Singapore man, 38, died from Salmonella after eating Spize food, consumed bento 5 hours after it was packed

Mohamad Fadli Mohd Saleh, 38, an auxiliary police officer, died of sepsis and multi-organ failure a week after eating from a bento box prepared by Spize.

The coroner’s court heard Fadli had eaten the food prepared by Spize restaurant between 2.53pm and 4pm on Nov. 6, 2018.

This was about five hours after the food had been prepared at Spize’s River Valley outlet between 9.30am and 10.30am.

A post-mortem initially stated the cause of Fadli’s death as cardiorespiratory failure.

A subsequent report found that Fadli had died of sepsis and multi-organ failure following acute gastroenteritis.

Seven separate suspected food-borne incidents were linked to Spize between Nov. 6 and 9.

Numbers

  • 211 people consumed food from Spize.
  • 73 people fell sick
  • 47 people of them were hospitalised, including Fadli
  • 36 tested positive for salmonella

The other 35 have recovered from salmonella.

The salmonella outbreak was described as “unusually severe”.

Salmonella is a “self-limiting disease”, with an incubation period of between 12 and 36 hours.

This Spize incident had an immediate incubation period that was much shorter, within just eight hours, and there was a high hospitalisation rate.

The possibility of there being a virulent strain of pathogens was ruled out after an investigation.

The severity of those affected was perhaps due to the increased bacteria loads of the contaminated food item.

Details of packed bento:

There were three types of rice placed in the bento boxes:

  • Indonesian rice, which included egg fried rice, prawn omelette mung beans and tofu;
  • Malaysian rice, which included kampung fried rice, chicken sambal and stir-fried morning glory; and
  • Chinese rice, which was egg fried rice with Chinese sausage, omelette, crispy fish and other ingredients.

State coroner Kamala Ponnampalam said in her case findings Aug 23/19, “The joint investigations by the agencies uncovered several alarming lapses in the food handling and food preparation methods which directly contributed to the outbreak of acute gastroenteritis,” said the coroner.

Strains of salmonella were found on the ready-to-eat bento sets at Spize’s River Valley Road outlet, where the food was prepared.

The bacteria was also found on raw food items and commonly touched surfaces such as a door handle leading to a cold room and the cold room rack at the restaurant.

“This was suggestive of cross-contamination with raw meat, borne by the food handlers,” said the coroner. 

“There was also faecal matter detected in the ready-to-eat food (belacan egg fried rice) and on the kitchen tools like the chopping board and knife used in the chicken rice preparation which points to poor hygiene practices, either in the handling of unclean raw meat, or in poor personal hygiene.”

Seven of the 34 food handlers were not registered with NEA and had not attended the basic food hygiene course.

There was no soap provided at the restaurant’s basin, so it was likely that the food handlers did not wash their hands with soap before handling cooked ingredients, preparing meals, after handling raw ingredients, or after touching other parts of the kitchen.

This could have led to cross-contamination of salmonella bacteria between the raw ingredients and cooked food, the court heard.

 

Vibrio risk model development using various water inputs

Vibrio parahaemolyticus is a leading cause of seafood-borne gastroenteritis. Given its natural presence in brackish waters, there is a need to develop operational forecast models that can sufficiently predict the bacterium’s spatial and temporal variation.

 This work attempted to develop V. parahaemolyticus prediction models using frequently measured time-indexed and -lagged water quality measures. Models were built using a large data set (n = 1,043) of surface water samples from 2007 to 2010 previously analyzed for V. parahaemolyticus in the Chesapeake Bay. Water quality variables were classified as time indexed, 1-month lag, and 2-month lag. Tobit regression models were used to account for V. parahaemolyticus measures below the limit of quantification and to simultaneously estimate the presence and abundance of the bacterium. Models were evaluated using cross-validation and metrics that quantify prediction bias and uncertainty.

Presence classification models containing only one type of water quality parameter (e.g., temperature) performed poorly, while models with additional water quality parameters (i.e., salinity, clarity, and dissolved oxygen) performed well. Lagged variable models performed similarly to time-indexed models, and lagged variables occasionally contained a predictive power that was independent of or superior to that of time-indexed variables. Abundance estimation models were less effective, primarily due to a restricted number of samples with abundances above the limit of quantification. These findings indicate that an operational in situ prediction model is attainable but will require a variety of water quality measurements and that lagged measurements will be particularly useful for forecasting.

Future work will expand variable selection for prediction models and extend the spatial-temporal extent of predictions by using geostatistical interpolation techniques.

