Whole Foods faces tremendous risk in connection with the death of an 8 year-old from E. coli O157:H7 infection

Whole Foods trumps food porn over food safety.

whole.foodsThe parents of Joshua Kaye, an 8 year-old boy from Braintree, Massachusetts who died on July 7, 2014, after contracting an E. coli O157:H7 infection that turned into hemolytic uremic syndrome, have filed suit against Whole Foods, the retail store from which they allege to have purchased the contaminated meat, and Rain Crow Ranch, a Missouri company that allegedly produced and sold the meat to Whole Foods. Joshua Kaye was one of three Massachusetts residents known to contract E. coli between June 13 and June 25, 2014, prompting an investigation by the U.S. Department of Agriculture Food Safety and Inspection Service (“FSIS”), in conjunction with the Center for Disease and Control Prevention (“CDC”) and the Massachusetts Department of Public Health. FSIS, which began its investigation on June 25, 2014, purportedly initially linked the E. coli contamination to Whole Foods stores in Newton and South Weymouth, Massachusetts, through epidemiological evidence.

FSIS reports that laboratory testing performed on August 13, 2014, presumably Pulsed-field Gel Electrophoresis (“PFGE”), provided a link between the three Massachusetts cases and the Whole Foods markets. On August 15, 2014, Whole Foods initiated the voluntary recall of 368 pounds of ground beef products from its two stores.

Joshua Kaye’s father, Andrew Kaye, told New England Cable News (“NECN”) that DNA samples had linked their son to the E. coli outbreak. Furthermore, Plaintiffs’ Complaint asserts that a stool sample taken from Joshua Kaye resulted in an E. coli 0157:H7 positive culture that “identically matched the Whole Foods Market E. coli 0157:H7 outbreak strain.” Both Whole Foods and Rain Crow Ranch have denied any clear link between the Massachusetts E. coli illnesses and their respective businesses.

Plaintiffs have asserted claims against Whole Foods for: (1) Breach of Implied Warranty of Merchantability; (2) Breach of Warranty in Violation of M.G.L. ch. 93A; (3) Breach of M.G.L. ch. 93A; (4) Negligence; (5) Gross Negligence and Reckless Conduct; (6) Negligent Infliction of Emotional Distress; (7) Conscious Pain and Suffering; (8) Wrongful Death; and (9) Punitive Damages.

What Does It Mean for Whole Foods? As a non-manufacturing product seller, Whole Foods appears to have pass-through liability for the sale of contaminated beef. On that basis, we expect Whole Foods to tender the defense and indemnification of their claim to Rain Crow Ranch. Whole Foods’ success in getting their tender accepted, however, will depend upon the terms of their contract with Rain Crow Ranch for the purchase of ground beef, as well as their role, if any, in the production process in advance of sale. For instance, if Whole Foods’ handling or processing of the subject beef caused or contributed to the alleged E. coli contamination, its independent negligence would preclude a common law indemnification claim and potentially impede a claim for contractual indemnity.

Further, Whole Foods’ tender will be complicated, by Plaintiffs’ assertion of Massachusetts General Laws Chapter 93A claims (“93A”). 93A provides a cause of action for unfair or deceptive practices in the conduct of any trade or commerce. Entities found to have breached 93A can be subject to double or treble damages. Plaintiffs have asserted two separate 93A claims against Whole Foods: (1) for the sale of contaminated meat in contradiction to its marketing of the product as safe; and (2) for failing to make a reasonable offer of settlement in response to Plaintiffs’ 93A demand letter. The latter 93A claim presumably falls outside the bounds of any indemnification provision contained within a purchase agreement entered into by the defendants relative to the subject beef, because it arises from acts independent of the sale of Rain Crow Ranch’s product.

Lessons learned from a textbook outbreak: EHEC-O157:H7 infections associated with the consumption of raw meat products, June 2012, Limburg, Belgium

On 5 June 2012 several enterohemorrhagic Escherichia coli, EHEC, O157:H7 infections were reported to the public health authorities of Limburg.

communicationMethods

We performed a case-control study, a trace back/forward investigation and compared strains isolated from human cases and food samples. A case was defined as anyone with a laboratory-confirmed E. coli O157:H7-infection in North-East Limburg from May 30 2012 till July 15 2012. Family members with bloody diarrhea were also included as cases. E. coli O157 was isolated by culture and the presence of the virulence genes was verified using (q)PCR. Isolates were genotyped and compared by Pulsed Field Gel Electrophoresis (PFGE) and insertion sequence 629-printing (IS629-printing).

