Resistant Salmonella causes 6,200 illnesses a year in US

Chris Dall of the Center for Infectious Disease Research Policy reports the U.S. Centers for Disease Control and Prevention (CDC) has published new estimates of the incidence of antibiotic-resistant Salmonella infections in the United States, putting the burden at about 6,200 cases annually.

ab-res-salmIn a report in Emerging Infectious Diseases, CDC researchers estimate the overall incidence of resistant salmonella infections as roughly 2 for 100,000 persons per year from 2004 to 2012They also determined that clinically important resistance was linked to four specific Salmonella serotyopes: Enteritidis, Newport, Typhimurium, and Heidelberg.

Nontyphoidal Salmonella causes an estimated 1.2 million foodborne illnesses and about 450 deaths each year, according to the CDC. While most people who get Salmonella infections recover within a week and do not require antibiotics, more severe infections are generally treated with either ampicillin, ceftriaxone, or ciprofloxacin. Resistance to these drugs can result in increased hospitalization, invasive illnesses, and death.

The new estimates are based on data from the US Census Bureau and from two surveillance systems the CDC uses to track Salmonella and drug-resistant Salmonella: The National Antimicrobial Resistance Monitoring System (NARMS) and the Laboratory-based Enteric Disease Surveillance (LEDS) system. NARMS monitors resistance in Salmonella by testing isolates from infected individuals and determining the percentage of isolates that show resistance. LEDS collects Salmonella surveillance data, including serotypes, from state and territorial public health labs.

The researchers defined three mutually exclusive categories of resistance for the study: ampicillin-only resistance, ceftriaxone/ampicillin resistance, and ciprofloxacin nonsusceptibility.

According to the LEDS data, there were 369,254 culture-confirmed Salmonella infections from 2004 through 2012. Four primary serotypes—Enteritidis, Typhimurium, Newport, and Heidelberg—accounted for 52% of all fully serotyped isolates. NARMS tested 19,410 isolates from 2004 through 2012, and overall resistance was detected in 2,320 isolates. Ampicillin-only resistance was the most common resistance pattern detected, followed by ceftriaxone/ampicillin resistance and ciprofloxacin nonsusceptibility.

Using these data, the researchers determined that from 2004 to 20012 there were approximately 6,200 resistant culture-confirmed infections annually. Overall incidence was 1.93/100,000 person-years for any clinically important resistance, 1.07 for ampicillin-only resistance, .51 for ceftriaxone/ampicillin resistance, and .35 for ciprofloxacin nonsusceptibility.

The authors note that while Enteritidis, Typhimurium, Newport, and Heidelberg account for only half of all culture-confirmed Salmonella infections, the four serotypes accounted for 73% of the Salmonella infections that involved clinically important resistance.

The predominance of these four serotypes, they write, reflects their ability to persist in food animals, be transmitted through the food system, and cause illness. It also suggests that strategies to reduce Salmonella infections caused by these four serotypes could have an impact on the incidence of resistant infections overall.

“The 4 major serotypes that have been driving the incidence of resistant infections should continue to be high priorities in combating resistance,” the authors write.

The report also notes that two of these serotypes—Typhimurium and Newport—have been associated with outbreaks of drug-resistant Salmonella infections linked to contaminated meat, which highlights the need for NARMS to continue monitoring emerging resistance patterns by serotype.

The authors caution, however, that while this estimate of resistant Salmonella infection incidence will help define the magnitude of the problem and guide prevention efforts, it might be telling only part of the story. That’s because it relies on culture-confirmed infections only.

The CDC has estimated that for every culture-confirmed case of Salmonella, there may as many as 29 undetected cases. That could put the annual US incidence as high as 180,000 cases.

