Category Archives: E. coli

It’s also a hockey blog

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The Maple Leafs are the unofficial team of barfblog. With both Doug and I from the Toronto area we’ve followed their play from the hockey hotbeds of Brisbane and Raleigh and email each other (along with Leaf’s fan and friend of the blog Steve Naylor) during a lot of games.
Last night there were a few exchanges.

The best of which was from Doug, ‘You should know by now, once the Leafs show up, they’ll disappoint.’ That’s what happens when the team hasn’t won a cup in 51 years.

It’s fun to watch a game that I’m emotionally invested in.

It’s not as much fun when my team loses.

Oh well. Training camp for next season starts in September. The trip to the Yonge St. parade will have to wait another year.

84 now sick with E. coli O157:H7 linked to romaine lettuce

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According to the U.S. Centers for Disease Control, 31 more ill people from 10 states were added to this investigation since the last update on April 18, 2018.

Three more states have reported ill people: Colorado, Georgia, and South Dakota.

The most recent illness started on April 12, 2018. Illnesses that occurred in the last two to three weeks might not yet be reported because of the time between when a person becomes ill with E. coli and when the illness is reported to CDC.

Information collected to date indicates that romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.

The investigation has not identified a common grower, supplier, distributor, or brand of romaine lettuce.

Do not eat or buy romaine lettuce unless you can confirm it is not from the Yuma, Arizona, growing region.

Product labels often do not identify growing regions; so, do not eat or buy romaine lettuce if you do not know where it was grown.

This advice includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce. If you do not know if the lettuce in a salad mix is romaine, do not eat it.

Do not serve or sell any romaine lettuce from the Yuma, Arizona growing region. This includes whole heads and hearts of romaine, chopped romaine, and salads and salad mixes containing romaine lettuce.

Restaurants and retailers should ask their suppliers about the source of their romaine lettuce.

CDC, public health and regulatory officials in several states, and the U.S. Food and Drug Administration are investigating a multistate outbreak of Shiga toxin-producing Escherichia coliO157:H7 (E. coli O157:H7) infections.

Eighty-four people infected with the outbreak strain of E. coli O157:H7 have been reported from 19 states.

Forty-two people have been hospitalized, including nine people who have developed a type of kidney failure called hemolytic uremic syndrome.

No deaths have been reported.

A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

The silence from the leafy greens lobby is deafening: A tale of two women with E. coli

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A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

Maggie Menditto, the executive administrator of the McDowell Foundation for social justice, writes in the New York Times that before my illness, I was a healthy 22-year-old just out of college. But at some point, my doctors speculated, I must have eaten leafy greens contaminated by E. coli bacteria.

My mother had driven me to my local emergency room in the middle of the night after several days of unbearable abdominal cramps and a startling amount of blood coming out of new and terrifying places. The doctor on call thought it was probably just a bad case of colitis.

As the sun began to rise, I was asked if I’d like to go home and take Imodium or if I’d like to stay in the hospital. Given the severity of my pain, I was surprised that I was even given a choice. I allowed myself to be wheeled upstairs with a needle in my vein administering a steady stream of antibiotics, a common treatment for colitis.

But that weekend, I took a turn for the worse, throwing up every hour until there was nothing left in my system but sticky green bile. An infectious disease doctor was called in, my stool sample tested, and I was finally given a diagnosis of E. coli infection.

Doctors don’t know for sure how I became infected with E. coli — at the time, last October, the outbreak tied to romaine lettuce was still several months in the future — but we do have some clues. I’m a vegetarian, so we know it didn’t come from eating meat. Although none of my family members got sick, my father also tested positive for E. coli. The only food we remembered sharing was a batch of arugula from a local farmers’ market about five days before I became ill, making it the most likely culprit.

The antibiotics were immediately stopped, as they have been linked to an increased likelihood of developing dangerous complications from the bacterial infection. But by then the signs were already beginning to show. My platelet count was dropping at a dangerous rate, my kidney function had begun to falter. I had developed hemolytic uremic syndrome, a life-threatening complication of E. coli infection.

I was treated to the first ambulance ride of my life to transfer to Georgetown University Hospital, where I would remain hospitalized for the next 33 days.

