4 dead, 33 ill from Listeria in lettuce: Of course Dole knew

Beginning August 2, 1998, over 80 Americans fell ill, 15 were killed, and at least six women miscarried due to listerosis. On Dec. 19, 1998, the outbreak strain was found in an open package of hot dogs partially consumed by a victim. The manufacturer of the hot dogs, Sara Lee subsidiary Bil Mar Foods, Inc., quickly issued a recall of what would become 35 million pounds of hot dogs and other packaged meats produced at the company’s only plant in Michigan. By Christmas, testing of unopened packages of hot dogs from Bil Mar detected the same genetically unique L. monocytegenes bacteria, and production at the plant was halted.

four.monkeysA decade later, the deaths of two Toronto nursing home residents in the summer of 2008 were attributed to listeriosis infections. These illnesses eventually prompted an August 17, 2008 advisory to consumers by the Canadian Food Inspection Agency (CFIA) and Maple Leaf Foods, Inc. to avoid serving or consuming certain brands of deli meat as the products could be contaminated with L. monocytogenes. When genetic testing determined a match between contaminated meat products and listeriosis patients, all products manufactured at a Toronto Maple Leaf Foods plant were recalled and the facility closed. An investigation by the company determined that organic material trapped deep inside the plant’s meat slicing equipment harbored L. monocytogenes, despite routine sanitization that met specifications of the equipment manufacturer. In total, 57 cases of listeriosis as well as 22 deaths were definitively connected to the consumption of the plant’s contaminated deli meats.

As far back as 2013, Blue Bell ice cream was finding Listeria in places like floors, catwalks and cleaning tubs. Blue Bell had positive listeria findings from at least 11 swabs of plant surfaces between March 2013 and November 2014. Each time, it vigorously cleaned the area, and moved on without testing the equipment that touches the ice cream. At the same time, Blue Bell had problems with the layout of its plants, with condensation dripping all over the place. After federal officials linked an illness outbreak to Blue Bell in 2015, they tested the company’s food processing equipment and found LM. Three people died and 10 were sickened.

In all three Listeria outbreaks, the companies had data that showed an increase in Listeria-positive samples.

But rather than pay attention, they ignored the safety.

Those who study engineering failures –the BP oil well in the Gulf, the space shuttle Challenger, Bhopal – say the same thing: human behavior can mess things up.

listeria4In most cases, an attitude prevails that is, “things didn’t go bad yesterday, so the chances are, things won’t go bad today.”

And those in charge begin to ignore the safety systems.

Or hope the problem will just go away.

Kellogg’s was taking Salmonella-contaminated peanut paste based on paperwork in 2009? Pay attention, Nestle did.

In 2009, the operator of a yakiniku barbecue restaurant chain linked to four deaths and 70 illnesses from E. coli O111 in raw beef in Japan admitted it had not tested raw meat served at its outlets for bacteria, as required by the health ministry.

“We’d never had a positive result [from a bacteria test], not once. So we assumed our meat would always be bacteria-free.”

Chipotle Mexican Grill was aware of a norovirus outbreak among people who had eaten in one of its restaurants in Simi Valley, Calif., but did not tell public health officials there until after it had closed and cleaned the restaurant. More than 200 people were sickened.

So it’s no surprise that officials at Dole’s Springfield, Ohio plant, which bags lettuce and other supposedly healthy meals, knew about Listeria in its facility for 18 months before shutting down and issuing a recall.

Four people have died and 33 sickened in Canada and the U.S. from Listeria in the Dole products.

Kudos to Bill Marler and his Food Safety News, as well as Food Poisoning Bulletin, for filing the Freedom of Information request on U.S. Food and Drug Administration inspections at the Dole plant and putting together a preliminary picture of who knew what when.

Inspection reports (483) obtained by Food Safety News revealed the timeline of positive Listeria results and inaction. Dole Fresh Vegetables Inc. finally suspended production at its salad plant in Springfield, OH, on Jan. 21 this year after a random test by state officials showed a bagged salad contained Listeria monocytogenes.

Dole restarted production at the plant in Springfield, OH, on April 21. Company officials won’t say what was done to clean the plant or how they plan to prevent future contamination there.

powell_soli_AUG2Inspectors from FDA checked the production plant three times in January and twice in February after genetic fingerprinting showed the undeniable link between the sick people and salads from the facility. They collected swab samples, unfinished product samples, testing records and other documents and information.

According to the FDA’s inspection reports, in July 2014 Dole did swab tests of surfaces in the Springfield plant. The tests returned positive results for Listeria, but the facility kept producing salads, shipping them to dozens of states and at least five Canadian provinces.