Plague in domestic cats — Idaho, 2016

The U.S. Centers for Disease Control and Prevention reports in May 2015, Yersinia pestis, the bacterium that causes plague, was identified in dead Piute ground squirrels (Urocitellus mollis) reported through the Idaho Department of Fish and Game’s wildlife mortality monitoring program; in June 2015, the Idaho Division of Public Health (DPH) sent an advisory to veterinarians in four southwestern Idaho counties requesting that they notify their local public health officials of suspected plague in animals.* Y. pestis was not confirmed in any pets during 2015.

yersinia-pestisDuring May 30–July 26, 2016, local veterinarians notified public health officials that five dogs and 12 cats were being evaluated for possible plague. Local veterinarians also performed necropsies, when applicable, to establish the diagnosis. Idaho’s Central District Health Department and Eastern Idaho Public Health coordinated with DPH on submission of specimens to the DPH Bureau of Laboratories for Y. pestis testing and interviewed veterinary staff and pet owners. Specimens from blood, spleen, liver, and lymph nodes were screened using real–time polymerase chain reaction and confirmed by culture and phage lysis testing.

sorenne-cats-aug-15Among evaluated animals, Y. pestis was isolated from six of 12 cats; five of the six were from areas in southwestern Idaho where dead ground squirrels with confirmed Y. pestis had been reported in May 2016, and one was from from eastern Idaho. Among these six cats, specimen collection occurred during May 31–July 12, 2016; cats ranged in age from 10 months to 14.5 years (median = 4 years), four (67%) were male, five (83%) resided both indoors and outdoors, and one resided outdoor only. All six cats were domestic shorthair breed and had been neutered or spayed. Fever and lymphadenopathy (n = 4, 67%) were the most commonly reported signs of illness. None of the cats had known pulmonary involvement. Three of the six cats were treated with appropriate antibiotics (1); of these, two survived and one was euthanatized. The three other cats had died or had been euthanatized. All six cats reportedly had contact with ground squirrels and other wild rodents or rabbits before becoming ill; one had flea control administered before illness onset.

Cat owners, their household members, and veterinary staff were advised to be alert for fever and other plague symptoms (2) in themselves and other pets that might have had contact with the ill cats. Veterinary staff members were reminded about methods to prevent occupational exposure when managing pets suspected of having plague (1). In June 2016, an updated plague advisory was sent to veterinarians in four southwestern Idaho counties and eight eastern Idaho counties. Local public health districts used the Idaho Health Alert Network to enhance situational awareness among health care providers and issue guidance on management and reporting of plague cases. Public communication strategies to raise awareness about the risk for and prevention of Y. pestistransmission to persons and pets included an online map of plague-affected areas, warnings posted in affected public areas, and press releases advising residents about preventive measures. No human plague cases were reported.

Cat-associated human plague cases, including fatalities, have been reported in the western United States since 1977 (3). Compared with dogs, cats are highly susceptible to plague illness and can transmit disease to humans directly through exposure to respiratory droplets and infectious body fluids associated with bites or scratches (1). Cats could also carry infected fleas into households. Y. pestis–infected cats usually develop fever, anorexia, lethargy, and lymphadenitis (submandibular in approximately 75% of cases); approximately 10% of cases are pneumonic (4) and present the most risk to pet owners and veterinary staff members. During 1926–2012, six (43%) of all primary pneumonic cases of human plague that occurred in the United States had contact with domestic cats (5). No plague vaccine for pets is available.

Veterinarians should consider the diagnosis of plague in pets, including cats, with compatible signs and exposure to rodent habitats, rodents, or ill pets in areas where plague is endemic or epizootic. Suspicion of plague should trigger the following actions by veterinary staff: 1) implementation of personal protective measures, including wearing masks and gloves; 2) isolation of the ill pet; 3) assessment of pulmonary involvement; 4) initiation of diagnostic testing for Y. pestis; 5) prompt administration of antibiotic therapy; 6) implementation of flea control for affected animals and the hospital environment; 7) provision of advice on household flea control to pet owner; and 8) notification of public health officials (1). Pet owners can reduce the risk for plague in pets by controlling pet roaming, implementing a flea control program, and minimizing rodent habitats and food sources inside and outside the home. Additional information on prevention of plague is available at http://www.cdc.gov/plague/prevention/index.html.

Not the 4-H: 21 confirmed sick with Salmonella in 8 US states from contact with dairy bull calves

The U.S. Centers for Disease Control (CDC) is working with Wisconsin health, agriculture, and laboratory agencies, several other states, and the U.S. Department of Agriculture Animal and Plant Health Inspection Service (USDA-APHIS) to investigate a multistate outbreak of multidrug-resistant Salmonella Heidelberg infections.