IMPORTANCE Vibrio parahaemolyticus is one of the leading causes of seafood-borne illness in the United States and across the globe. Exposure often occurs from the consumption of raw shellfish. Despite public health concerns, there have been only sporadic efforts to develop environmental prediction and forecast models for the bacterium preharvest.

This analysis used commonly sampled water quality measurements of temperature, salinity, dissolved oxygen, and clarity to develop models for V. parahaemolyticus in surface water. Predictors also included measurements taken months before water was tested for the bacterium. Results revealed that the use of multiple water quality measurements is necessary for satisfactory prediction performance, challenging current efforts to manage the risk of infection based upon water temperature alone.

The results also highlight the potential advantage of including historical water quality measurements. This analysis shows promise and lays the groundwork for future operational prediction and forecast models.

Vibrio parahaemolyticus in the Chesapeake Bay: Operational in situ predition and forecast models can benefit from inclusion of lagged water quality measurements

Public and Environmental Health Microbiology

Benjamin J. K. Davis, John M. Jacobs, Benjamin Zaitchik, Angelo DePaola, Frank C. Curriero

DOI: 10.1128/AEM.01007-19

https://aem.asm.org/content/85/17/e01007-19.abstract?etoc

Tennesee restaurant closed temporarily for washing kitchen utensils in lake

A Chinese restaurant in Old Hickory was closed temporarily Tuesday by the Metro health Department after a video showed employees washing kitchen utensils in a nearby lake.

A video taken on Tuesday morning and posted to social media showed restaurant employees washing cooking utensils in Old Hickory Lake. The man who took the video, Lance Glover, said he recorded the incident around 7 a.m. Tuesday.

The video showed people cleaning what appears to be a fire grate in Old Hickory Lake. Glover’s video then shows the employees returning with the equipment to the restaurant.

The Metro Health Department shut down No. 1 Chinese Restaurant, located 1435 Robinson Rd., after inspectors visited the restaurant.

According to Victor Oguntimehin, the health inspector, the restaurant operators initially denied they washed items in the lake. The restaurant admitted to washing the utensils in the lake after Oguntimehin showed them Glover’s video.

Mary Capps, who fishes on Old Hickory Lake, told News 4 she has seen the employees cleaning “greasy grates” almost every morning.

Money: Cost of Salmonella infections in Australia, 2015

Gastroenteritis caused from infections with Salmonella enterica (salmonellosis) causes significant morbidity in Australia. In addition to acute gastroenteritis, approximately 8.8% of people develop irritable bowel syndrome (IBS) and 8.5% of people develop reactive arthritis (ReA). We estimated the economic cost of salmonellosis and associated sequel illnesses in Australia in a typical year circa 2015.

We estimated incidence, hospitalizations, other health care usage, absenteeism, and premature mortality for four age groups using a variety of complementary data sets. We calculated direct costs (health care) and indirect costs (lost productivity and premature mortality) by using Monte Carlo simulation to estimate 90% credible intervals (CrI) around our point estimates.

We estimated that 90,833 cases, 4,312 hospitalizations, and 19 deaths occurred from salmonellosis in Australia circa 2015 at a direct cost of AUD 23.8 million (90% CrI, 19.3 to 28.9 million) and a total cost of AUD 124.4 million (90% CrI, 107.4 to 143.1 million). When IBS and ReA were included, the estimated direct cost was 35.7 million (90% CrI, 29.9 to 42.7 million) and the total cost was AUD 146.8 million (90% CrI, 127.8 to 167.9 million).

Foodborne infections were responsible for AUD 88.9 million (90% CrI, 63.9 to 112.4 million) from acute salmonellosis and AUD 104.8 million (90% CrI, 75.5 to 132.3 million) when IBS and ReA were included. Targeted interventions to prevent illness could considerably reduce costs and societal impact from Salmonella infections and sequel illnesses in Australia.

Cost of salmonella infections in Australia, 2015

September 2019

Journal of Food Protection vol. 82 no. 9

LAURA FORD,1 PHILIP HAYWOOD,2 MARTYN D. KIRK,1 EMILY LANCSAR,3 DEBORAH A. WILLIAMSON,4 and KATHRYN GLASS1*

 

500 sick, 2 dead since 2011: FDA focusing on the papaya industry

Norman Sharpless and Frank Yiannas of the U.S. Food and Drug Administration write that fresh papayas are most often eaten raw, without cooking or processing to eliminate microbial hazards; and therefore, the way they are grown, harvested, packed, held, processed and distributed is crucial to minimizing the risk of contamination with human pathogens.