In the critical care unit, I was strapped into several machines that would monitor my vitals. The next morning, a doctor came in and inserted a temporary access catheter into the right side of my neck. I was wheeled down to a lower level of the hospital for the first of my six plasmapheresis treatments, a particularly draining experience in which blood was removed, cleaned and then returned to my body via a large tube in my neck.

A team of hematologists, nephrologists, infectious disease specialists and a general physician visited every morning. They’d ask, “How are you feeling, Frances?”

Everyone knows me as Maggie, but in an annoying quirk of my hospitalization, my medical records and wristband all bear my legal name, Frances. “One name for each grandmother,” my mom reasoned when my parents decided to christen me Frances Margaret. An unintended consequence of their thoughtfulness is that I have spent much of my life correcting people who called me Frances. “It’s Maggie, short for Margaret, my middle name,” I said.

But in the hospital, it helped to have a second persona. Frances put on a brave face during the hours of treatment in sterilized facilities, while Maggie drew inward, refusing books and music or anything else that reminded me of who I was outside the hospital walls. From where I sat, pinned to machines by the needles in my veins, in a body I hardly recognized, and with a label on my wrist displaying a name that wasn’t mine, I couldn’t be sure that it was me this was really happening to. I listened patiently as doctors and nurses and technicians came into my room to offer Frances their well wishes, draw blood, or discuss what medications she should take or what procedures might make her body strong once more.

During my first week of hospitalization, the kidney doctors debated whether to begin the dialysis process, sticking to the typical “wait-and-see” approach. But by the end of the week there was no question. I had gained 30 pounds from all the excess fluid and could hardly stand up and walk on my own. I began my first of many three-hour-long dialysis treatments, where they siphoned off the liquid, doing the work of my kidneys that I had so long taken for granted.

I had mostly avoided social media since getting sick, but one day, I logged onto Facebook to see that across the country, people I knew and people I didn’t — a pair of girls I once babysat for, a football team in Rhode Island — were praying for Maggie, hoping Maggie pulled through. The more people that worried about me, the sicker I must be, I thought.

The dialysis continued for three weeks with tiny but measurable results. My platelet counts began to climb, and I started to pee again. But it wasn’t enough to impress the nephrologists, who decided to surgically place a catheter in my chest, to both drain and administer fluids.

Doctors began discussing a kidney transplant and temporary home-care dialysis training. I was sent home for a weekend to rest up before my first training for an eventual dialysis machine to be brought to my parents’ house, but we didn’t get that far. I went to bed after dinner and woke up in an ambulance racing back to the hospital I had just left. My blood pressure had begun a dangerous rise as my kidneys began to start working again, and I had the first of three seizures that night.

The next few days are mostly lost from memory, but some hazy images survive. Waking up in a tube to discover I was getting an M.R.I. A nurse delicately pulling glue from my hair from where the technicians had inserted sensors. My hospital bed being wheeled out of the operating room after the catheter was removed from inside my chest. The sharp lines of the white hallway walls, every corner offering a shadowy descent into someone else’s hospital story.

Through my half-closed lids, I see a rare pocket of sunlight at the end of the corridor. Briefly I feel the warmth of its gaze as we trek on through the seemingly endless maze of the hospital’s hallways and locked doors. The dryness in my mouth is the first clue that I’m back in my body, that my kidneys have begun to heal themselves at an admirable pace.

My mom finds me soon after, as I’m attempting to drink water from a clear plastic straw. She reaches out and holds it in place. The nurse comes in to tell us that it all went well, that Frances’s vitals look good, that we’ll be ready to transfer her back upstairs soon.

“She goes by Maggie,” my mom says.

“Oh, I’m sorry,” the nurse says, glancing down at her chart before stepping back into the hall, “Maggie.”

I turn to smile at my mom. It doesn’t matter what they call me anymore. She holds my hand as we’re guided back upstairs to my hospital room for the last time.

Sometimes now, in my apartment, on the train, while walking down a crowded street, I like to run my fingers over the fresh scars lining my collarbone. Now that the toxins have left my system, now that my body has built itself back up, I have only the scars to remind me that Frances was tested, that Maggie survived. That it really happened to me.

Altoona, Penn. Area High School student Mia Zlupko was shocked when doctors told her some scary news.

“All the doctors came in, and it was kind of like a big surprise like ‘It’s E. coli,'” Mia said.

