22 sick with E. coli: Cross-contamination from Reno Provisions

Following the recent news that a local E. coli outbreak came from a dessert item made by restaurant Reno Provisions, owner Mark Estee released a personal statement on Wednesday.

cross.contaminationEstee said that he and his employees were “deeply saddened” when they heard that the outbreak was connected to their chocolate mousse, citing that “our first and foremost concern is always the safety of our guests.” He said that they will assist the affected families as they recover.

Estee also expressed his gratitude for the professionalism of The Twisted Fork restaurant, which had originally been linked to the outbreak after they sold the chocolate mousse to their customers. He said that he also respects how quickly the Washoe County Health District was able to investigate the source of the illness.

According to the statement, the E. coli made its way into the kitchen through the cross-contamination of meat and dessert processing equipment.

“Our food production records allowed us to quickly identify that the wrong mixer was used to blend meat, transferring contaminants to the dessert,” Estee said. “This was an isolated incident that violated our preparation protocols.”

Under the guidance of a Hazard Analysis Critical Control Point (HACCP) consultant, the restaurant has reviewed its food safety standards and retrained each employee and will continue to do so.

Chapman wins (but no one wins in foodborne outbreaks) it was the celery: Taylor Farms Pacific, Inc. recalls celery, E. coli linked to Costco outbreak

Taylor Farms Pacific, Inc. of Tracy, CA, is recalling the products listed below because they may include celery which could potentially contain E. coli O157:H7.

costco.chicken.salad.nov.15The products listed below are being recalled out of an abundance of caution due to a Celery and Onion Diced Blend testing positive for E. coli O157:H7 in a sample taken by the Montana Department of Health. The Celery and Onion Diced Blend tested by the state of Montana was used in a Costco Rotisserie Chicken Salad that has been linked to a multi-state E. coli 0157:H7 outbreak.

Consumers may call 209-830-3141 for any further information Monday to Friday, exclusive of holidays, between the hours of 8am-5pm (PST). Consumers with concerns about an illness from consumption of any of the recalled products should contact a health care provider.

The utility of multiple molecular methods including whole genome sequencing as tools to differentiate Escherichia Coli O157:H7 outbreaks

A standardised method for determining Escherichia coli O157:H7 strain relatedness using whole genome sequencing or virulence gene profiling is not yet established.

remaincalm.kevin.baconWe sought to assess the capacity of either high-throughput polymerase chain reaction (PCR) of 49 virulence genes, core-genome single nt variants (SNVs) or k-mer clustering to discriminate between outbreak-associated and sporadic E. coli O157:H7 isolates.

Three outbreaks and multiple sporadic isolates from the province of Alberta, Canada were included in the study. Two of the outbreaks occurred concurrently in 2014 and one occurred in 2012. Pulsed-field gel electrophoresis (PFGE) and multilocus variable-number tandem repeat analysis (MLVA) were employed as comparator typing methods. The virulence gene profiles of isolates from the 2012 and 2014 Alberta outbreak events and contemporary sporadic isolates were mostly identical; therefore the set of virulence genes chosen in this study were not discriminatory enough to distinguish between outbreak clusters. Concordant with PFGE and MLVA results, core genome SNV and k-mer phylogenies clustered isolates from the 2012 and 2014 outbreaks as distinct events. k-mer phylogenies demonstrated increased discriminatory power compared with core SNV phylogenies. Prior to the widespread implementation of whole genome sequencing for routine public health use, issues surrounding cost, technical expertise, software standardisation, and data sharing/comparisons must be addressed.

Going public (not): 252 sick, I dead from E. coli in UK, yet officials were silent

Be the bug.

leek.e.coliThat’s what I tell people when they recite the different-cutting-board mythology as somehow, raw vegetables – grown in dirt and water from who knows where – are immune from E. coli and other bugs.

And talk about the bugs.

That raises awareness and helps people from getting sick.

But the UK, and their piping hot cooking technology, doesn’t believe in saying much.

Stuffed shirt approach.

While the paper below summarizes the outbreak four years later, it says nothing about the responsibility of health types – on the public dime — to make their information public.

 Between December 2010 and July 2011, 252 cases of STEC O157 PT8 stx1 + 2 infection were reported in England, Scotland and Wales. This was the largest outbreak of STEC reported in England and the second largest in the UK to date.

Eighty cases were hospitalized, with two cases of hemolytic uremic syndrome and one death reported. Routine investigative data were used to generate a hypothesis but the subsequent case-control study was inconclusive. A second, more detailed, hypothesis generation exercise identified consumption or handling of vegetables as a potential mode of transmission. A second case-control study demonstrated that cases were more likely than controls to live in households whose members handled or prepared leeks bought unwrapped [odds ratio (OR) 40, 95% confidence interval (CI) 2·08-769·4], and potatoes bought in sacks (OR 13·13, 95% CI 1·19-145·3). This appears to be the first outbreak of STEC O157 infection linked to the handling of leeks.