Portrait of the cute baby bull calf

Portrait of the cute baby bull calf

Public health investigators used the PulseNet system to identify illnesses that may have been part of this outbreak. PulseNet, coordinated by CDC, is the national subtyping network of public health and food regulatory agency laboratories. PulseNet performs DNA fingerprinting on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks.

Twenty-one people infected with an outbreak strain of Salmonella Heidelberg have been reported from eight states.

Among 19 people with available information, illnesses started on dates ranging from January 11, 2016 to October 24, 2016. Ill people range in age from less than 1 year to 72, with a median age of 21. Sixty-two percent of ill people are female. Among 19 ill people with available information, 8 (42%) reported being hospitalized, and no deaths have been reported.

WGS showed that isolates from ill people are closely related genetically to one another. This close genetic relationship means that people in this outbreak are more likely to share a common source of infection.

Epidemiologic, traceback, and laboratory findings have identified dairy bull calves from livestock markets in Wisconsin as the likely source of infections. Dairy bull calves are young, male cattle that have not been castrated and may be raised for meat. Dairy bull calves in this outbreak have also been purchased for use with 4-H projects.

In interviews, ill people answered questions about any contact with animals and foods eaten in the week before becoming ill. Of the 19 people interviewed, 15 (79%) reported contact with dairy bull calves or other cattle. Some of the ill people interviewed reported that they became sick after their dairy bull calves became ill or died.

One ill person’s dairy calves were tested for the presence of Salmonella bacteria. This laboratory testing identified Salmonella Heidelberg in the calves. Further testing using WGS showed that isolates from ill people are closely related genetically to isolates from these calves. This close genetic relationship means that the human infections in this outbreak are likely linked to ill calves.

As part of routine surveillance, the Wisconsin State Laboratory of Hygiene, one of seven regional labs affiliated with CDC’s Antibiotic Resistance Laboratory Network, conducted antibiotic resistance testing on clinical isolates from the ill people associated with this outbreak. These isolates were found to be resistant to antibiotics and shared the same DNA fingerprints, showing the isolates were likely related to one another.

dairy-male-calves-salmonellaWGS identified multiple antimicrobial resistance genes in outbreak-associated isolates from fifteen ill people and eight cattle. This correlated with results from standard antibiotic resistance testing methods used by CDC’s National Antimicrobial Resistance Monitoring System (NARMS) laboratory on clinical isolates from two ill people in this outbreak. The two isolates tested were susceptible to gentamicin, azithromycin, and meropenem.  Both were resistant to amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftriaxone, chloramphenicol, nalidixic acid, streptomycin, sulfisoxazole, tetracycline, and trimethoprim-sulfamethoxazole and had reduced susceptibility to ciprofloxacin. Antibiotic resistance limits treatment options and has been associated with increased risk of hospitalization, bloodstream infections, and treatment failures in patients.

Traceback information available at this time indicates that most calves in this outbreak originated in Wisconsin. Wisconsin health and agriculture officials continue to work with other states to identify herds that may be affected.

 

1 dead, 4 sick in 2014: Miami cheese producer jailed for 15 months

On August 4, 2014, Oasis Brands, Inc. voluntarily recalled quesito casero (fresh curd) due to possible Listeria monocytogenes contamination.

oasis-listeria-oct_-14On October 6, 2014, Oasis Brands, Inc. recalled cuajada en hoja (fresh curd) after the U.S. Food and Drug Administration isolated Listeria monocytogenes from environmental samples collected from the production facility.

Whole-genome sequences of the Listeria monocytogenes strains isolated from recalled quesito casero cheese produced by Oasis Brands, Inc. were found to be highly related to sequences of Listeria strains isolated from one person who became ill in September 2013 and four persons who became ill during June through October 2014.

These five ill persons were reported from four states: Georgia (1), New York (1), Tennessee (2), and Texas (1).

Four of the five ill persons were hospitalized. One death was reported in Tennessee. Three illnesses were related to a pregnancy – one of these was diagnosed in a newborn.

All ill persons were reported to be of Hispanic ethnicity and reported consuming Hispanic-style soft cheese. Two persons who were able to answer questions about specific varieties of Hispanic-style soft cheeses reported consuming quesito casero, though neither could remember the brand.