The 16-year-old is a dancer who enjoys eating healthy. It’s not uncommon for her to grab a salad from the store, which is exactly what she did earlier this month. However, after eating it she became sick and was throwing up with abdominal pain.

“It was a scary process and I wouldn’t want to go through it again,” she said. “I know everyone else wouldn’t want to go through it.”

After four days in the hospital no one could figure out what exactly was wrong.

Just as Mia was heading home she learned her diagnosis. A relief for her mom Tina.

“Had we not gone back to the doctor and then gone to the emergency room, she could have gotten much sicker very quickly,” Tina Zlupko explained.

Now the teen is hoping to share an important message with others so no one else has to go through what she did.

“I’m definitely more aware and I want other people to be aware about it,” Mia said.

The CDC advisory now includes chopped and bagged romaine lettuce, as well as whole heads and hearts of romaine lettuce.

So far at least 64 people have been infected in 16 states. Pennsylvania is one place that has been hit the hardest with at least 12 people infected.

Officials think the outbreak is coming from Yuma, Arizona. They warn people not to eat any romaine lettuce unless you know where it’s from.

Always use a thermometer: 244 sickened by shiga toxin-producing E. coli at US Marine training base

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In Nov. 2017, over 200 U.S. Marines-in-training were sickened by shiga-toxin producing E. coli at Marine Corps Recruit Depot San Diego and Camp Pendleton.

That outbreak was blamed on undercooked beef prepared by a civilian contractor, according to the results of an investigation.

First rule of public health (substitute military or any other organization): make public health look good.

According to Healio, the outbreak occurred in October and November among newly enlisted men at Marine Corps Recruit Depot, San Diego, and Camp Pendleton, a nearby base where recruits conduct weapons and field training, according to Amelia A. Keaton, MD, MS, EIS officer in the CDC’s Outbreak Response and Prevention Branch.

The outbreak involved Shiga toxin-producing E coli (STEC) — a major cause of foodborne illness in the United States each year and the pathogen responsible for the current multistate outbreak of E. coli linked to romaine lettuce. In all, 244 male recruits are suspected of being sickened, including 15 who developed a life-threatening complication of STEC infections called hemolytic uremic syndrome (HUS). Among those who developed HUS, six were deemed critically ill but none died, Keaton told Infectious Disease News during the CDC’s annual EIS conference.

She said the outbreak presented several challenges for investigators and highlighted some unique risk factors among military trainees living in close quarters.

“Nobody on our team had a military background, so we first wanted to understand what their training environment is like,” Keaton said. “Do they have any unique exposures that people in the general public don’t have? We wanted to get a sense of what day-to-day life was like for these guys and what risk factors for infection they were exposed to.”

Keaton and colleagues interviewed 43 case patients and 135 healthy controls, plus Marine officers, food workers and staff. They observed food preparation practices and studied recruit sleeping quarters, bathroom facilities and cafeterias where meals were served to around 2,000 to 3,000 recruits at a time, Keaton said.

Although they were unable to directly test any meat, through interviews investigators found that ill recruits were 2.4 times likelier to report consuming undercooked beef than healthy controls. Moreover, Keaton said investigators directly observed beef being undercooked.

According to Keaton, most dining facilities on military bases are run by civilian contractors, including the facilities involved in this outbreak, which offered the same menu prepared by the same company. The Navy is in charge of inspecting such facilities once a month, she said.

“A lot of people reported eating meals that were visibly undercooked,” Keaton said. “When we observed food preparation, we saw that food workers were cooking a large number of hamburger patties and a large number of meals. Because such a large number of meals are being prepared, they’re only able to check foods intermittently with a meat thermometer. In some instances, we saw there were temperature abuses where they weren’t necessarily cooking to temperatures recommended by California state law.”

All the news just repeats itself: Leafy greens in public

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In October, 1996, a 16-month-old Denver girl drank Smoothie juice manufactured by Odwalla Inc. of Half Moon Bay, California. She died several weeks later; 64 others became ill in several western U.S. states and British Columbia after drinking the same juices, which contained unpasteurized apple cider — and E. coli O157:H7. Investigators believed that some of the apples used to make the cider might have been insufficiently washed after falling to the ground and coming into contact with deer feces (Powell and Leiss, 1997) not that washing would do much.