At least five more times in 2014 and three times in late 2015 Dole’s internal tests showed Listeria contamination, but Dole kept the salad lines kept rolling until January this year.

The FDA inspection report states that Dole’s vice president for quality assurance and food safety, as well as the company’s quality assurance manager, were aware internal tests on Jan. 5 and 7 this year showed Listeria on equipment and other surfaces in the plant. But Dole continued to produce and ship salads.

The plant kept operating until Jan. 21. The following day Dole posted a recall notice with the FDA and the Canadian Food Inspection Agency (CFIA) for salads produced at the Springfield facility. Dole branded salads and house brands for Walmart, Kroger, Loblaws and Aldi were included in the recall.

Marler, a prominent food safety lawyer who represents one of the victims in a lawsuit against Dole told Stephanie Strom of the N.Y. Times, “If the government inspectors hadn’t showed up, who knows when or if they were going to tell anyone.”

“They’d been having positive tests for listeria for some time,” said William Goldfield, a spokesman for Dole. “We understand these recent news reports may raise questions among our consumers and customers. They should be assured, however, that we have worked in conjunction with the F.D.A. to address those observations and ensure that Dole products are safe.”

Lauren Sucher, a spokeswoman at the F.D.A., said that companies must notify the agency when they find a food has a “reasonable probability” of causing serious adverse health consequences.

But, Ms. Sucher said, not all strains of listeria cause disease. “When listeria is found in the manufacturing environment, rather than on the food itself, it is not uncommon for a company to immediately take corrective action rather than test further to see if the strain of listeria poses a threat,” she wrote in an email.

Food companies that find listeria during periodic testing are not required to run further tests to determine whether the pathogen is of a toxic variety.

In Dole’s case, it was swabbing various locations in its plant in Springfield, Ohio, not necessarily testing the finished products, according to the F.D.A. inspection. Rather, Canadian public health officials investigating an outbreak of listeriosis dating to summer 2015, tested bagged Dole salads and found four varieties that were contaminated.

CDC: Faster tests, but lousy tracking

Changes in the tests that diagnose foodborne illness are helping identify infections faster but could soon pose challenges to finding outbreaks and monitoring progress toward preventing foodborne disease, according to a report published today in CDC’s Morbidity and Mortality Week Report.

vomit.2Culture-independent diagnostic tests (CIDTs) help doctors diagnose infections quickly because they provide results in hours instead of the days needed for traditional culture methods, which require growing bacteria to determine the cause of illness. But without a bacterial culture, public health officials cannot get the detailed information about the bacteria needed to help find outbreaks, check for antibiotic resistance, and track foodborne disease trends.

In 2015, the percentage of foodborne infections diagnosed only by CIDT was about double compared with the percentage in 2012-2014.

“Foodborne infections continue to be an important public health problem in the United States,” said Robert Tauxe, M.D., M.P.H, director of CDC’s Division of Foodborne, Waterborne and Environmental Diseases. “We are working with partners to make sure we still get important information about harmful bacteria despite the increasing use of diagnostic tests that don’t require a culture.”

The increased use of CIDT could affect public health officials’ ability to monitor trends and detect outbreaks. In the short term, clinical laboratories should work with their public health laboratories to make sure a culture is done whenever a CIDT indicates that someone with diarrheal illness has a bacterial infection. For a long-term solution, CDC is working with partners to develop advanced testing methods that, without culture, will give health care providers information to diagnose illness and also give the detailed information that public health officials need to detect and investigate outbreaks.

Limited progress in reducing foodborne illness

The report included the most recent data from CDC’s Foodborne Diseases Active Surveillance Network, or FoodNet. It summarizes preliminary 2015 data on nine germs spread commonly through food. Overall, progress in reducing rates of foodborne illnesses has been limited since 2012, according to the report. The most frequent causes of infection in 2015 were Salmonella and Campylobacter, which is consistent with previous years.

Other key findings from the FoodNet report include:

The incidence of Salmonella Typhimurium infection, often linked to poultry and beef, decreased 15 percent from 2012-2014 levels.

This decline may be due in part to tighter regulatory standards and vaccination of chicken flocks against Salmonella.

The incidence of some infections increased:

Reported Cryptosporidium infections increased 57 percent since 2012-2014, likely due to increased testing for this pathogen.

Reported non-O157 Shiga toxin-producing Escherichia coli (STEC) infections increased 40 percent since 2012-2014. Quicker and easier testing likely accounted for some or all of this increase.