 A large Great Britain-wide outbreak of STEC O157 phage type 8 linked to handling of raw leeks and potatoes

Epidemiology and Infection / Volume 144 / Issue 01 / January 2016, pp 171-181



Testing a necessary evil of food safety: FDA’s microbiological surveillance sampling

As part of the U.S. Food and Drug Administration’s risk-based and preventive approach to food safety, which is at the core of the FDA Food Safety Modernization Act, the agency began developing a new, more robust surveillance sampling approach in 2014. As the agency moves forward with this approach, it will continue to refine procedures based on lessons learned. The goals of the surveillance sampling are to keep contaminated products from reaching consumers and to facilitate a greater understanding of hazards.

food.lab.testingFDA will publish information regarding test results on the web, including total number of samples collected/tested, and collection date, sample type, and pathogen detected for positive samples.

The Sampling Approach

Under the new sampling approach, the FDA is collecting a statistically determined number of samples of targeted foods over a shorter period of time—12 to18 months—to ensure a statistically valid amount of data is available for decision making.  The sampling approach will help the FDA determine if there are any common factors among positive findings such as season, region, and whether the product was produced domestically or imported.  The FDA’s past approach to microbiological surveillance sampling has been to collect a relatively small number of samples for many different commodities over many years. 

The sampling design for each food represents what U.S. consumers are likely to find in the marketplace. Accordingly, the agency has considered the volume of the target food that is imported and produced domestically and the number of states/countries that produce the target food.

During the first year of this new effort, the FDA focused on sprouts, whole fresh avocados, and raw milk cheese (aged 60 days). The FDA collected more than 800 samples total and tested them for Salmonella, Listeria monocytogenes and E. coli O157:H7. For fiscal year 2016, The FDA will sample and test cucumbers and hot peppers for Salmonella and E. coli O157:H7, taking 1,600 samples of each commodity. The agency also plans to test hot peppers for Shiga toxin producing E. coli. The FDA will conduct whole genomic sequence testing on any samples that test positive. In the future, the number of samples collected of a targeted commodity may vary, depending on the question(s) the FDA intends to answer. Data from the sampling assignments already conducted will be released soon.

The FDA will evaluate the data or results generated throughout the sample collection period and use the data to inform the agency’s short and longer term decision making. By developing these data sets, the FDA seeks to identify potential vulnerabilities and ways to enhance the food safety system.

Depending on the results, the FDA may react or take certain steps, such as:

  • Decreasing sampling, if few positive samples are obtained;
  • Implementing more targeted sampling if trends are identified; for example, if positive samples come from a specific geographic region, a specific facility, or during a particular season;
  • Follow-up inspections;
  • Working with state or international regulatory partners to take corrective actions and implement preventive controls;
  • Developing new or enhanced industry guidance; and
  • Conducting outreach and information sharing to better protect consumers.


19 sick in 7 states from Shiga toxin-producing Escherichia coli O157:H7 infections linked to Costco rotisserie chicken salad

The U.S. Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, the U.S. Department of Agriculture Food Safety and Inspection Service, and public health officials in several states are investigating an outbreak of Shiga toxin-producing Escherichia coli O157:H7 (STEC O157:H7) infections.

costco.chicken.salad.nov.15As of November 23, 2015, 19 people infected with the outbreak strain of STEC O157:H7 have been reported from 7 states.

The majority of illnesses have been reported from states in the western United States.

5 ill people have been hospitalized, and 2 have developed hemolytic uremic syndrome, a type of kidney failure. No deaths have been reported.

The epidemiologic evidence available at this time suggests that rotisserie chicken salad made and sold in Costco Wholesale stores in several states is a likely source of this outbreak.

14 (88%) of 16 people purchased or ate rotisserie chicken salad from Costco in the week before illness started.

The ongoing investigation has not identified what specific ingredient in the chicken salad is linked to illness.

On November 20, 2015, Costco reported to public health officials that the company had removed all remaining rotisserie chicken salad from all stores in the U.S. and stopped further production of the product until further notice.

Consumers who purchased rotisserie chicken salad from any Costco store in the United States on or before November 20, 2015, should not eat it and should throw it away.

Even if some of the rotisserie chicken salad has been eaten and no one has gotten sick, throw the rest of the product away.

This product has a typical shelf life of 3 days and is labeled “Chicken Salad made with Rotisserie Chicken” with item number 37719 on the label.