Almost 10 years later, on Sept. 14, 2006, the U.S. Food and Drug Administration announced that an outbreak of E. coli O157: H7 had killed a 77-year-old woman and sickened 49 others (United States Food and Drug Administration, 2006). The outbreak ultimately killed four and sickened at least 200 across the U.S. This was documented-outbreak 29 linked to leafy greens, but also apparently the tipping point for growers to finally get religion about commodity-wide food safety, following the way of their farmer friends in California, 10 years later.

In the decade between these two watershed outbreaks, almost 500 outbreaks of foodborne illness involving fresh produce were documented, publicized and led to some changes within the industry, yet what author Malcolm Gladwell would call a tipping point — “a point at which a slow gradual change becomes irreversible and then proceeds with gathering pace” — in public awareness about produce-associated risks) did not happen until the spinach E. coli O157:H7 outbreak in the fall of 2006. At what point did sufficient evidence exist to compel the fresh produce industry to embrace the kind of change the sector has heralded since 2007? And at what point will future evidence be deemed sufficient to initiate change within an industry?

The 1993 outbreak of E. coli O157:H7 associated with undercooked hamburgers at the Jack-in-the-Box fast food chain propelled microbial food safety to the forefront of public awareness, at least in the U.S. (Powell and Leiss, 1997). In 1996, following extensive public and political discussions about microbial food safety in meat, the focus shifted to fresh fruits and vegetables, following an outbreak of Cyclospora cayetanesis ultimately linked to Guatemalan raspberries that sickened 1,465 in 21 U.S. states and two Canadian provinces (U.S. Centers for Disease Control and Prevention, 1997). That same year, Beuchat (1996) published a review on pathogenic microorganisms in fresh fruits and vegetables and identified numerous pathways of contamination.

By 1997, researchers at CDC were stating that pathogens could contaminate at any point along the fresh produce food chain — at the farm, processing plant, transportation vehicle, retail store or foodservice operation and the home — and that by understanding where potential problems existed, it was possible to develop strategies to reduce risks of contamination (Tauxe et al., 1997). Researchers also reported that the use of pathogen-free water for washing would minimize risk of contamination (Suslow, 1997; Beuchat, 1998).

Beuchat and Ryu (1997) reported in a review that sources of pathogenic microorganisms for produce included:

Preharvest

  • Feces
  • Soil
  • Irrigation water
  • Water used to apply fungicides, insecticides
  • Green or inadequately composted manure
  • Air (dust)
  • Wild and domestic animals (including fowl and reptiles)
  • Insects
  • Human handling

Postharvest

  • Feces
  • Human handling (workers, consumers)
  • Harvesting equipment
  • Transport containers (field to packing shed)
  • Wild and domestic animals (including fowl and reptiles)
  • Insects
  • Air (dust)
  • Wash and rinse water
  • Sorting, packing, cutting, and further processing equipment
  • Ice
  • Transport vehicles
  • Improper storage (temperature, physical environment)
  • Improper packaging (including new packaging technologies)
  • Cross-contamination (other foods in storage, preparation, and display areas)
  • Improper display temperature.

kFresh fruits and vegetables were identified as the source of several outbreaks of foodborne illness in the early 1990s, especially leafy greens (Table 1).

Date Product Pathogen Cases Setting/dish State
Apr-92 Lettuce S. enteriditis 12 Salad VT
Jan-93 Lettuce S. Heidelberg 18 Restaurant MN
Jul-93 Lettuce Norovirus 285 Restaurant IL
Aug-93 Salad E. coli O157:H7 53 Salad Bar WA
Jul-93 Salad E. coli O157:H7 10 Unknown WA
Sep-94 Salad E. coli O157:H7 26 School TX
Jul-95 Lettuce E. coli O153:H48 74 Lettuce MT
Sep-95 Lettuce E. coli O153:H47 30 Scout Camp ME
Sep-95 Salad E. coli O157:H7 20 Ceasar Salad ID
Oct-95 Lettuce E. coli O153:H46 11 Salad OH
May-96 Lettuce E. coli O157:H10 61 Mesclun Mix ML
Jun-96 Lettuce E. coli O153:H49 7 Mesclun Mix NY

Outbreaks of foodborne illness related to leafy greens, 1992-1996.