Results

The outbreak involved 24 cases, of which 17 were laboratory-confirmed. Five cases developed Hemolytic Uremic Syndrome (HUS) and fifteen were hospitalized. Cases reported a significantly higher consumption of “steak tartare”, a raw meat product (OR 48.12; 95% CI; 5.62- 416.01). Cases were also more likely to buy meat-products at certain butcheries (OR 11.67; 95% CI; 1.41 – 96.49). PFGE and IS629-printing demonstrated that the vtx1a vtx2a eae ehxA positive EHEC O157:H7 strains isolated from three meat products and all seventeen human stool samples were identical. In a slaughterhouse, identified by the trace-back investigation, a carcass infected with a different EHEC strain was found and confiscated.

Conclusion

We present a well described and effectively investigated foodborne outbreak associated with meat products. Our main recommendations are the facilitation and acceleration of the outbreak detection and the development of a communication plan to reaches all persons at risk. 

Archives of Public Health, 2014, 72:44

http://www.archpublichealth.com/content/pdf/2049-3258-72-44.pdf

Abstract (provisional)

9 sickened with E. coli O157 in Oct. 2013 linked to imported cucumbers served at Jimmy John’s in Denver

I’m sure university departmental meetings across the U.S. continue to chomp down on catered Jimmy John’s sandwiches, even though they have a terrible food safety record:

cucumber282 sick from Norovirus in Garden City, Kansas, in 2014;

29 sick from E. coli O26 on clover sprouts in early 2012; and,

140 sick from Salmonella on alfalfa sprouts in 2011.

Now, the Colorado Department of Public Health & Environment reports that in Oct. 2013, an outbreak of E. coli O157:H7 sickened nine people, including 1 probable case and 8 laboratory-confirmed cases with matching pulsed-field gel electrophoresis (PFGE) and multiple-locus variable number tandem repeat analysis (MLVA) patterns from E. coli O157:H7 isolated from stool.

All 9 cases reported eating sandwiches at Denver-area Jimmy John’s locations in early October 2013. The outbreak investigation consisted of case finding and interviews, 2 separate case-control studies, environmental investigations, produce traceback, and laboratory testing.

348sThe results of this investigation indicate that consumption of Jimmy John’s sandwiches containing cucumbers imported from Mexico was the likely cause of the outbreak. To our knowledge, this is the first E. coli O157:H7 outbreak associated with cucumbers reported in the United States. Public health and food safety officials should be aware that cucumbers may be contaminated with E. coli O157:H7, which could cause sporadic E. coli O157:H7 infections as well as outbreaks. As of the date of this report, no other cases of E. coli O157:H7 with the PFGE pattern combination seen in this outbreak were reported in Colorado. 

Can E. coli O157:H7 blow from feedlots to lettuce or spinach fields? (Yes) Does it matter? (Probably)

The impact of proximity to a beef cattle feedlot on E. coli O157:H7 contamination of leafy greens was examined. In each of two years, leafy greens were planted to nine plots located 60, 120, and 180 meters from a cattle feedlot (3 plots each distance).

cattle.lettuceLeafy greens (270) and feedlot manure samples (100) were collected six different times from June to September in each year. Both E. coli O157:H7 and total E. coli were recovered from leafy greens at all plot distances.

E. coli O157:H7 was recovered from 3.5% of leafy green samples per plot at 60 meters, which was higher (P < 0.05) than the 1.8% of positive samples per plot at 180 meters, indicating a decrease in contamination as distance from the feedlot was increased. Although E. coli O157:H7 was not recovered from air samples at any distance, total E. coli was recovered from air samples at the feedlot edge and all plot distances, indicating that airborne transport of the pathogen can occur.