FoodNet has been monitoring illness trends since 1996. FoodNet provides a foundation for food safety policy and prevention efforts because surveillance data can tell us where prevention efforts are needed to reduce foodborne illnesses.

CDC is working with federal, state, and local partners, and the food industry to improve food safety. New regulations and continuing industry efforts are focusing on challenging areas. USDA has made improvements in its poultry inspection and testing models and has tightened standards for both Salmonella and Campylobacter in poultry.

“In 2013, we launched a series of targeted efforts to address Salmonella in meat and poultry products, known as the Salmonella Action Plan, and recent data show that since then the incidence of Salmonella Typhimurium infection has dropped by 15 percent,” said USDA Deputy Undersecretary for Food Safety, Al Almanza. “However our work is not done. The newly published performance standards for poultry parts will lead to further Salmonella reductions and fewer foodborne illnesses.”

In 2015, FDA published new rules to improve the safety of the food supply including produce, processed foods, and imported foods.

Dr. Kathleen Gensheimer, MD, MPH, director of the FDA’s Coordinated Outbreak Response and Evaluation team and Chief Medical Officer, Foods and Veterinary Medicine Program, said, “We want to respond quickly to foodborne illness, but our true goal is to move forward with preventive measures that will be implemented from farm to table. In addition to collaboration with other government agencies at the local, state and federal level, the rules we are implementing under the FDA Food Safety Modernization Act will help the food industry minimize the risk of contamination to our food supply.”

For more information on avoiding illnesses from food, please visit www.foodsafety.gov.

About FoodNet

FoodNet collects information to track rates and determine trends in laboratory-confirmed illnesses caused by nine germs transmitted commonly by food: Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin-producing O157 and non-O157, Shigella, Vibrio, and Yersinia. Annual data are compared with data from the previous three years (2012-2014). Since 2010, FoodNet has been tracking the increasing use of CIDTs used by clinical laboratories for diagnosis of bacterial enteric infection.

FoodNet is a collaboration among CDC, 10 state health departments, the USDA’s Food Safety and Inspection Service, and the FDA. FoodNet covers 48 million people, encompassing about 15 percent of the United States population. The sites are the states of Connecticut, Georgia, Maryland, Minnesota, New Mexico, Oregon, and Tennessee, and selected counties in California, Colorado, and New York.

 

FoodNet: An electronic success story

I started the Food Safety Network (FSnet) in Jan. 1993.

hqdefaultLots of people have stolen or borrowed the idea since, but they don’t have a good origin story.

Posers.

They’re just copycats.

I was a lost genetics graduate student/journalist who happened along to Mansel who let me do what I wanted to do to get a PhD.

And I am forever grateful to him for that.

Back then, the U.S. Centers for Disease Control Morbidity and Mortality Weekly would take about six months to arrive by mail.

I started doing things electronically, because I had e-mail at the University of Waterloo previously.

It would be another three years until Al Gore invented the Internet.

Now, it’s been 20 years since the inauguration of FoodNet.

That the CDC annual data has become so common and is no longer worthy of mention in what remains of the media is an outstanding scientific and policy accomplishment.

The heros of wars – as we gear up for ANZAC Day here in Australia – are usually the grunts and the public folks who toil in obscurity.

I retrieved my grandfather’s medals from WW1 and II when we gathered our final belongings from Kansas last month, not because I thought he was a great person – he wasn’t – but he served, and so much of public health is about serving.

hqdefault-1Out of all my professoring moments, the ones that stick with me are positively influencing students – who knew Chapman would stand out, I thought he was Stork in Animal House when I met him – and the folks who serve: public health, military, whatever.

I don’t want to deal with your bureaucracy, but I can respect what you do.

It’s all about service.

To evaluate progress toward prevention of enteric and foodborne illnesses in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) monitors the incidence of laboratory-confirmed infections caused by nine pathogens transmitted commonly through food in 10 U.S. sites.* This report summarizes preliminary 2015 data and describes trends since 2012.

In 2015, FoodNet reported 20,107 confirmed cases (defined as culture-confirmed bacterial infections and laboratory-confirmed parasitic infections), 4,531 hospitalizations, and 77 deaths. FoodNet also received reports of 3,112 positive culture-independent diagnostic tests (CIDTs) without culture-confirmation, a number that has markedly increased since 2012 (1). Diagnostic testing practices for enteric pathogens are rapidly moving away from culture-based methods. The continued shift from culture-based methods to CIDTs that do not produce the isolates needed to distinguish between strains and subtypes affects the interpretation of public health surveillance data and ability to monitor progress toward prevention efforts. Expanded case definitions and strategies for obtaining bacterial isolates are crucial during this transition period.