According to Andrea Torres of ABC Channel 10, after making promises to the feds, Christian Rivas knew he was distributing cheese with listeria and did so anyway.

Rivas was in federal prison Nov. 11, 2016 and faced 15 moths in prison after federal prosecutors armed with the results of CDC tests and FDA inspections were ready to show consumers were “fraudulently led to believe” the cheese was safe to eat when it wasn’t. 

Before the criminal case, authorities recalled 15 of their “Lacteos Santa Martha ” products targeting Central American migrants in Florida, Georgia, Tennessee, Virginia and North Carolina. The list included the “Queso Seco Olanchano,” the “Queso Seco Hondureno,” the  “Queso Cuzcatlan,” and the “Crema Guatemalteca.”

Rivas plead guilty to charges that he acted with an “intent to defraud and mislead, delivered cheese processed and packed at the Oasis facility into interstate commerce that was adulterated,” according to the U.S. Department of Justice. 

U.S. District Judge Robert N. Scola sentenced Rivas to 15 months in prison.  

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, and Justin Green, Special Agent in Charge, U.S. Food and Drug Administration, Office of Criminal Investigations (FDA-OCI), Miami Field Office, announced the sentencing

“We will continue to pursue and bring to justice those who put the public’s health at risk by allowing contaminated foods to enter the U.S. marketplace,” Green said. 

Beware jailhouse nachos

The U.S. Centers for Disease Control reports on October 12, 2015, a county health department notified the Wyoming Department of Health of an outbreak of gastrointestinal illness among residents and staff members at a local correctional facility.

jail-nachos-2The majority of ill persons reported onset of symptoms within 1–3 hours after eating lunch served at the facility cafeteria at noon on October 11. Residents and staff members reported that tortilla chips served at the lunch tasted and smelled like chemicals. The Wyoming Department of Health and county health department personnel conducted case-control studies to identify the outbreak source.

Consuming lunch at the facility on October 11 was highly associated with illness; multivariate logistic regression analysis found that tortilla chips were the only food item associated with illness. Hexanal and peroxide, markers for rancidity, were detected in tortilla chips and composite food samples from the lunch. No infectious agent was detected in human stool specimens or food samples. Extensive testing of lunch items did not identify any unusual chemical. Epidemiologic and laboratory evidence implicated rancid tortilla chips as the most likely source of illness.

This outbreak serves as a reminder to consider alternative food testing methods during outbreaks of unusual gastrointestinal illness when typical foodborne pathogens are not identified. For interpretation of alternative food testing results, samples of each type of food not suspected to be contaminated are needed to serve as controls.

Gastrointestinal illness associated with rancid tortilla chips at a correctional facility — Wyoming, 2015

CDC MMWR

Tiffany Lupcho et al.

https://www.cdc.gov/mmwr/volumes/65/wr/mm6542a4.htm?s_cid=mm6542a4_e

11 sick in multistate outbreak of Shiga toxin-producing E. coli O157 linked to Adams Farm

Since the initial announcement on September 24, four more ill people were reported from Massachusetts (2), Pennsylvania (1), and Virginia (1).

ground-beef-325Eleven people infected with the outbreak strain of STEC O157:H7 were reported from five states.

Illnesses started on dates ranging from June 27, 2016 to September 10, 2016. Ill people ranged in age from 1 year to 74, with a median age of 32. Forty-five percent of ill people were female. Seven ill people were hospitalized. One ill person developed hemolytic uremic syndrome, a type of kidney failure, and no deaths were reported.

This outbreak appears to be over. However, the recalled beef, veal, and bison products may still be in freezers. Consumers who don’t know about the outbreak could continue to eat recalled products and get sick. Read the Recall and Advice to Consumers, Restaurants, and Retailers.

Case Count: 11

States: 5

Deaths: 0

Hospitalizations: 7

Recall: Yes

Foodborne (1973-2013) and waterborne (1971-2013) disease outbreaks – United States

This isn’t the detailed overview, but the annual overall snapshot of food and waterborne illness in the U.S.

cdc-outbreak-data-2013My favorite part has always been the second figure. To avoid foodborne illness, move to Texas. That hasn’t changed since 1973.