Dave Gombas told an International Association for Food Protection symposium on leafy green safety on Oct. 6, 2006 in Washington, D.C. that if growers did everything they were supposed to do — in the form of good agricultural practices — and it was verified, there may be fewer outbreaks. He then said government needs to spend a lot more on research.

Wow. The same person who has vacillated between the Produce Marketing Association and the U.S. Food and Drug Administration for the past couple of decades (all you critics who complain about folks jumping back-and-forth-and-back as part of a genetically-engineered conspiracy may want to look at the all-natural, all-good-for-ya produce sector) pronounced on grower verification in which nothing has been done.

Since we were on the same panel in Washington, in 2006, I asked Gombas, why is the industry calling for more investment in research about the alleged unknowns of microbial contamination of produce when the real issue seems to be on-farm delivery and verification? Hiding behind the unknown is easy, working on verifying what is being done is much harder.

More calls for research.

Nothing on human behavior in a fresh produce environment.

It’s just another case of saying the right things in public, but failing to acknowledge what happens on individual farms. Verification is tough. Auditing may not work, because many of these outbreaks happened on third -party audited operations. Putting growers in a classroom doesn’t work, and there’s no evidence that begging for government oversight yields a product that results in fewer sick people.

In 1999, several more outbreaks of Shiga-toxin producing E. coli (STEC) were linked to leafy greens (Table 2), and the U.S. group, the United Fresh Fruit and Vegetable Association, developed and published HACCP-based food safety guidelines for industry (United Fresh Fruit and Vegetable Association, 1999).

Date Product Pathogen Cases Setting/dish State
Feb-99 Lettuce E. coli O157:H9 65 Restaurant NE
Jun-99 Salad E. coli O111:H8 58 Texas Camp TX
Sep-99 Lettuce E. coli O157:H11 6 Iceberg WA
Oct-99 Lettuce E. coli O157:H7 40 Nursing Home PA
Oct-99 Lettuce E. coli O157:H7 47 Restaurant OH
Oct-99 Salad E. coli O157:H7 5 Restaurant OR

Table 2. 1999 U.S. outbreaks of STEC linked to leafy greens

By 2000, Rafferty and colleagues demonstrated that E. coli could spread on-farm in plant production cuttings from one contaminated source, magnifying an outbreak to a whole farm (Rafferty et al., 2000). A 2001 outbreak of Shigella flexneri (886 ill) in tomatoes further focused public and scientific attention onto fresh produce.

Solomon and colleagues (2002a) discovered that the transmission of E. coli O157:H7 to lettuce was possible through both spray and drip irrigation. They also found that the pathogen persisted on the plants for 20 days following application and submerging the lettuce in a solution of 200ppm chlorine did not eliminate all viable E.coli O157:H7 cells, suggesting that irrigation water of unknown microbial quality should be avoided in lettuce production (Solomon et al., 2002a). In a follow-up experiment, Solomon and colleagues (2002b) explored the transmission of E. coli O157:H7 from manure-contaminated soil and irrigation water to lettuce plants. The researchers recovered viable cells from the inner tissues of the lettuce plants and found that the cells migrated to internal locations in plant tissue and were thus protected from the action of sanitizing agents. These experiments demonstrated that E. coli O157:H7 could enter the lettuce plant through the root system and migrate throughout the edible portion of the plant (Solomon et al., 2002b). Such results were widely reported in general media.

During this time, several outbreaks of E. coli were again linked to lettuce and salad (Table 3).

Date Product Pathogen Cases Setting/dish State
Oct-00 Salad E. coli O157:H7 6 Deli IN
Nov-01 Lettuce E. coli O157:H7 20 Restaurant TX
Jul-02 Lettuce E. coli O157:H8 55 Bagged, Tossed WA
Nov-02 Lettuce E. coli O157:H7 13 Restaurant IL
Dec-02 Lettuce E. coli O157:H7 3 Restaurant MN

Table 3: Leafy green outbreaks of STEC, 2000 — 2002.

 In 2003, according to Mexican growers, the market impact of an outbreak of hepatitis A traced to exported green onions lasted up to 4 months while prices fell 72 per cent (Calvin et al., 2004). Roma tomatoes were identified as the source of a salmonellosis outbreak that resulted in over 560 cases in both Canada and the US (CDC 2005).