FoodNet is a collaboration among CDC, 10 state health departments, the U.S. Department of Agriculture’s Food Safety and Inspection Service (USDA-FSIS), and the Food and Drug Administration (FDA).

FoodNet conducts active, population-based surveillance for laboratory-confirmed infections caused by Campylobacter, Cryptosporidium, Cyclospora, Listeria, Salmonella, Shiga toxin–producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia in 10 sites covering approximately 15% of the U.S. population (an estimated 49 million persons in 2014). Confirmed infections are defined as culture-confirmed bacterial infections and laboratory-confirmed parasitic infections (e.g., identified by enzyme immunoassay). Positive CIDT results are defined as the detection of antigen or nucleic acid sequences of the pathogen, or for STEC, Shiga toxin or the genes that encode a Shiga toxin, in a stool specimen or enrichment broth using a CIDT.† Positive CIDT results that were confirmed by culture are included only among the confirmed infections. For this analysis, the term “positive CIDT report” refers to positive CIDT results that were not confirmed by culture (either because the specimen was not cultured at the clinical or public health laboratory or because a culture did not yield the pathogen). Hospitalizations occurring within 7 days of specimen collection are recorded. The patient’s vital status at hospital discharge, or 7 days after specimen collection if the patient was not hospitalized, is also captured. Hospitalizations and deaths that occur within 7 days of specimen collection are attributed to the infection.

Incidence of confirmed infections is reported for all FoodNet pathogens and calculated by dividing the number of confirmed infections in 2015 by U.S. Census estimates of the surveillance area population for 2014. A second incidence measurement, calculated by adding positive CIDT reports to confirmed infections, is also reported for Campylobacter, Salmonella, Shigella, and STEC.§ A negative binomial model with 95% confidence intervals (CIs) was used to estimate changes in incidence of infections in 2015 compared with 2012–2014. To describe changes in testing practices, percentage difference in number of positive CIDT reports was calculated for 2015 compared with 2012–2014, by pathogen.

Surveillance for physician-diagnosed postdiarrheal hemolytic uremic syndrome (HUS), a complication of STEC infection, is conducted through a network of nephrologists and infection preventionists and by hospital discharge data review. This report includes HUS data for persons aged <18 years for 2014, the most recent year for which data are available, and compares 2014 incidence with 2011–2013 incidence.

Cases of Infection, Incidence, and Trends

In 2015, FoodNet identified 20,107 confirmed cases of infection, 4,531 hospitalizations, and 77 deaths (Table 1). The number and incidence of confirmed infections per 100,000 population were reported for Salmonella (n = 7,728 [incidence = 15.89]), Campylobacter (6,309 [12.97]), Shigella (2,688 [5.53]), Cryptosporidium (1,612 [3.31]), STEC non-O157 (796 [1.64]), STEC O157 (463 [0.95]), Vibrio (192 [0.39]), Yersinia (139 [0.29]), Listeria (116 [0.24]), and Cyclospora (64 [0.13]). Among confirmed infections, the vast majority were diagnosed only by culture; the exception is STEC, for which most were identified by a CIDT (Table 2).

Among 6,827 (88%) serotyped Salmonella isolates, the top serotypes were Enteritidis, 1,358 (20%); Newport, 816 (12%); and Typhimurium, 739 (11%). Among 175 (91%) speciated Vibrio isolates, 113 (65%) were V. parahaemolyticus, 27 (15%) were V. alginolyticus, and 12 (7%) were V. vulnificus. Among 606 (76%) serogrouped STEC non-O157 isolates, the top serogroups were O26 (32%), O103 (27%), and O111 (18%).

Compared with incidence in 2012–2014, the 2015 incidence of confirmed infections was significantly higher for STEC non-O157 (40% increase; CI = 21%–62%), and Cryptosporidium (57% increase; CI = 20%–106%). No significant changes were observed in 2015 for other pathogens compared with the previous 3-year averages. Among the top three most commonly identified Salmonella serotypes, the incidence in 2015 compared with 2012–2014 was significantly lower for Typhimurium (15% decrease; CI = 4%–25%) and unchanged for Enteritidis and Newport.

FoodNet identified 55 cases of postdiarrheal HUS in children (0.50 cases per 100,000) in 2014; 30 (55%) occurred among children aged <5 years (1.01 cases per 100,000). Compared with 2011–2013, the incidence was significantly lower for all children (27% decrease; CI = 1%–46%) but no change for children aged <5 years was observed.