All it means is, cowboys and girls don’t look too hard.

It’s just a little barfing – get over it

Foodborne Disease Outbreaks

During 1973–2013, the U.S. Centers for Disease Control (CDC) received reports of 30,251 foodborne disease outbreaks with 742,945 outbreak-associated illnesses from the 50 states, Puerto Rico, the District of Columbia, and freely associated states/territories. An average of 738 (range: 298–1,404) outbreaks were reported each year.

The average annual number of foodborne disease outbreaks reported to CDC increased in 1998 in comparison to previous years, coinciding with the transition to an electronic reporting system, and decreased in 2009 in comparison to 1998–2008 coinciding with the transition to reporting through NORS (FDOSS and WBDOSS share an enhanced reporting platform, the National Outbreak Reporting System (NORS) (http://www.cdc.gov/nors). NORS also collects information on disease outbreaks with modes of transmission other than food and water, including person-to-person contact, animal contact, and environmental contamination.)

In 2013, a total of 792 single-state exposure outbreaks were reported with 11,786 illnesses by 47 states and Puerto Rico (Table) (Figure 2); an additional 26 multistate outbreaks (i.e., exposure to the implicated food occurred in more than one state) with 1,530 associated illnesses also were reported. CDC periodically publishes more detailed annual summaries describing the implicated foods, etiologic agents, settings, and points of contamination associated with foodborne disease outbreaks (http://www.cdc.gov/foodsafety/fdoss/data/annual-summaries/index.html).

Waterborne Disease Outbreaks

During 1971–2013, CDC received reports of 1,957 waterborne disease outbreaks with 642,782 outbreak-associated illnesses from 50 states and six freely associated states/territories. An average of 46 waterborne outbreaks was reported each year (Figure 1). In 2013, a total of 55 outbreaks causing at least 2,824 illnesses occurred in 21 states. No multistate outbreaks were reported; waterborne disease outbreak data for 2013 are preliminary (Table) (Figure 3). CDC periodically publishes more detailed summaries of waterborne disease outbreaks associated with recreational water and of waterborne disease outbreaks associated with drinking water (http://www.cdc.gov/healthywater/surveillance/surveillance-reports.html).

cdc-outbreak-data-2013-stateReported outbreaks represent only a small fraction of all foodborne and waterborne illnesses that occur each year and the outbreak data reported here are subject to limitations. Outbreaks caused by certain pathogens or vehicles might be more likely to be recognized, investigated, or reported. Some illnesses reported as sporadic (i.e., not outbreak-associated) are likely not recognized as being part of a reported outbreak or might be part of an undetected outbreak. In addition, all outbreak-related illnesses might not be identified during an investigation, smaller outbreaks might not come to the attention of public health authorities, and some outbreaks might not be investigated or reported to CDC.

Reporting practices for foodborne and waterborne disease outbreaks vary among states and territories, which might have differing definitions or interpretations of which events are reportable and unique laws related to disease outbreak reporting. Thus, variations in reporting rates by state or territory might reflect variations in levels of effort and funding for foodborne and waterborne disease outbreak investigation, rather than true differences in outbreak incidence rates by state. NORS maintains a dynamic database; this report includes data available on May 1, 2015, for foodborne disease outbreaks and May 4, 2015, for waterborne disease outbreaks; data published in this Summary might differ from those published earlier or later.

Foodborne disease outbreaks are defined as two or more cases of a similar illness resulting from ingestion of a common food. Waterborne disease outbreaks are defined as two or more cases of a similar illness linked epidemiologically by time and location to exposure to water or water-associated chemicals volatized into the air.

36 sickened: Sprouts are a known cause of foodborne illness

The U.S. Centers for Disease Control (CDC), several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Salmonella Reading and Salmonella Abony infections.

amy-sprouts-guelph-05Thirty-six people infected with the outbreak strains of Salmonella Reading or Salmonella Abony were reported from nine states.

Seven ill people were hospitalized. No deaths were reported.

Epidemiologic and traceback evidence indicated that alfalfa sprouts supplied by Sprouts Extraordinaire of Denver, Colorado were the likely source of this outbreak.