At least 5 sickened with E. coli O157 from chicken salad at Costco in NW US

“Chicken Salad made with Rotisserie Chicken” from Costco has been connected with at least one case of E. coli O157:H7 in Washington. Consumers who purchased this product – item number 37719 – from any Washington Costco location should discard it.

costco.chicken.saladThe Department of Health, along with the Centers for Disease Control and Prevention (CDC) and other western states, are investigating E. coli illnesses from chicken salad purchased from various Costco stores in late October. Washington has confirmed one case of E. coli O157:H7 from King County, who became ill in late October. This confirmed case was not hospitalized.

“We take E. coli very seriously in Washington,” said State Epidemiologist Dr. Scott Lindquist, “and we are working with CDC and state partners to determine the source.”

Others states with confirmed E. coli cased linked to Costco chicken salad include Colorado (4), Montana (NA), and Utah (NA). In addition to CDC, the U.S. Food and Drug Administration and U.S. Department of Agriculture are working with Costco to determine the source of the contamination.

It was the mousse: 21 sickened with E. coli O157 linked to Nevada producer

An E. coli outbreak that sickened nearly two dozen people and prompted a restaurant in south Reno to voluntarily close has been linked to a dessert food manufactured, sold, and distributed by Reno Provisions, the Washoe County Health District announced Friday afternoon.

ccmarquis22“Our epidemiologists and environmental health staff have identified a dessert that was prepared by Reno Provisions,” Washoe County District Health Officer Kevin Dick said in a news release. “Several people who ate at the Twisted Fork restaurant had the dessert, as did some other people outside the Reno area who then developed the E. coli infection. That commonality led investigators to the dessert supplier, and to tests of food and equipment at Reno Provisions.”

In a prepared statement released Friday, Mark Estee, owner of Reno Provisions, said, in part: “Reno Provisions has taken aggressive steps to make sure its facilities are safe and meet and exceed all food preparation standards … we offer our deepest apologies to all who have been effected by this outbreak. The entire Reno Provisions team has been working tirelessly to solve this problem and ensure that it never happens again.”

The Health District said it will now shift its investigation from the restaurant to the manufacturer. The Health District confirmed that all of the remaining desserts associated with e-coli contaminations have been disposed of.

Since mid-October, 21 confirmed or probable cases of E. coli O157:H7 have been reported in Washoe County.

The owner of Reno Provisions says the the E. coli outbreak has been traced back to a small batch of the restaurant’s Chocolate Marquis Mousse, which “has since been disposed of and discontinued.”

The owner of Reno Provisions says the the E. coli outbreak has been traced back to a small batch of the restaurant’s Chocolate Marquis Mousse, which “has since been disposed of and discontinued.”

Not the headline Batz would have used: Which U.S. foods are most likely to get you sick

Friend of the barfblog.com Michael Batz, says there is a difference between “which foods are most likely to get you sick?” and “which foods cause the greatest burden in the U.S.?”

So he provided commentary on a story he helped create.

The story ran in Fortune, and claimed the U.S. economy will take a $15.5 billion dollar food safety hit through lost income, lost revenue, healthcare-related costs and some intangibles, like “pain and suffering,” according to the U.S. Department of Agriculture.

Research shows the most common foodborne pathogen is norovirus, which is the leading cause of gastroenteritis. The most deadly is listeria; though it is rare, with just 123 confirmed cases in 2013, 24 led to death. The most expensive is salmonella, which is quite common — 7,277 cases in 2013, but with a small fraction (127) resulting in death.

How worried should Americans be about the safety of the food supply? Which foods are most likely to get Americans sick? A deep dive into the data offers a look at where the risks lie.

To identify the most dangerous foods, the Emerging Pathogen Institute, a research institute at the University of Florida, compiled a greatest hits of dangerous pathogen/food pairings. Using a methodology that combined the likelihood of contracting an illness and the illness’s severity to calculate total disease burden, the group identified a Top Ten list of combinations.

Rank Food and Pathogen Cost Illnesses Hospitalizations Deaths
1 Poultry (campylobacter) $1,257m 608,231 6,091 55
2 Pork (toxoplasma) $1,219M 35,537 1,815 134
3 Deli meats (listeria) $1,086M 651 595 104
4 Poultry (salmonella) $712M 221,045 4,159 81
5 Dairy products (listeria) $724M 434 397 70
6 Complex Foods (salmonella) $630M 195,655 3,682 72
6 Complex foods (norovirus) $914M 2,494,222 6,696 68
8 Produce (salmonella) $548M 170,264 3,204 63
8 Beef (toxoplasma) $689M 20,086 1,026 76
10 Eggs (salmonella) $370M 115,003 2,164 42

 The top pairings don’t necessarily map to the major outbreaks of disease; only four of the top ten outbreaks in 2014 were from pairings on the list. J. Glenn Morris, director of the Emerging Pathogen Institute, told Fortune that, outbreaks are “a small fraction” of the total number of foodborne illnesses. In most cases, foodborne illnesses are limited to a small group of people, which makes it difficult for authorities to track.

cdc.fbi.illnessBatz explains the which-foods-cause-the-greatest-burden-in-the-U.S. is about everyone. It is the summary row in a table with 300 million lines, each row representing a different person. Each row could be considered something like individual risk.