Results suggest that risk for airborne transport of E. coli O157:H7 from cattle production is increased when cattle pen surfaces are very dry, and when this situation is combined with cattle management or cattle behaviors that generate airborne dust.

cow.poop2__1.storyCurrent leafy green field distance guidelines of 120 meters (400 feet) may not be adequate to limit the transmission of E. coli O157:H7 to produce crops planted near concentrated animal feeding operations. Additional research is needed to determine safe set-back distances between cattle feedlots and crop production that will reduce fresh produce contamination.

Effect of Proximity to a Cattle Feedlot on Escherichia coli O157:H7 Contamination of Leafy Greens and Evaluation of the Potential for Airborne Transmission

01.dec.14

Applied and Environmental Microbiology

Elaine D. Berry, James E. Wells, James L. Bono, Bryan L. Woodbury, Norasak Kalchayanand, Keri N. Norman, Trevor V. Suslow, Gabriela López-Velasco and Patricia D. Millner

http://aem.asm.org/content/early/2014/11/24/AEM.02998-14.abstract

Cargill ground beef recalled after E. coli O157 positive in Western Canada

Cargill Meat Solutions (Est. 700) is recalling Your Fresh Market brand ground beef products from the marketplace due to possible E. coli O157 contamination.  Consumers should not consume the recalled products described below.

e.coli.O157.cargill.dec.14The following products have been sold at Walmart stores in Alberta, British Columbia, Manitoba and Saskatchewan.

Recalled products

Brand Name: Your Fresh Market

Common Name: Extra Lean Ground Beef Sirloin

Size: 475g                        

Code(s) on Product:            Best Before 2014.NO.28

UPC: 6 05388 18363 7

Brand Name: Your Fresh Market

Common Name: Extra Lean Ground Beef         

Size: 475g                            

Code(s) on Product:            Best Before 2014.NO.28

UPC: 6 05388 18369 9

Brand Name: Your Fresh Market

Common Name: Medium Ground Beef 

Size: 475g                            

Code(s) on Product:            Best Before 2014.NO.28

UPC: 6 05388 18365 1

Brand Name: Your Fresh Market

Common Name: Lean Ground Beef       

Size: 475g                            

Code(s) on Product:            Best Before 2014.NO.28 and 2014.NO.29

UPC: 6 05388 18376 7

Brand Name: Your Fresh Market

Common Name: Extra Lean Ground Beef         

Size: 900 g               

Code(s) on Product:            Best Before 2014.NO.28

UPC: 6 05388 18372 9

Brand Name: Your Fresh Market

Common Name: Lean Ground Beef       

Size: 900 g               

Code(s) on Product:            Best Before 2014.NO.28

UPC: 6 05388 18378 1

Brand Name: Your Fresh Market

Common Name: Lean Ground Beef       

Size: 1.6 kg             

Code(s) on Product:            Best Before 2014.NO.28 and 2014.NO.29

UPC: 6 05388 18379 8

Check to see if you have recalled products in your home. Recalled products should be thrown out or returned to the store where they were purchased.

Food contaminated with E. coli O157 may not look or smell spoiled but can still make you sick.

This recall was triggered by test results. The Canadian Food Inspection Agency (CFIA) is conducting a food safety investigation, which may lead to the recall of other products. If other high-risk products are recalled, the CFIA will notify the public through updated Food Recall Warnings.

The CFIA is verifying that industry is removing recalled product from the marketplace.

There have been no reported illnesses associated with these products.

Minnesota firm recalls ground beef products due to possible E. coli O157:H7 contamination

Ranchers Legacy Meat Co., of Vadnais Heights, Minn., is recalling 1,200 pounds of ground beef products that may be contaminated with E. coli O157:H7, according to the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS).

rancher's.legacy.ground.beef.14Products subject to the recall are packaged in plastic cryovac sealed packets, and contain various weights of ground beef.  All products produced on Nov. 19, 2014 are subject to recall.