FoodNet also received 3,112 positive CIDT reports. The number of positive CIDT reports, by pathogen, were Campylobacter (2,021), Shigella (454), Salmonella (361), and STEC (254). These numbers represent an increase in positive CIDT reports in 2015 of 92% for Campylobacter, 284% for Shigella, 247% for Salmonella, and 120% for STEC, when compared with the 2012–2014 averages; the overall increase in CIDT reports for these four pathogens was 122%. Adding positive CIDT reports to confirmed cases resulted in the following incidence rates per 100,000 population: 17.12 for Campylobacter, 16.63 for Salmonella, 6.46 for Shigella, and 3.12 for STEC (Figure). Compared with 2012–2014, the 2015 incidence of confirmed infections plus positive CIDT reports was significantly higher for STEC but not for any other pathogen.

Discussion

Use of CIDTs is finding cases that were not being previously diagnosed. Among confirmed cases, the incidence of Cryptosporidium and STEC non-O157 infections in 2015 was significantly higher than the average for the previous 3 years. The increase in incidence of STEC non-O157 infections is attributable, in part or in full, to increases in diagnostic testing (2). The proportion of laboratories testing for STEC non-O157 increased to 74% in 2015, compared with 55% in 2012 (FoodNet, unpublished data). The increase in Cryptosporidium follows the pattern observed in national data since 2005 and is likely also driven by increases in diagnostic testing (3,4).

The incidence of Salmonella serotype Typhimurium infections continues to decline, and it has dropped to the third most commonly reported serotype. The use of a live attenuated Typhimurium vaccine in poultry (5), in addition to more stringent performance standards for Salmonella contamination of poultry carcasses (6) might have contributed to this decline. The significant decrease in HUS incidence in 2014 compared with the preceding 3 years (2011–2013) mirrors significant decreases in STEC O157 incidence observed during the same period (7). Efforts are still needed to decrease contamination of produce, beef, and other foods to achieve the Healthy People 2020 goal for STEC O157 of 0.6 cases per 100,000 population.¶

The percentage of infections diagnosed only by CIDTs markedly increased in 2015. Diagnostic testing practices for enteric pathogens are rapidly moving away from culture-based methods, and the impact of this change varies by pathogen. Although CIDTs are still most commonly being used for Campylobacter and STEC, the highest percentage increase in use compared with the previous 3-year average was observed for Shigella and Salmonella, most likely due to laboratories using the newly available DNA-based syndrome panels (FoodNet, unpublished data)

In FoodNet, current methods to assess trends in the incidence of illness caused by bacterial pathogens are based only on culture-confirmed infections. The ability to assess and interpret change is impeded as the number of positive CIDT reports continues to rise because of important limitations in the understanding of CIDTs and possible changes in clinician and laboratory practices surrounding them. For example, analyses need to consider the likelihood of false-positive CIDTs and of CIDTs that are more sensitive than routine culture methods; such characteristics vary among CIDTs. The availability of CIDTs might also increase testing for some pathogens. Surveillance systems need to adapt to these changes by expanding case definitions to include positive CIDT reports. Isolates are still needed for antimicrobial susceptibility testing, serotyping, subtyping, and whole genome sequencing (1); these data are critical for monitoring trends, detecting clusters of illness, and investigating outbreaks. For Salmonella, with serotypes diverse in reservoirs and sources, the inability to distinguish serotypes will prevent tracking of important changes in incidence by serotype, and markedly limit detection and investigation of outbreaks. For STEC, because identification of serogroups requires culture, it is not known which STEC-positive CIDT reports represent O157 versus non-O157.

The findings in this report are subject to at least five limitations. First, increasing use of CIDTs by clinical laboratories might affect the number of culture-confirmed infections reported; use of CIDTs might result in an increase (as seen for STEC non-O157 infections) or decrease (as fewer cases might be diagnosed by traditional methods) in reported incidence. Second, the sensitivity and specificity of CIDTs vary by test type, brand, and other factors; some CIDT reports could be false positives (1). Third, health care–seeking behaviors, access to health services, and other characteristics of the population in the surveillance area might affect the generalizability of the findings. Fourth, the proportion of illnesses transmitted by non-food routes differs by pathogen; data provided in this report are not limited to infections from food.** Finally, changes in incidence between periods can reflect year-to-year variation during those periods rather than sustained trends, and the number of infections and patterns observed might change as final data become available.

The use of CIDTs in clinical laboratories has many advantages. Illnesses can be diagnosed much faster than when culture is required. Also, some CIDTs are becoming available to detect infections caused by pathogens not routinely sought by standard laboratory methods. One of these is enterotoxigenic E. coli, an important cause of travelers’ diarrhea (8).