During 2003-2005, several additional outbreaks of E. coli O157:H7 were linked to fresh leafy greens, including one multi-state outbreak involving Dole bagged lettuce (Table 4). 

Date Product Pathogen Cases Setting/dish State
Sep-03 Lettuce E. coli O157:H7 51 Restaurant CA
Nov-03 Spinach E. coli O157:H7 16 Nursing Home CA
Nov-04 Lettuce E. coli O157:H7 6 Restaurant NJ
Sep-05 Lettuce E. coli O157:H7 11 Dole, bagged Multiple

Table 4: Leafy green STEC outbreaks, 2003 — 2005.

During 2005–2006, four large multistate outbreaks of Salmonella infections associated with eating raw tomatoes at restaurants occurred in the U.S., resulting in 459 culture-confirmed cases of salmonellosis in 21 states. Investigations determined that the tomatoes had been supplied to restaurants either whole or precut from tomato fields in Florida, Ohio, and Virginia (CDC, 2006).

Allwood and colleagues (2004) examined 40 items of fresh produce taken from a retail setting in the U.S. that had been preprocessed (including cut, shredded, chopped or peeled) at or before the point of purchase. They found fecal contamination indicators (E. coli, F-specific coliphages, and noroviruses) were present in 48 per cent of samples.

 Researchers in Minnesota conducted a small-scale comparative study of organic versus conventionally grown produce. They found that while all samples were virtually free of pathogens, E. coli was 19 times more prevalent on produce acquired from the organic farms (Mukherjee et al., 2004). They estimated that this was due to the common use of manure aged for less than a year. Use of cattle manure was found to be of higher risk as E. coli was found 2.4 times more often on farms using it than other animal manures (Mukherjee et al., 2004).

On Sept. 14, 2006, the U.S. Food and Drug Administration (2006) issued a public statement warning against the consumption of bagged fresh spinach.

“Given the severity of this illness and the seriousness of the outbreak,” stated Dr. Robert Brackett, Director of FDA’s Center for Food Safety and Applied Nutrition (CFSAN), “FDA believes that a warning to consumers is needed (United States Food and Drug Administration, 2006).”

That is no different from the sometimes conflicting messages coming from FDA today about the E. coli O157:H7 outbreak on lettuce that originated in Yuma, Arizona: these public health folks are figuring it out on the go.

Sean Rossman of USA Today reports today that in the current E. coli O157:H7 outbreak linked to Yuma lettuce, 70% of those who’ve gotten sick are female.

Similarly, when leafy greens were the culprit of an E. coli outbreak last year, 67% of those infected were women or girls. In 2016, females were 73% of those ill from an outbreak in alfalfa sprouts, notes the U.S. Centers for Disease Control and Prevention.

Here are some suggestions:

  • The first line of defense is the farm, not the consumer.
  • All ruminants — cows, sheep, goats, deer — can carry dangerous E. coli like the O157:H7 strain that sickened people in the spinach outbreak, as well as the Taco Bell and Taco Johns outbreaks ultimately traced to lettuce.
  • Any commodity is only as good as its worst grower.

We’ve had a few peer-reviewed thoughts on these topics:

Powell, D.A. and Chapman, B. 2007. Fresh threat: what’s lurking in your salad bowl?. Journal of the Science of Food and Agriculture. 87: 1799-1801.

Implementing On-Farm Food Safety Programs in Fruit and Vegetable Cultivation, Improving the Safety of Fresh Fruit and Vegetables

Luedtke, A., Chapman, B. and Powell, D.A. 2003. Implementation and analysis of an on-farm food safety program for the production of greenhouse vegetables. Journal of Food Protection. 66:485-489.

Powell, D.A., Bobadilla-Ruiz, M., Whitfield, A. Griffiths, M.G.. and Luedtke, A. 2002. Development, implementation and analysis of an on-farm food safety program for the production of greenhouse vegetables in Ontario, Canada. Journal of Food Protection. 65: 918- 923.

A listing of 78 outbreaks linked to leafy greens since 1995 is posted here.