All of the following have a Package Code (use by) 12/10/2014 and bear the establishment number “Est. 40264” inside the USDA mark of inspection. Individual products include:

  • Ranchers Legacy Ground Beef Patties 77/23
  • Ranchers Legacy Ground Chuck Patties 80/20
  • Ranchers Legacy USDA Choice Ground Beef 80/20
  • Ranchers Legacy USDA Choice WD Beef Patties 80/20
  • Ranchers Legacy RD Beef Patties 80/20
  • OTG Manufacturing Chuck/Brisket RD Patties
  • Ranchers Legacy Chuck Blend Oval Beef Patties
  • Ranchers Legacy WD Chuck Blend Patties
  • Ranchers Legacy USDA Choice NAT Beef Patties 80/20
  • Ranchers Legacy NAT Beef Patties 80/20
  • Ranchers Legacy USDA Choice NAT Beef Patties 80/20
  • Ranchers Legacy Ground Chuck Blend
  • Ranchers Legacy Chuck Blend Bulk Pack NAT Patties
  • Ranchers Legacy Chuck Blend NAT Beef Patties

The product was discovered by FSIS inspection personnel during a routine inspection. Products testing positive on November 21, 2014 were held at the establishment.  The products being recalled were produced on the same day and equipment as the positive product.  Products were shipped to distributors for sales nationwide.

Color is not a reliable indicator that meat has been cooked to a temperature high enough to kill harmful bacteria.

The only way to be sure the meat or poultry is cooked to a high enough temperature to kill harmful bacteria is to use a thermometer to measure the internal temperature.
- Fish: 145°F
- Beef, pork, lamb chops/steaks/roasts: 145°F with a three minute rest time
- ground meat: 160°F
- poultry: 165°F
- hot dogs: 160°F or steaming hot.

When available, the retail distribution list(s) will be posted on the FSIS website at www.fsis.usda.gov/recalls.

20 years after Jack in the Box, foodborne illnesses still an issue

Darin Detwiler, a senior policy coordinator for food safety at STOP Foodborne Illness in Chicago and a graduate lecturer in regulatory affairs of the food industry at Northeastern University in Boston, writes in this op-ed:

rileyDI am deeply saddened to read about the deaths this year of a two young girls (one in Whatcom County and another in Portland,) both caused by E.coli.

My 16-month-old son, Riley Detwiler, died from E.coli during the 1993 “Jack in the Box” outbreak. He became ill just as the Whatcom County Health Department warned of a child with E. coli at his daycare. The other child ate an undercooked, contaminated hamburger at the Bellingham restaurant. After noticing symptoms, I took Riley to St. Joseph’s Hospital where, after two days, doctors decided to airlift him to Children’s Hospital in Seattle.

Doctors removed most of his intestines, destroyed by foodborne pathogens, and collaborated with experts to make him healthy. I stood every day beside Riley’s little toddler body — dwarfed by wires and tubes. He laid in a coma for weeks until I held him one last time after he died. His poisoning and death made national headlines — even gaining the attention of President Clinton.

The 1993 “Jack in the Box” outbreak sickened over 650 people and took the lives of four young children. Today, many experts refer to that event as the “9/11” for the meat industry.

A pivotal moment in history, the attacks on 9/11 killed almost 3,000 people and resulted in sweeping changes in our national concept of homeland safety and our day to day security practices. The 1993 Jack in the Box E.coli outbreak should have been a pivotal moment in food safety. However, foodborne pathogens, according to the CDC, still cause 3,000 to 5,000 Americans to die each year. Even worse is the fact that Americans’ perception of food safety has not changed dramatically since then.

Two decades ago I hoped Riley’s death would lead to important national changes in industry, federal regulations, and in American’s awareness and behaviors. Unfortunately, I was wrong. Rarely has a week gone by when I have not heard or read about a food recall, an illness or a death from foodborne pathogens. Changes may be coming, but they will have come too late for the families of nearly 50,000 Americans who have died from food pathogens since Riley’s passing.

The CDC reports that at least 48 million Americans each year become ill from contaminated food leading to at least 128,000 hospitalizations. The CDC also stresses that for every single case of foodborne illness that gets reported, 38 cases go unreported.

Clearly, only the tip of this crisis is seen and reported. The majority of those made ill or who die from food poisoning are young children with immune systems not yet capable of fighting off the variety of foodborne pathogens found in America’s food supply.

Over the last 21 years, every time I see a news report of food recalls or of new illnesses and deaths from foodborne pathogens, I think about Riley — his smiling face, his few words and his few steps, his life cut short by problems in our food supply that persist to this day. These echoes of a needless loss come with the reminder that more needs to be done to prevent tragedies like this from erasing any sense of security and safety in the foods we eat and serve to our families.