Since 2011, American consumers have been exposed to eight outbreaks caused by Salmonella serotypes linked to imported, fresh papaya. And, just this June we started an investigation into an outbreak of Salmonella Uganda illnesses tied to the consumption of whole, fresh papaya imported from Mexico. While the 2019 outbreak is ongoing, the first seven outbreaks accounted for almost 500 reported cases of illness, more than 100 hospitalizations, and two deaths.

This trend has to stop. The pattern of recurrent outbreaks we have observed since 2011, including the 2019 illnesses, have involved Salmonella infections traced back to, or are suspected of being associated with, papaya grown in Mexico. The recurring nature of these outbreaks is a clear indication that more must be done within all sectors of the papaya industry to protect its customers and to meet its legal obligations. This includes growers, importers and even retailers that can and must do more.

This is why today we have issued a letter calling on all sectors of the papaya industry to take actions to prevent these outbreaks in the future. We are urging growers, packers, shippers and retailers in the papaya industry to review their operations and make all necessary changes to strengthen public health safeguards.

Our letter calls on the papaya industry to assess the factors that make their crops vulnerable to contamination. If a foodborne pathogen is identified in the crop or growing environment, a root cause analysis should be performed to determine the likely source of contamination. Procedures and practices that minimize that contamination must be implemented.

We are strongly encouraging the papaya industry to examine the use and monitoring of water used to grow, spray (pesticides, fungicides), move, rinse or wax crops to identify and minimize risks from potential hazards. All sectors of the industry should adopt tools and practices needed to enhance traceability since papayas are a perishable commodity, to more rapidly facilitate the tracking of involved product to expedite its removal from commerce, prevent additional consumer exposures, and properly focus any recall actions.

And finally, they should fund and actively engage in food safety research to identify the potential sources and routes of contamination by microbial pathogens and develop data-driven and risk-based preventive controls.

In response to this most recent Salmonella Uganda outbreak, the FDA deployed an inspection team to the packing house and farm that was linked to the contaminated papayas via traceback and epidemiological evidence. The findings of those visits will be made public when their investigation is complete. We have also increased sampling and screening of papayas at the border. In addition, the FDA is actively collaborating with our counterparts in the Mexican government regarding this current outbreak through the agency’s Latin America Office to determine ways to further our collaborative prevention efforts.

The U.S. Federal Food, Drug, and Cosmetic Act prohibits food producers from introducing, or delivering for introduction, into interstate commerce adulterated foods (meaning foods that are potentially harmful to consumers). Additionally, there are new requirements under the FDA Food Safety Modernization Act (FSMA). The Produce Safety Rule under FSMA sets science- and risk-based minimum standards for domestic and foreign farms for the safe growing, harvesting, packing and holding of covered produce, which includes papayas. Another FSMA rule, the Foreign Supplier Verification Program (FSVP) makes importers responsible for verifying that the foods they bring into the U.S., including papayas, have been produced in a manner that meets applicable U.S. safety standards. 

I prefer mangoes.

Missouri county imposes mandatory hepatitis A vaccines for food service workers

While the Alabama Department of Public Health (ADPH) is recommending the hepatitis A vaccine for all food service workers, a Missouri county has imposed mandatory Hepatitis A vaccinations for food handlers.

Tommy Tobin of Forbes reports Franklin County, Missouri, joins a handful of jurisdictions across the country with mandatory Hepatitis A vaccine programs aimed at preventing further cases. This development is part of a larger trend aimed at expanding vaccinations for Hepatitis A and addressing future outbreaks of the disease.

The CDC is investigating outbreaks of Hepatitis A across 29 states. According to the CDC, 233 individuals have died from Hepatitis A between 2016 and 2019 out of over 24,000 reported cases. Several states, including Kentucky, Florida, Ohio, and West Virginia, have seen thousands of cases.

In an effort to curb the increase in reported cases of Hepatitis A, many local jurisdictions are considering mandatory Hepatitis A vaccines for food service workers. For example, Missouri has reported 387 cases of Hepatitis A in the past two years. Over 50 of these cases are from Franklin County, which has a population of about 100,000 residents. Franklin County officials have imposed mandatory vaccinations for individuals who handle food. Food establishments, including restaurants, have 90 days to ensure their employees are vaccinated.  Nearby St. Louis County, Missouri enacted a mandatory vaccine requirement nearly 20 years ago. Similar ordinances requiring vaccines for food service workers were enacted in Kentucky’s Ashland and Boyd Counties last year.