Risk is not low if cause is not known: 5, then 19, now 34 sick and 1 dead sick in E. coli outbreak linked to Edmonton restaurant

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If the E. coli-romaine lettuce made it to an Alaskan prison, maybe it made it to an Edmonton restaurant.

Just asking.

According to the Toronto Star, one person has died and more than 30 people have fallen ill following an E. coli outbreak that Alberta Health Services has called “extremely complex” to investigate.

In a statement, AHS says it has expanded its investigation into the source of an outbreak of E. coli, beyond cases directly linked to an Edmonton restaurant late last month.

While 21 of these lab-confirmed cases are linked to Mama Nita’s Binalot restaurant in Edmonton, AHS no longer has public health concerns related to the restaurant.

The number of lab-confirmed cases of E. coli has increased to 34, including 11 patients who have needed hospital care, and one patient who has died likely due to E. coli infection.

“This outbreak is extremely complex, however AHS, in partnership with other provincial and federal agencies, is doing all we can to protect the health of Albertans,” said Dr. Chris Sikora, a medical officer of health in the Edmonton zone, in a statement. “The risk of illness remains very low.”

AHS has not yet identified the source of these cases, but believes they are linked to the initial outbreak.

The risk is not low if the cause is not known.

AHS has worked closely with the owners of Mama Nita’s Binalot since it was identified that a cluster of people with lab-confirmed E. coli ate at the restaurant. AHS says the owners have taken significant steps to manage this issue, including voluntarily closing until AHS was confident the restaurant could reopen without presenting a risk to the public.

Flour power: Raw is risky

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When I was a kid, I had this multi-colored swim towel that stated Flower Power (right, not exactly as shown).

I should have known that if a 1960s slogan had been co-opted by towel manufacturers in the early 1970s, it was a sign of corporate greed rather than earth-tone sentiment.

For the past decade, raw flour has increasingly come under the food safety microscope.

Flour was suspect in a 2008 outbreak of Salmonella in New Zealand. In June, 2009, an outbreak of shiga-toxin producing E. coli (primarily O157:H7) in Nestle Toll House cookie dough sickened at least 77 people in 30 American states. Thirty-five people were hospitalized – from flour in the cookie dough.

Hemp seed flour sickened 15 Germans in 2010.

There was the U.S. General Mills outbreak of 2016 which sickened at least 56 people with the outbreak strain of E. coli O121 and O26, followed by a separate outbreak of E. coli O121 in Robin Hood flour in Canada in late 2016 going into 2017, that sickened at least 29.

It’s this latter outbreak that has journalist Jim Romahn’s attention.

Romahn writes the release of 759 pages of mostly e-mails indicates there was a massive effort involved in a recall of flour milled in Saskatoon that was contaminated with E. coli O121.

Twenty-two Canadians were identified as sickened by the flour, including one key case where the person consumed raw dough.

With hindsight, health officials were able to determine the first person sickened was Nov. 13, 2016. The others sickened and linked to the flour were between then and Feb. 26, 2017.

Robin Hood flour was identified as the source in March and on March 26 the Canadian Food Inspection Agency began a recall that eventually grew to scores of brand-name products across Canada and even an export shipment to Guyana.

The recall involved a number of major companies, such as Smucker Foods of Toronto and the Sobeys supermarket chain.

There were some unusual difficulties, including the challenge of contacting Mennonites who have no telephones.

The investigation and lab results eventually traced the source to flour milled at Ardent’s Saskatoon plant on Oct. 15, 16 and 17.

A high percentage of packages of flour milled on those dates turned up with E. coli O121.

But even then it’s not clear where the wheat originated.

Ardent Mills said it was probably spring wheat, but it could have also contained soft wheat, and that it probably was from the 2016 harvest, but might have had some wheat from the 2015 harvest.

That’s reflective of the amount of blending that happens both with the wheat used in milling and the flours that are blended into products for sale.

The documents were released under Access to Information at the request of a woman who spent time in a hospital in Medicine Hat, Alta.

 An Outbreak of Shiga Toxin–Producing Escherichia coli O121 Infections Associated with Flour – Canada, 2016–2017

MMWR Morb Mortal Wkly Rep 2017; 66: 705–706

Morton V, Cheng JM, Sharma D, Kearney A.