Today, foodborne illnesses and deaths are associated with not only meat, but also with many other foods once considered completely safe. Foodborne pathogens are dangerous for all consumers and especially dangerous for those most susceptible to foodborne pathogens: the very young, elderly, pregnant, and those who are immune-compromised.

We may never understand exactly how the young girls from Lynden and Portland became sick and died from presumably safe food. What we should learn from these tragic deaths is that all foods pose the threat of illness or even death and that young consumers are most at risk. Also, foodborne pathogens are spread not only by consuming contaminated food, but also through physical contact with pathogens. My son died from E. coli without ever having eaten a hamburger in his life. Hand washing and prevention of cross-contamination are important. If we as a country can keep this in mind and stay vigilant, together we can minimize the spread and the threat of foodborne pathogens. 

Tainted celery linked to Gonzales farm

An outbreak of E. coli in Minnesota has been linked to celery grown in Gonzales, but the attorney representing many of the sickened people said Thursday that he is not, yet, targeting the grower.

celery.potato.saladAccording to a recently released report by the Minnesota Department of Health, 57 people were sickened and nine were hospitalized. The victims were members of a band of the Lake Superior Chippewa called Fond du Lac. Fortunately, none of the victims developed a potentially deadly kidney condition common to the identified strain: E. coli O157:H7, according to documents obtained from the MDH.

MDH found that the most common food items were the celery and onions. Potato salad, which included celery and onions, was found to be tainted with E. coli O157:H7. Cases were also identified at events where potato salad was not served, but celery was. The celery was traced back to a field adjacent to a defunct dairy operation near Gonzales, according to the MDH.

MDH concluded that the common server at five Fond du Lac events – including an Elder picnic and a wedding ceremony – between July 1 and July 17 on the reservation was Jim-N-Joe’s Northland Katering. The catering business produced invoices showing the celery was purchased from Upper Lakes Foods Inc., which provided bills of lading from Pro*Act, a Vancouver produce distributor, and Salinas-based Mann Packing.

The two distributors worked together to identify the “field of interest,” and the celery was traced back to Martignoni Ranch block 5c outside of Gonzales. Aerial views of the field show it butting up against a dairy operation, which Bill Marler, the attorney for several of the victims, described as “defunct.”

But a call placed to the dairy, M and M Dairy Inc., and to Rocci Martignoni, who is listed as president of M and M, was not immediately returned Thursday. But inspectors for the California Department of Public Health took water and soil samples from the field and did not find the pathogen.

Michael Needham, chief of the Emergency Response Unit for the California Health Department, said Thursday that his understanding was that no E.coli was discovered on the farm, but added that his report is not yet complete.

Because there is no scientific smoking gun connecting the celery in the potato salad to the farm the celery was grown on, Marler said he is reluctant to file a lawsuit against Martignoni. He is, however, filing a lawsuit against the caterer.

“I don’t feel like I have enough evidence to bring a lawsuit against the celery grower,” Marler said Thursday from his Seattle office. “But that may change as discovery proceeds and new evidence surfaces.”

Was it the celery? 74 sickened with E. coli O157:H7 associated with Jim-N-Jo’s Northland Katering, Minnesota:, July 2014

Bill Marler has kindly made public the final health report regarding the E. coli O157:H7 outbreak that sickened at least 74 people attending a July picnic for Elders of the Fond du Lac Band of Lake Superior Chippewa, in Minnesota.

CeleryOn July 17, 2014, a physician called the Minnesota Department of Health (MOH) to report that five individuals had been treated in the emergency department at Community Memorial Hospital in Cloquet for bloody diarrhea. All five cases had reported attending a picnic for Elders of the Fond du Lac Band of Lake Superior Chippewa on July 11that was catered by Jim-N-Jo’s Northland Katering. The caterer is licensed by the University of Minnesota (UMN) and operated out of a kitchen located at the Cloquet Forestry Center. MOH Environmental Health (EH), UMN EH, Fond du Lac Human Services, and MOH Tribal Relations were notified and an investigation was initiated.

