wkly Rep 2016;65:606–607. June 2016, DOI: http://dx.doi.org/10.15585/mmwr.mm6523a4.

Jessica Hancok-Allen, Alicia B. Cronquist, JoRene Peden, Debra Adamson, Nereida Corral, Kerri Brown

http://www.cdc.gov/mmwr/volumes/65/wr/mm6523a4.htm?s_cid=mm6523a4_x