(You think you’re a special snowflake? Nope, you’re just a row in the giant spreadsheet of life.)

Our individual risks differ so greatly. Unless you’re pregnant, you don’t need to worry about transmitting Listeria monocytogenes or Toxoplasma gondii to your fetus. Your risks go up when you’re immunocompromised, particularly for some bugs. The young and old face increased risks, though again, every disease is different. People of different ages and genders have different food consumption patterns, too.

And even then, that one row represents risks faced at every meal over the course of a year. Some foods have much higher risks per serving, yet we don’t eat them that often. We consume other foods with lower risks per serving in very high quantities. When you’re telling someone which foods are riskiest, which do you mean? It’s tricky.

Five or so years ago, my colleagues and I published the results of trying to just get at that summary row. Or to be more specific, we tried to say something about which pathogens, which foods, and which pathogen-food pairs cause the greatest public health impact. This kind of information is, I believe, important for getting a handle on the landscape of foodborne disease, to help guide our efforts to reduce the burden.

fbi.batz.pie.chart.nov.15The report had a punchy “top ten” type title and got some attention (for which I’m thankful). But the attention has always come with a price, and that price is that when work like this is written up, it’s almost always presented to readers as some version of which foods to avoid.

I get it, I really do. It’s natural to frame things to readers this way, to take research and make it personally relevant to them. But it kind of butchers the work, and can do as much to misinform as to educate.

So kudos to Tamar Haspal of Fortune for mostly getting it right in an article that presents risks at the broad, national level. Boo to whoever wrote the headline, which conflates population and individual risk and asks “which foods are most likely to make you sick?”

Translating research is always tricky, and I’m never quoted quite to my satisfaction (I can’t get none). In the article, I say we value mortality at $8.7 million per life lost because “there’s also a social welfare value to a life.” Well, that’s not quite right, and I’m doubtful I put it quite that way, and my economist friends are likely groaning at the phrasing, but it’s fine. It’s mostly right, anyway. You have to learn to turn the other cheek.

But other things I just can’t let go. Like the fact that, for the record, I hate pie charts.

Dangerous E. coli in RTE foods in China

Enteropathogenic Escherichia coli (EPEC) is an important foodborne pathogen that potentially causes infant and adult diarrhea.

green-beans-black-bean-sauceThe occurrence and characteristics of EPEC in retail ready-to-eat (RTE) foods have not been thoroughly investigated in China. This study aimed to investigate EPEC occurrence in retail RTE foods sold in the markets of China and to characterize the isolated EPEC by serotyping, virulence gene analyses, antibiotic susceptibility test, and molecular typing based on enterobacterial repetitive intergenic consensus–polymerase chain reaction (ERIC-PCR).

From May 2012 to April 2013, 459 RTE food samples were collected from retail markets in 24 cities of China. E. coli in general, and EPEC specifically, were detected in 144 (31.4%) and 39 (8.5%) samples, respectively. Cold vegetable in sauce was the food type most frequently contaminated with EPEC (18.6%). Of 39 EPEC isolates, 38 were atypical EPEC (eae+) and 1 was typical EPEC (eae+bfpA+) by multiplex PCR assays. The virulence genes espA, espB, tir, and iha were detected in 12, 9, 2, and 1 of 39 isolates, respectively, while genes toxB, etpD, katP, and saa were not detected.

O-antigen serotyping results showed that among 28 typeable isolates, the most common serotype was O119, followed by O26, O111, and O128. Many isolates were resistant to tetracycline (64.1%; 25/39), ampicillin (48.7%; 19/39), and trimethoprim/sulfamethoxazole (48.7%; 19/39). ERIC-PCR indicated high genetic diversity in EPEC strains, which classified 42 strains (39 isolates and 3 reference strains) into 32 different profiles with a discrimination index of 0.981.

The findings of this study highlight the need for close surveillance of the RTE foods at the level of production, packaging, and storage to minimize risks of foodborne disease. 

Occurrence and characterization of Enteropathogenic Escherichia coli (EPEC) in retail ready-to-eat foods in China

Foodborne Pathogens and Disease. -Not available-, ahead of print. doi:10.1089/fpd.2015.2020.

Zhang Shuhong, Wu Qingping, Zhang Jumei, and Zhu Xuemei