Methods

Cases were identified through routine laboratory surveillance and interviews with event attendees identified through contact information provided by event hosts. A case was defined as an individual who attended an event catered by Jim-N-Jo’s Northland Katering and subsequently developed diarrhea (3 loose stools in a 24- hour period) that was either bloody or at least 3 days in duration, or an individual who had E. coli 0157:H7 isolated from a stool culture with a pulsed-field gel electrophoresis (PFGE) pattern indistinguishable from or within 3 bands of the main outbreak pattern by at least 1enzyme (Xbal or Bin i ). All Shiga toxin-producing E. coli cases reported to MOH are interviewed about potential exposures, including food consumption, as part of routine enteric disease surveillance. Event attendees identified through event hosts were interviewed about food consumption at the event and illness history.

Stool samples from consenting patrons and food workers were submitted to the MDH Public Health Laboratory (PHL} for bacterial and viral testing.

A UMN sanitarian visited the catering facility on July 18 to evaluate food preparation and handling procedures, interview employees, collect food invoices, and gather contact information and menus for catered events.

The Minnesota Department of Agriculture (MDA) conducted traceback investigations of food items of interest to determine the source and possible routes of contamination of those items. MDA also collected samples of suspected products from the caterer for E. coli 0157:H7 testing by the MDA Laboratory. All E. coli 0157:H7 isolates recovered from food were forwarded to the MOH PHL for PFGE subtyping.

Results

A total of 199 individuals from seven catered events were interviewed. Of these, 74 (37%) reported recent gastrointestinal illness, including 57 (29%) who met the case definition. Seventeen individuals were excluded from analysis; 16 attendees reported i!!ness that did not met the case definition, and 1individual possibly represented a secondary infection to an ill household contact. The state of residence was reported as Minnesota for 48 cases, Wisconsin for 4, Alabama for 2, Illinois for 1, Indiana for 1, and Ohio for 1.

celeryThirty-seven (65%) of the cases were female; the median case age was 62 years (range, 4 to 85 years). All cases reported diarrhea, 55 {96%) cramps, 35 (61%) bloody stools, 21 (37%) vomiting, and 11(19%) fever. The median incubation for cases was 91 hours (range, 9 to 174 hours); the median duration of illness was 157 hours (range, 52 to 288 hours) for the 11cases who had recovered by the time of interview. Illness onset dates ranged from July 8 to July 23. Twenty-one {37%) cases sought medical care at a clinic, 18 (32%) were seen at an emergency department, and 9 (16%) were hospitalized. Hospitalizations ranged from 2 to 6 days. !’Jo cases were diagnosed with hemolytic uremic syndrome or died.

Twenty-seven laboratory-confirmed cases representing three different catered events were identified, including seven ill individuals who originally tested negative for Shiga toxin by Meridian lmmunoCard STAT! EHEC at a clinical laboratory. Multiple closely related Xbal and Bin i patterns were observed among attendees of each event. Nineteen (70%) isolates were indistinguishable by Xbal from the subtype designated EXHXOl.0238 by the Centers for Disease Control and Prevention (CDC) (Minnesota pattern designation MN1393), five (19%) isolates were designated as EXHXOl.0074 (Minnesota pattern designation WAl), and one isolate each was designated as EXHXOl.0696, EXHXOl.0344, and EXHXOl.0248. Each of these patterns was two or fewer bands different from the main pattern Xbal with the exception of EXHXOl.0344, which was four bands different from the main pattern and two bands different from WAl. By Bini, 20 (74%) isolates were designated as EXHA26.1045, 6 (22%) isolates were designated as EXHA26.0621, and 1isolate was designated as EXHA26.1577.

During the initial follow-up with the Fond du Lac Band, it was discovered that many of the attendees of the Elder Picnic also might have had attended a Veteran’s powwow held July 12-13 on the reservation. The food for this event was provided by several licensed operators, but did not include Jim-N-Jo’s Northland Katering. The powwow was ruled out as the source of illness because only two ill individuals reported only attending the Veteran’s powwow. All other attendees of the powwow also attended an event catered by Jim-N-Jo’s.