With the numerous cases across the country of Hepatitis A, the National Restaurant Association recently issued guidance to its member restaurants in an effort to reduce future cases.  In this guidance, the Association recommended that restaurant managers and operators encourage employees to get vaccinated, educate restaurant staff about the virus, and monitor for any signs of the disease. (Note: The National Restaurant Association did not respond to requests for comment on this story). Separately, a CDC advisory panel recently recommended expanding the use of the Hepatitis A vaccine to all youth aged 2 to 18. 

7 sick with Listeria in Canada linked to Rosemount brand cooked diced chicken: 2 dead 22 sick in US possibly related

As of August 23 2019, there have been seven confirmed cases of Listeria monocytogenes illness in three Canadian provinces: British Columbia (1), Manitoba (1) and Ontario (5) linked to cooked Rosemount brand cooked diced chicken.

The Public Health Agency of Canada notes Rosemount cooked diced chicken was supplied to institutions (including cafeterias, hospitals and nursing homes) where many of the individuals who became sick resided, or visited, before becoming ill.

Individuals became sick between November 2017 and June 2019. Six individuals have been hospitalized. Individuals who became ill are between 51 and 97 years of age. The majority of cases (86%) are female.

The collaborative outbreak investigation was initiated because of an increase of Listeria illnesses that were reported in June 2019. Through the use of a laboratory method called whole genome sequencing, two Listeria illnesses from November 2017 were identified to have the same genetic strain as the illnesses that occurred between April and June 2019. It is possible that more recent illnesses may be reported in the outbreak because of the period of time it takes between when a person becomes ill and when the illness is reported to public health officials. In national Listeria monocytogenes outbreak investigations, the reporting time period is usually between four and six weeks.

The U.S. CDC is also investigating an outbreak  of Listeria illnesses occurring in several states. The type of Listeria identified in the U.S. is closely related genetically (by whole genome sequencing) to the Listeria making people sick in Canada. Canada and U.S. public health and food safety partners are collaborating on these ongoing Listeria investigations.

CDC is not recommending that consumers avoid any particular food at this time. Restaurants and retailers are not advised to avoid serving or selling any particular food. We will update our advice if a source is identified.

Latest Outbreak Information

At A Glance

Reported Cases: 24

States: 13

Hospitalizations: 22

Deaths: 2

24 people infected with the outbreak strain of Listeria monocytogeneshave been reported from 13 states.

Of 23 ill people with information available, 22 hospitalizations have been reported.

Two deaths have been reported.

If you process tahini, you should include Salmonella as a known or reasonably foreseeable hazard

After a few months of retreating and thinking about next steps for barfblog, and focusing on consumer food safety observations in our new kitchens, I’m getting back in the posting mix.

And still, one of my favorite emails (after the weekly MMWR notification) is FDA’s updated warning letters. There’s so much to be learned in these beyond the fun stuff like peeling the skin off of a bearded dragon (not a euphemism).

Here’s my favorite from today’s update, courtesy of Sunshine International Foods Inc – a tahini processor.

There are a few nuggets in this one but my big takeaway is that the letter provides a fantastic blueprint for all other tahini processors to follow if they want to meet what FDA expects. Including that you absolutely need to include Salmonella as a known or reasonably foreseeable hazard in a preventive control plan.

Oh and if you are a retailer or food service buyer, looking through these warning letter alerts are probably a good idea – I’d be making vendor decisions based on these (and asking my current suppliers how they are different from the folks who receive them).

From the letter:

Your hazard analysis did not identify a known or reasonably foreseeable hazard for each type of food manufactured, processed, packed, or held at your facility to determine whether there are any hazards requiring a preventive control, as required by 21 CFR 117.130(a)(1). The hazard evaluation must include an evaluation of environmental pathogens whenever a ready-to-eat (RTE) food is exposed to the environment, as required by 21 CFR 117.130(c)(1)(ii). Your RTE tahini products made from natural sesame seeds are exposed to the processing environment following pasteurization and prior to packaging, and your repackaged RTE tahini products are exposed to the processing environment throughout the processing of these products. Although you have identified “Microbial Growth Staphylococcus Aureus” as a potential significant food safety hazard in your hazard analyses for your RTE tahini products (including RTE tahini manufactured from natural sesame seeds with creation date 5-01-18, RTE flavored tahini manufactured from natural sesame seeds with creation date 5-01-18, repackaged RTE tahini with creation date 5-01-18, and RTE flavored tahini using raw tahini received at your facility with revision date 3-6-19), these hazard analyses do not identify contamination of RTE tahini with the environmental pathogen of Salmonella as a known or reasonably foreseeable hazard for each type of food manufactured, processed, packed, or held at your facility to determine whether it is a hazard requiring a preventive control.