On August 5, 2016, Sprouts Extraordinaire recalled alfalfa sprout products from the market due to possible Salmonella contamination.

This outbreak appears to be over. However, sprouts are known to cause foodborne illness and outbreaks

Public health investigators used the PulseNet system to identify illnesses that may have been part of this outbreak. PulseNet, coordinated by CDC, is the national subtyping network of public health and food regulatory agency laboratories. PulseNet performs DNA fingerprinting on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks.

Thirty-six people infected with the outbreak strains were reported from nine states. Of those ill people, 30 were infected with Salmonella Reading, 1 was infected with Salmonella Abony, and 5 were infected with both.  A list of the states and the number of cases in each can be found on the Case Count Map page.

Illnesses started on dates ranging from May 21, 2016 to September 10, 2016. Ill people range in age from less than 1 year to 72, with a median age of 30. Fifty-six percent of ill people were female. Seven ill people reported being hospitalized, and no deaths were reported.

This outbreak appears to be over. However, sprouts are known to cause foodborne illness and outbreaks.

Epidemiologic and traceback evidence indicated that alfalfa sprouts supplied by Sprouts Extraordinaire of Denver, Colorado were the likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Of the 31 ill people who were interviewed, 18 (58%) reported eating or possibly eating alfalfa sprouts in the week before illness started. This proportion is significantly higher than results from a 2006 survey of healthy people, in which 3% reported eating raw alfalfa sprouts on a sandwich in the week before they were interviewed. Ill people in the current outbreak reported eating raw sprouts on sandwiches from several restaurants.

sprout-salad-aust-aug-15Federal, state, and local health and regulatory officials performed a traceback investigation from five restaurants where ill people reported eating alfalfa sprouts. This investigation indicated that Sprouts Extraordinaire supplied alfalfa sprouts to all five of these locations.

On August 5, 2016, Sprouts Extraordinaire recalled its alfalfa sprout products from the market due to possible Salmonella contamination. These products were sold in boxes labeled “5-lb Living Alfalfa.” Read the Advice to Restaurants, Retailers and Consumers.

This outbreak appears to be over. However, sprouts are known to cause foodborne illness and outbreaks. More information about steps to reduce your risk of getting sick from eating sprouts is available on the Advice to Restaurants, Retailers and Consumers page.

At A Glance

Case Count: 36

States: 9

Deaths: 0

Hospitalizations: 7

A table of sprout-related outbreaks is available at: http://barfblog.com/wp-content/uploads/2016/02/Sprout-associated-outbreaks-2-23-16.xlsx

Playing with raw dough: 63 sickened with Shiga toxin-producing Escherichia coli infections linked to flour (final update)

The U.S. Centers for Disease Control worked with public health and regulatory officials in many states and the U.S. Food and Drug Administration (FDA) to investigate a multistate outbreak of Shiga toxin-producing Escherichia coli (STEC) infections.

gold-medal-all-purpose5lbSixty-three people infected with the outbreak strains of STEC O121 or STEC O26 were reported from 24 states. A list of the states and the number of cases in each can be found on the Case Count Map page. WGS showed that isolates from ill people were closely related genetically. This close genetic relationship means that people in this outbreak were more likely to share a common source of infection.

Illnesses started on dates ranging from December 21, 2015 to September 5, 2016. Ill people range in age from 1 year to 95, with a median age of 18. Seventy-six percent of ill people were female. Seventeen ill people were hospitalized. One person developed hemolytic uremic syndrome, a type of kidney failure, and no deaths were reported.

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

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Twenty-eight (76%) of 37 people reported that they or someone in their household used flour in the week before they became ill. Nineteen (50%) of 38 people reported eating or tasting raw homemade dough or batter. Twenty-one (57%) of 37 people reported using Gold Medal brand flour. Three ill people, all children, reported eating or playing with raw dough at restaurants.

In an epidemiologic investigation, investigators compared the responses of ill people in this outbreak to those of people of similar age and gender reported to state health departments with other gastrointestinal illnesses. Results from this investigation indicated an association between getting sick with STEC and someone in the household using Gold Medal brand flour.