Jim-N-Jo’s catered at least 12 events from July 5 to July 17. Menus and contact information for attendees were available for six events. Illness that met the case definition was identified at four of these events (July 11, picnic on the Fond du Lac Reservation; July 12, wedding; July 14-16, 3-day conference for a private company; and July 16, focus group on the Fond du Lac Reservation), and an additional case was identified through routine surveillance that attended an event hosted by Carlton County on July 17 that was also catered by Jim-N-Jo’s.

Of the 199 individuals interviewed, 122 (61%) attended the picnic on July 11; among these, 43 (35%) cases were identified. One culture-confirmed case reported onset of illness on July 8 before attending the picnic and could not recall attending any other catered events. However, the case did report taking part in other activities sponsored by the tribe that may have been catered by Jim-N-Jo’s . The food served at the picnic inciuded hamburgers, hot dogs, brats, chicken breasts, buns, condiments,onion, lettuce, tomato, cheese slices, sauerkraut, baked beans, potato salad, fruit salad (watermelon, cantaloupe, pineapple, honeydew, and strawberries), corn, chips, cookies, and packaged beverages. In the univariate analysis including attendees of the picnic, consumption of potato salad (37 of 38 cases vs. 44 of 66 controls; odds ratio [OR], 18.5; 95% confidence interval [Cl], 2.4 to 143.9; p < 0.001) was associated with illness.

Twenty-two of the individuals interviewed attended the focus group on Ju!y 16; two (9%) met the case definition (both were culture-confirmed). Of these, one case also attended the Elder picnic and reported onset of illness before the focus group. The menu for the focus group included a build-your-own salad buffet with several types of cut leafy greens, chicken, numerous vegetable toppings, bread and butter, strawberries, cookies, and water. Fresh celery and onions were available as vegetable toppings.

The wedding on July 12 was attended by approximately 300 people. Only a partial list of wedding attendees was provided. Of the 20 people interviewed, 9 (45%) met the case definition (including 5 cases who were culture­ confirmed). The menu for the wedding included pulled pork sandwiches, buns, cheese, onions, fruit salad (watermelon, cantaloupe, pineapple, honeydew and strawberries), vegetable tray (carrots, celery, broccoli, and cauliflower), dill dip, ranch dip, cheesy potatoes, baked beans, corn, packaged beverages, and cupcakes not provided by the caterer. Among wedding guests, no food was statistically associated with illness. However, consumption of celery sticks (5 of 9 cases vs. 2 of 8 controls; OR, 3.75; 95% Cl, 0.5 to 29.8; p = 0.33), and cantaloupe (6 of 8 cases vs. 3 of 7 controls; OR, 4.0; 95% Cl, 0.4 to 35.8; p = 0.31) had elevated odds ratios. The original menu provided to MOH did not include chopped onions that were available as a sandwich garnish. Five of nine cases were re-inten1iewed about onion consumption; no cases reported consuming onions at the event.

Twelve of the 21 people who attended the 3-day conference (July 14-16) were interviewed; three cases were identified. Lunch was served each day (July 14: pulled pork sandwiches, cheese, onions, potato salad, fruit salad, and cookies; July 15: salad, wild rice, red potatoes, beef tips, grapes, bread, and cookies; and July 16: chicken wild rice soup, make-your-own sandwich buffet, cookies, and banana bread). The small number of cases and controls precluded a meaningful statistical analysis among conference attendees.

No list of attendees was provided for the meeting held on July 17. One case was identified through routine surveillance who attended the event. The case reported eating ham, turkey, sausage, lettuce, tomato, cucumber, potato salad, strawberries, and a cookie.

Raw celery and onions were the only food items served at all five events with identified cases. Three events (picnic, 3-day conference, and meeting) were served the same batch of potato salad that contained raw celery and onions. The celery was also served as part of a vegetable tray at the wedding and a chopped garnish on the salad bar for the focus group. Chopped onions were also available at all events. In the univariate analysis including all events, consumption of celery (46 of 52 cases vs. 55 of 95 controls; OR, 5.6; 95% Cl, 2.2 to 14.3; p <0.001) was significantly associated with illness, and onions (42 of 51 cases vs. 61of 90 controls; OR, 2.2; 95% Cl, 1.0 to 5.2; p = 0.08) approached a statistically significant association with illness. In a multivariate model, only consumption of celery (adjusted OR, 10.1;p = 0.004) was significantly associated with illness.