More work is needed to extend the benefits of CIDT to the public health sector. During this initial period when clinical laboratories are transitioning to the use of CIDTs, reflex culturing†† of specimens with positive CIDT reports should be considered for bacterial pathogens to obtain isolates needed for public health practice. For the future, expedited research and development are needed to create methods to detect the genetic sequences of pathogens directly and rapidly from stool specimens, which has the potential to benefit both clinical and public health practice, because subtype, resistance profile, and other features can be obtained from the genetic sequence.

Infection with Pathogens Transmitted Commonly Through Food and the Effect of Increasing Use of Culture-Independent Diagnostic Tests on Surveillance — Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2012–2015

Weekly / April 15, 2016 / 65(14);368–371

Jennifer Y. Huang, MPH; Olga L. Henao, PhD; Patricia M. Griffin, MD; Duc J. Vugia, MD; Alicia B. Cronquist, MPH; Sharon Hurd, MPH; Melissa Tobin-D’Angelo, MD; Patricia Ryan, MD; Kirk Smith, DVM; Sarah Lathrop, PhD; Shelley Zansky, PhD; Paul R. Cieslak, MD; John Dunn, DVM; Kristin G. Holt, DVM; Beverly J. Wolpert, PhD1; Mary E. Patrick, MPH

http://www.cdc.gov/mmwr/volumes/65/wr/mm6514a2.htm?s_cid=mm6514a2_x

Lab worker stricken with Salmonella at CDC

CDC is investigating how one of its laboratory workers who was recently diagnosed with Salmonella infection may have acquired their infection due to work they performed in a BSL-2 laboratory (a level of lab work involving pathogens that are common and treatable causes of illness). 

cdcSalmonella is not a select agent. Preliminary laboratory tests indicate that the worker was infected with a strain of Salmonella which matched the strain being worked on in the lab.  The worker is well and back at CDC and, based on what we know now, no other staff were exposed. The worker had hands-on training by experienced microbiologists and completed all required safety training. The worker was following standard protocols to perform a basic procedure on a frozen sample in an effort to culture or grow the bacteria. The agency is investigating to see if additional safeguards are needed to prevent exposures when performing this procedure in the future.

Raw is risky: Campylobacter infections associated with raw milk consumption sicken 99 in Utah, 2014

The U.S. Centers for Disease Control reports that a total of 99 cases (59 confirmed and 40 probable) of campylobacteriosis, including 10 patients who were hospitalized, and one who died, occurred in an outbreak in northern Utah associated with a single raw milk dairy.

raw.milk.death.1917The outbreak was documented by epidemiologic, environmental, and laboratory evidence. Despite routine testing of raw milk showing results within acceptable limits, the milk still contained dangerous bacteria.

To limit outbreaks from raw milk consumption, more reliable routine tests are needed that do not rely solely on bacterial, coliform, and somatic cell counts. Case investigation and pulsed-field gel electrophoresis patterns from environmental samples can support an epidemiologic link and allow implementation of control measures.

In May 2014, the Utah Public Health Laboratory (UPHL) notified the Utah Department of Health (UDOH) of specimens from three patients infected with Campylobacter jejuni yielding indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. All three patients had consumed raw (unpasteurized and nonhomogenized) milk from dairy A. In Utah, raw milk sales are legal from farm to consumer with a sales permit from the Utah Department of Agriculture and Food (UDAF). Raw milk dairies are required to submit monthly milk samples to UDAF for somatic cell and coliform counts, both of which are indicators of raw milk contamination. Before this cluster’s identification, dairy A’s routine test results were within acceptable levels (<400,000 somatic cells/mL and <10 coliform colony forming units/mL). Subsequent enhanced testing procedures recovered C. jejuni, a fastidious organism, in dairy A raw milk; the isolate matched the cluster pattern. UDAF suspended dairy A’s raw milk permit during August 4–October 1, and reinstated the permit when follow-up cultures were negative. Additional cases of C. jejuni infection were identified in October, and UDAF permanently revoked dairy A’s permit to sell raw milk on December 1. During May 9–November 6, 2014, a total of 99 cases of C. jejuni infection were identified. Routine somatic cell and coliform counts of raw milk do not ensure its safety. Consumers should be educated that raw milk might be unsafe even if it meets routine testing standards.

Where did the Listeria come from? US outbreak of listeriosis linked to Dole salads appears over

A couple of days after the Canadians wrapped up their investigation, the U.S. Centers for Disease Control and Prevention has issued its own final report on the Listeria outbreak linked to packaged salads produced at a Dole Processing Facility in Springfield, Ohio.