Federal, state, and local regulatory officials performed traceback investigations using package information collected from ill people’s homes and records collected from restaurants where ill people were exposed to raw dough. These initial investigations indicated that the flour used by ill people or used in the restaurants was produced during the same week in November 2015 at the General Mills facility in Kansas City, Missouri, where Gold Medal brand flour is produced.

whole-wheat_-flour_-jan_-13-768x576On May 31, 2016, General Mills recalled several sizes and varieties of Gold Medal Flour, Gold Medal Wondra Flour, and Signature Kitchens Flour due to possible E. coli contamination. The recalled flours were produced in the Kansas City facility and sold nationwide.

In June 2016, laboratory testing by FDA isolated STEC O121 in open samples of General Mills flour collected from the homes of ill people in Arizona, Colorado, and Oklahoma. WGS showed that the STEC O121 isolates from the flour samples were closely related genetically to the STEC O121 isolates from ill people. The flour collected in Oklahoma was not included in the initial General Mills recall. The other flour samples that were tested came from lots of flour included in the initial recall announced by General Mills. In July 2016, laboratory testing by General Mills and FDA isolated STEC O26 from a sample of General Mills flour. WGS showed that the STEC O26 isolated from the flour sample was closely related genetically to isolates from an ill person in the PulseNet database. The flour tested was not included in the earlier General Mills recalls. As a result of these findings, General Mills expanded its recall on July 1, 2016 and again on July 25, 2016 to include more production dates.

Although the outbreak investigation is over, illnesses are expected to continue for some time. The recalled flour and flour products have long shelf lives and may still be in people’s homes. Consumers who don’t know about the recalls could continue to eat the products and get sick. A list of the recalled products and how to identify them is available on the Advice to Consumers page.

This outbreak is a reminder that is it not safe to taste or 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 germs that can make people sick.

7 sick: Multistate outbreak of Shiga toxin-producing E. coli O157:H7 linked to beef products from Adams Farm

The U.S. Centers for Disease Control, multiple states, and the U.S. Department of Agriculture Food Safety and Inspection Service (USDA-FSIS) are investigating a multistate outbreak of Shiga toxin-producing Escherichia coliO157:H7 (STEC O157:H7) infections.

adams-farmSeven people infected with the outbreak strain of STEC O157:H7 have been reported from four states.

Five ill people have been hospitalized. No one has developed hemolytic uremic syndrome, a type of kidney failure, and no deaths have been reported.

Epidemiologic, traceback, and laboratory evidence indicate that beef products produced by Adams Farm Slaughterhouse in Athol, Massachusetts is a likely source of this outbreak.

On September 24, 2016, Adams Farm Slaughterhouse recalled beef, veal, and bison products due to possible E. coli O157:H7 contamination.

The products subject to recall have establishment number EST. 5497 inside the USDA mark of inspection and include several lot numbers and cuts of meat. The full list can be found on the USDA website.

These items were shipped to farmers’ markets, retail locations, and restaurants in Massachusetts, Connecticut, and eastern New York. The products may have been shipped to neighboring states.

We recommend that consumers, restaurants, and retailers do not use, serve, or sell the recalled meat products.

Don’t cook recalled meat products and eat them. Throw the meat out or return it to the place of purchase. If you throw it away, put it in a sealed bag in the trash so that children, pets, or other animals can’t eat it..

Public health investigators are using the PulseNet system to identify illnesses that may be part of this outbreak.

Illnesses started on dates ranging from June 27, 2016 to September 4, 2016. Ill people range in age from 1 year to 74, with a median age of 25. Fifty-seven percent of ill people are female. Five ill people have been hospitalized.

Epidemiologic, traceback, and laboratory evidence indicate that beef products produced by Adams Farm Slaughterhouse in Athol, Massachusetts is a likely source of this outbreak.

In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. All five (100%) of the five people reached for interview reported eating ground beef in the week before they became ill.  Preliminary traceback information indicates that ill people ate ground beef which had been produced by Adams Farm Slaughterhouse.

The Connecticut Department of Public Health collected leftover ground beef from an ill person’s home and from a restaurant for testing; that beef had been produced by Adams Farm Slaughterhouse. Test results showed the outbreak strain of STEC O157:H7 in both samples of the leftover ground beef.