Also, folks should do better on cleaning and sanitizing the hard to get spots where Salmonella or Listeria might be living.

1. All food-contact surfaces, including utensils and food-contact surfaces of equipment, must be cleaned as frequently as necessary to protect again contamination of food, as required by 21 CFR 117.35(d). However, our investigators observed the following conditions:

a. Hardened tahini was present around the gasket between a stainless-steel pipe feeding from the hold/pasteurizer tank to the hopper for the retail jar filler located in the Pasteurizer/Filling/Packing Room.

b. Soft tahini was observed around and beneath the lid seams to the retail line filler hopper in the Pasteurizer/Filling/Packing Room.

c. Soft and hardened tahini were observed inside the retail line filler hopper and (b)(4) filler heads.

d. Soft tahini was observed inside the square mixer and grinding/milling hopper in the Roasting/Milling Room.

e. Chocolate tahini was observed inside the stainless-steel pipe feeding into the (b)(4) in the Pasteurizer/Filling/Packing Room.

Spanish sushi restaurant linked to outbreak; also had some odd online reviews

Sushi and sashimi is one of those foods that splits the food safety nerd world. Some folks eat it, some don’t.

That’s really a personal risk management decision.

There’s lots going on in a sushi restaurant risk-wise: holding rice at room temperature for a long time, to allow for easy rolling increases the risk of Bacillus cereus illnesses; the fish can have parasitic worms from the water environment living in them; and, there’s been an ongoing issue related to Salmonella likely due to processing handling (see back scrape).

It can all be done with reduced risk – but it takes dedication from buyers, suppliers and food handlers.

Control the B. cereus in rice with acidification, temperature control or time.

Address parasites with freezing.

Limit Salmonella through supplier controls.

Folks in Majorca, Spain apparently recently ate at a restaurant that wasn’t great at risk management, according to the always fun Sun.

Twenty-four customers fell ill after dining at Dragon Sushi restaurant in the city of Palma de Majorca, in the eastern Spanish region of Majorca.

However, reviewers offered mixed opinions about the grub on offer at the tourist hotspot eatery.

In a review entitled “Worst sushi ever!”, a reviewer said: “This place had the worst sushi I’ve ever had in my life.”

Meanwhile in another review titled “Terrible!! Never go again!! Pinworms in my edamame!!”, another diner said: “I really can’t recommend this sushi restaurant! Worst sushi ever in my life!!”

Local health councillor Patricia Gomez confirmed that 24 cases of food poisoning had taken place among clients who said they ate at the Japanese food outlet last weekend.

A spokeswoman for the Health Department said the victims are suffering symptoms including “gastroenteritis” and further tests are being carried out to find out what caused the illness.

According to local media, many of the victims – including children – are still in hospital after suffering diarrhoea, fever and vomiting.

My amateur epi guess is that it’s a rice/B. cereus outbreak.

UK Chinese restaurant had ‘ideal conditions for food poisoning bacteria in the kitchen’

Kate Lally of the Wirral Globe reports environmental health officers found a catalogue of problems at Sun Ying in Birkenhead including chefs wearing dirty clothes, raw chicken being chopped on the same surface as vegetables, and filthy kitchen surfaces and food storage racks.

Chefs told inspectors they regularly left items such as cooked duck and cooked rice out for some six hours at a time.

A report following the environmental health visit states this presents “ideal conditions for food poisoning bacteria to grow” and that the “risk of causing food poisoning among customers is high.”

Inspectors also found sweet and sour chicken being kept “hot” in the all-you-can-eat buffet area was lukewarm and therefore should have been thrown away after a maximum of two hours.

Several packs of eggs – which appeared to have been purchased at a heavily reduced price – were found to be more than three weeks out of date.

Following the June inspection the restaurant – which has a 3-out-of-5 rating on Tripadvisor – was given the second lowest hygiene rating, and the report says staff’s food hygiene awareness was “inadequate.”

These people had no business running a restaurant, just like Sorenne at an aquarium … in Arizona … petting a two-toed sloth. Random.