160122-dole-salad-mn-1530_8b681a6748a4253c3ec1c087b4cd8b0d.nbcnews-fp-1200-800CDC, several states, and the U.S. Food and Drug Administration (FDA) investigated a multistate outbreak of Listeria monocytogenes infections (listeriosis).

A total of 19 people infected with the outbreak strain of Listeria were reported from nine states.

All 19 people were hospitalized, and one person from Michigan died as a result of listeriosis. One illness was reported in a pregnant woman.

Whole genome sequencing (WGS) performed on Listeria isolates from all 19 ill people showed that the isolates were closely related genetically.

According to the Public Health Agency of Canada, ill people in Canada were infected with the same outbreak strain of Listeria.

WGS performed on clinical isolates from ill people in Canada showed that the isolates were closely related genetically to Listeria isolates from ill people in the United States.

Epidemiologic and laboratory evidence indicated that packaged salads produced at the Dole processing facility in Springfield, Ohio and sold under various brand names were the likely source of this outbreak.

On January 27, 2016, Dole voluntarily recalled all salad mixes produced in the Springfield, Ohio processing facility. Any recalled salad mixes still on the market or in consumers’ homes would be past their expiration dates.

29 sick, 3 dead: Canadians wrap up Dole listeria investigation

Doug Carder of The Packer reports the Public Health Agency of Canada has wrapped up its investigation into a listeria outbreak linked to Dole Fresh Vegetables Inc.’s processing plant in Springfield, Ohio, that infected more than a dozen Canadians.

listeria4“Given that the source of the outbreak was identified and contaminated products have been recalled from the market, the outbreak investigation coordinating committee has been deactivated and the investigation is coming to a close,” according to a report posted on the Canadian health agency’s website regarding the investigation which began in late January.

The agency investigated 14 cases of Listeria monocytogenes in five Canadian provinces: Ontario (9), Quebec (2), New Brunswick (1), Prince Edward Island (1), and Newfoundland and Labrador (1), according to the report. Individuals became ill between May 2015 and February, the agency reported.

“All cases have been hospitalized, and three people have died, however it has not been determined if listeria contributed to the cause of these deaths,” according to Public Health Agency of Canada’s final report.

Dole reported Jan. 21 to U.S. health officials with the Food and Drug Administration and the Centers for Disease Control and Prevention that it had suspended operations at the Ohio plant once it learned of the possible connection to the listeria outbreak. On Jan. 27, the company voluntarily recalled all Dole and private-label packaged salads produced there.

FDA confirmed Jan. 28 the presence of Listeria monocytogenes in a packaged salad produced at the Springfield plant.

As of Feb. 25, the CDC had reported the outbreak had infected 18 people in nine states. All cases required hospitalization, according to CDC.

Laboratory results from the Canadian Food Inspection Agency confirmed a link between recalled packaged salad products and the listeria outbreak in Canada, according to the report. Lab results “confirmed that the Canadian and U.S. listeria outbreaks are highly genetically related,” according to the Canadian health agency’s report.

While Canadian health officials have concluded their investigation, the U.S. investigation into the outbreak remains active, according to FDA.

27 now sick from Salmonella in 20 states linked to organic shake and meal products

The U.S. Centers for Disease Control reports nine more ill people have been reported from eight states linked to RAW Meal products. The most recent illness started on March 13, 2016.

raw-mealFive ill people have been hospitalized, and no deaths have been reported.

Epidemiologic and laboratory evidence indicates that RAW Meal Organic Shake & Meal products made by Garden of Life, LLC are the likely source of this outbreak.

As a result of this investigation, Garden of Life, LLC voluntarily recalled several lots of RAW Meal Organic Shake & Meal products, available in chocolate, original, vanilla, and vanilla chai, on January 29, 2016 (initial recall) and February 12, 2016 (expanded recall).

Going public: E. coli secrecy must end

The Des Moines Register Editorial Board writes that last December, the Centers for Disease Control and Prevention, along with other health agencies around the nation, allegedly detected a spike in E. coli food-poisoning cases in people who had eaten at Pizza Ranch restaurants.

communicationOn Jan. 31, Richard Simmons Jr. of Kansas took his family, including his 7-year-old daughter, to the Pizza Ranch in Emporia, Kan. Simmons says his daughter ate food from the restaurant’s buffet, including chicken, salad and dessert pizza. A few days later, the girl fell ill, experiencing stomach cramps and diarrhea. After testing positive for E. coli, she was hospitalized in Wichita on Feb. 12, where she placed in the intensive-care unit care after her kidneys failed. She remained hospitalized for two weeks.