UMN sanitarians visited the catering kitchen on July 18. All five employees were interviewed. One employee reported onset of diarrhea on July 14 and recovery on July 16 and worked while ill during July 15-16. A stool specimen submitted by the employee was positive for E. coli 0157:H7 with the main outbreak PFGE pattern. The employee reported sampling or tasting food during preparation.

Ingredients and preparation procedures for menu items were reviewed. The sanitarian noted inconsistent glove use and issues with date marking. No improper practices or procedures were noted with regard to cooking, cooling, or cross-contamination. The ingredients for the potato salad that was served at the picnic, 3-day conference, and meeting were prepared over a 3 day period. On July 7, the potatoes were boiled and cooled; on

July 8, celery and onions were washed and cut; and on July 9, potatoes were peeled and cut, and potato salad ingredients (potatoes, celery, onions, hard boiled eggs, mayonnaise, mustard, dried dill, sugar, pickle juice, vinegar, salt, pepper, and commercially prepared potato salad) were assembled and mixed separately into four 5-gallon bins. The celery that was served at the wedding was cut into sticks on July 10, stored in water, and added to the vegetable tray on July 12. The celery that was served at the focus group was chopped sometime during July 7-15 and stored in water before the event.

On July 21, an MDA inspector picked up leftover food from the caterer that was served at the implicated events, including potato salad, strawberries, honeydew, pineapple, and cantaloupe . The potato salad was positive for E. coli O157:H7; all other food samples were negative. Multiple PFGE subtypes were isolated from the potato salad, including the two main patterns isolated from the cases and two other closely related patterns that were not found among the case isolates. Additionally, on July 28, leftover celery and onions from the same shipment as what had been served in the potato salad, at the wedding, and the focus group were collected from the caterer and tested. Both products were negative.

The caterer ordered all fresh produce from Upper Lakes Foods, Inc. The celery that was served at all of the events was received by the caterer on June 25 in a case of 24 heads. MDA worked with Pro*Act distributing and Mann Packing to identify the field in California where the celery was grown as Martignoni Ranch block Sc. The California Department of Public Health {CDPH) was notified of the outbreak and traceback investigation and was able to confirm that the field was owned by Costa Farms and harvested by Mann Packing. The field is adjacent to a defunct dairy operation north of Gonzales, California in the Salinas Valley. CDPH notified the California Food Emergency Response Team {CalFERT) which conducted an inspection of the field and collected five water and soil samples on August 13. No potential cross-contamination issues or positive environmental samples were detected. The inspectors reported that grazing cattle are occasionally present in the adjacent field, but were not in sight at the time of inspection.

Nationally, one additional E. coli O157:H7 case with an isolate that was indistinguishable by PFGE was identified in Indiana. The case reported onset of illness on July 2 and no travel to Minnesota. No connection was found to the Minnesota outbreak.

Conclusions

This was a foodborne outbreak of E. coli O157:H7 infections associated with multiple events catered by Jim-N­ Jo’s Katering. Cases were associated with five events that took place from July 11to July 17. Potato salad served at three events was found to be contaminated with E. coli 0157:H7 that was indistinguishable from case isolates by PFGE. Cases were also identified at two additional events that did not serve the potato salad, but served celery that was from the same shipment as the celery in the potato salad. Contaminated celery that was served in some form at all five events was the most likely vehicle of transmission. The source of contamination was not identified, but sampling in the field was limited. It is still plausible that celery could have become contaminated during production.

Benefit dinner to help Oklahoma family of child recovering from E. coli

Laura Harris said the community support she has felt since her son became ill has been overwhelming.

Jase Harris“It brings you to tears to see how generous they are,” Harris said. “It makes you appreciate coming from a small town.”

Two-year-old Jase Harris recently spent 10 days in Saint Francis Children’s Hospital in Tulsa where he was diagnosed with hemolytic uremic syndrome (HUS). Eight of those days Jase spent in the intensive care unit.

A benefit dinner for Jase and his family will take place from 5 to 8 p.m. today at the Wagoner Show Barn, across from Maple Park.

Those who would like attend are asked to contribute a financial donation of any amount. Beans or spaghetti will be served along with a drink and dessert.