Waiter, is that romaine from Yuma? At least 53 sick across 16 US states with outbreak strain of E. coli O157:H7 linked to lettuce

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David Meyer of Fortune magazine reports the U.S.’s mysterious E. coli outbreak now has a likely culprit: romaine lettuce grown around Yuma, Arizona. And consumers are being given conflicting advice on what to do to protect themselves.

The Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) said Wednesday that any consumers in the U.S. who have store-bought chopped romaine lettuce should throw it away. If they want to buy romaine lettuce from now on, they should first check with the store or restaurant that it wasn’t grown in the Yuma region, the agencies said.

However, Consumer Reports has gone a step further, advising people to avoid all romaine lettuce for the time being. Why? Because people may find it difficult to establish for sure that their lettuce does not come from the growing region that’s suspected to be the source.

Niraj Chokshi of the New York Times reported that CDC said in a statement, “If you do not know if the lettuce is romaine, do not eat it and throw it away,” the C.D.C..

The agency was first alerted to the outbreak by health officials in New Jersey, who had noticed an increase in E. coli cases in the state, said Dr. Laura Gieraltowski, an epidemiologist at the C.D.C. After some discussion, it became clear that many of those infected had eaten chopped romaine lettuce at restaurants before getting sick.

Concerned, the agency looked for related cases by checking PulseNet, a national network of laboratories that catalog samples of harmful bacteria from infected patients.

“When we looked back into our PulseNet system we saw that there were other cases in other states with the same DNA fingerprint,” Dr. Gieraltowski said.

The C.D.C. learned that the others infected by that particular strain, E. coli O157:H7, had also eaten chopped romaine lettuce at restaurants before getting sick, she said. It turned over the information to the Food and Drug Administration, which helped trace the outbreak to Yuma, Ariz.

To pinpoint the exact source, though, investigators would need samples of the tainted lettuce. But because of the short shelf life of lettuce and the time it takes for an outbreak to be identified, obtaining such a sample may prove difficult.

However, a cluster of eight illnesses in an Alaska prison may help pinpoint the source.

Dr. Joe McLaughlin, with the Epidemiology Section at the state Department of Health and Social Services, said health officials had responded last week to an outbreak of E. coli O157:H7 bacteria at the Anvil Mountain Correctional Center in Nome, Alaska.

None of the eight patients have died or been hospitalized, in cases which were noticed between April 5 and April 15. All ate “significantly higher” numbers of salads than other people at Anvil Mountain, however, and have shown the same symptoms.

“Our outbreak is the first one I know of that’s been associated nationally with the consumption of whole heads of lettuce rather than chopped lettuce,” McLaughlin said. “What this outbreak suggests is that the source of contamination may actually be at the farm rather than the actual processing of the lettuce.”

Duh.

CDC reports in its latest outbreak update  that information collected to date indicates that chopped romaine lettuce from the Yuma, Arizona growing region could be contaminated with E. coli O157:H7 and could make people sick.

At this time, no common grower, supplier, distributor, or brand has been identified.

Consumers anywhere in the United States who have store-bought chopped romaine lettuce at home, including salads and salad mixes containing chopped romaine lettuce, should not eat it and should throw it away, even if some of it was eaten and no one has gotten sick. If you do not know if the lettuce is romaine, do not eat it and throw it away.

Before purchasing romaine lettuce at a grocery store or eating it at a restaurant, confirm with the store or restaurant that it is not chopped romaine lettuce from the Yuma, Arizona growing region. If you cannot confirm the source of the romaine lettuce, do not buy it or eat it.

Restaurants and retailers should ask their suppliers about the source of their chopped romaine lettuce.

Food Safety Talk 150: Rambunctious Ramble in the Jungle

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The show opens with Ben recounting of his thoughts on Temple Grandin’s talk in North Carolina, and the Humboldt Broncos tragedy.  Don mentions his shout out on Do By Friday.  Ben starts off by the nominal food safety talk regarding sock microwaving and the Cold Pressure Council seal. Don counters with the NJ Panera outbreak which seems to be part of FDA outgoing multistate outbreak of E. coliO157:H7. Next up are blockchain and Canadian food recalls.  Listener feedback covers restaurant grading, killing lobsters, glitter, flour heating, milk spoilage, farmers market and recipe safety.

Episode 150 is available on iTunes and here.