The CDC later concluded Simmons’ daughter was one of 13 individuals believed to have been sickened by food from Pizza Ranch outlets in several states. Still, the CDC said nothing to the public about Pizza Ranch being the source of contaminated food. In fact, it wasn’t until The Des Moines Register contacted the federal agency on March 16, asking about the matter, that the CDC acknowledged the contaminated food had come from Pizza Ranch.

The CDC says its policy is to identify the providers of contaminated food only when “we perceive there are actions people can take to protect themselves.” In this case, a spokeswoman said, the restaurant chain stopped using the product suspected to be the cause of the illnesses, curtailing the outbreak. There was nothing else consumers could do at that point to avoid illnesses, she said.

The Iowa Department of Public Health, which was aware of the outbreak, took a similar stance. Even last week, Dr. Patricia Quinlisk, the department’s medical director, refused to discuss the business involved in the outbreak with a Register reporter. She said the department’s investigations remain confidential unless the department believes disclosure is necessary to protect the public health.

This is not the first time this has happened. Last fall, more than 50 people were sickened by cooked taco meat that was served to the staff at Des Moines’ Roosevelt High School. The cooked meat was purchased from a grocery store shortly before it was served as part of a staff luncheon for the school. State officials said the food was likely tainted during preparation at the store since the bacteria wouldn’t have had enough time to grow between the time the meat was purchased and the time it was served.

communication.context.13Unfortunately, county and state health officials chose not to disclose the name of the store that provided the meat. Thanks to a state law that was written not to protect the public health but to protect Iowa business and industry, Iowa’s public health reports on food-poisoning cases must be written in a manner that doesn’t identify the business believed to be at fault. The law goes on to say that the identity of the business may be shared with the public only when the state epidemiologist or the director of public health “determines such a release of information (is) necessary for the protection of the health of the public.”

The public deserves to know who is responsible for serving food than can seriously injure, or even kill, consumers. They also deserve to know what our “public health” officials are up to, and passing laws that specifically muzzle these officials and require them to remain silent about the source of contaminated food can’t possibly be in the public interest.

Final tally: 907 sick, 6 dead from Salmonella linked to imported cucumbers

According to the U.S. Centers for Disease Control, this outbreak appears to be over. However, Salmonella remains an important cause of human illness in the United States.

cucumber.facialA total of 907 people infected with the outbreak strains of Salmonella Poona were reported from 40 states.

A total of 204 ill people were hospitalized, and six deaths were reported from Arizona (1), California (3), Oklahoma (1), and Texas (1). Salmonella infection was not considered to be a contributing factor in two of the three deaths in California.

Epidemiologic, laboratory, and traceback investigations identified cucumbers imported from Mexico and distributed by Andrew & Williamson Fresh Produce as the likely source of the infections in this outbreak.

Two recalls of cucumbers that may be contaminated with Salmonella were announced in September 2015 as a result of this investigation: Andrew & Williamson Fresh Produce and Custom Produce Sales.

Investigation of illnesses that were reported after the peak of the outbreak in August and September 2015 did not identify an additional food linked to illness. The source of contamination for the cucumbers distributed by Andrew & Williamson Fresh Produce has not been identified.

Among people for whom information was available, illnesses started on dates ranging from July 3, 2015 to February 29, 2016. Ill people ranged in age from less than 1 year to 99, with a median age of 18. Forty-nine percent of ill people were children younger than 18 years. Fifty-six percent of ill people were female. Among 720 people with available information, 204 (28%) were hospitalized. Six deaths were reported.

salm.cucumber.sep.15WGS showed that isolates from ill people were closely related genetically. These results also included isolates from people who became ill in October, November and January after the outbreak’s peak. This close genetic relationship means that people in this outbreak were more likely to share a common source of infection, such as a contaminated food.

Several state health and agriculture departments collected and tested cucumbers from retail locations and isolated the outbreak strains of Salmonella Poona. Information indicated that these cucumbers were distributed by Andrew & Williamson Fresh Produce. Additionally, testing of cucumbers collected from the Andrew & Williamson Fresh Produce facility isolated the outbreak strains of Salmonella Poona.

WGS of Salmonella Poona isolates from ill people and from contaminated cucumbers distributed by Andrew & Williamson Fresh Produce showed that the strains were closely related genetically. This close genetic relationship provided additional evidence that ill people in this outbreak became ill from consuming cucumbers distributed by Andrew & Williamson.