Where’s the leafy greens lobby? Feds to seek listeria, leafy green connections after Dole outbreak

Mike Hornick of The Packer writes that health officials will begin routinely asking listeria outbreak victims if they consumed leafy greens, according to the Centers for Disease Control and Prevention.

lettuce.skull.noroThe addition of leafy greens to the standard federal questionnaire on listeria comes in response to last winter’s outbreak linked to a Dole Fresh Vegetables salad plant in Springfield, Ohio. That outbreak sickened 33 in the U.S. and Canada and was tied to at least one death. Dole stopped production in January and reopened the plant in April.

It was the first reported listeria outbreak in the U.S. associated with leafy greens, and the eighth with fresh produce. All occurred since 2008, according to an Aug. 26 report by the CDC.

“It is unclear whether the appearance of these outbreaks might be attributed to improved outbreak detection, changes in consumer behavior, or changes in production and distribution,” the report says. “Fresh produce processors are advised to review food safety plans and consider incorporating measures to avoid the growth and persistence of listeria.”

In the Ohio centered outbreak, the older questionnaire failed to identify a common source for seven infections reported by Nov. 30.

Then in December and January, eight new or previously interviewed patients or their representatives took part in open-ended interviews or provided shopper card records.

That revealed the connection. All reported consuming leafy greens in the month before the onset of illness.

Among these, seven reported romaine and six reported spinach, higher than national food consumption estimates of 47% and 24%, respectively. Six patients recalled consuming packaged salad, according to the report.

Dole Fresh Vegetables denied responsibility in two foodborne illness lawsuits that followed the outbreak.

CDC version: 4 dead, 33 sickened from Listeria linked to Dole packaged greens

The U.S. Centers for Disease Control came out with a summary of its investigation of Listeria in Dole packaged leafy greens produced at its Columbus, Ohio plant.

lettuce.tomato.skullIn September 2015, PulseNet, the national molecular subtyping network for foodborne disease surveillance, identified a cluster of Listeria monocytogenes (Listeria) clinical isolates indistinguishable by two-enzyme pulsed-field gel electrophoresis (PFGE) pattern combination and highly related by whole-genome multilocus sequence typing (wgMLST). A case was defined as isolation of Listeria with the outbreak PFGE pattern and highly related by wgMLST with an isolation date on or after July 5, 2015, the isolate date of the earliest case in this cluster.

A standardized Listeria Initiative questionnaire (1) was used to gather information about foods consumed in the 4 weeks before illness from seven persons identified by November 30, 2015, with isolation dates occurring July 5, 2015–October 30, 2015. This tool did not include leafy green vegetables and failed to identify a common source for the infections. During December 2015 and January 2016, eight new or previously interviewed patients or their surrogates participated in open-ended interviews or provided shopper card records, and all reported consuming leafy greens in the month before illness onset. Among these, seven (88%) reported romaine and six (75%) reported spinach, higher than national food consumption estimates of 47% (p = 0.022) and 24% (p = 0.003), respectively (2). Six patients (75%) recalled consuming packaged salad, and three patients (38%) who recalled brands reported packaged salad brands processed by Company A (that’d be Dole).

The Ohio Department of Agriculture obtained packaged salad processed at Company A’s Ohio facility from a store during routine sampling. On January 14, 2016, PulseNet analyzed sequence data from Listeria isolated from the packaged salad, and the isolate was highly related to the clinical isolates by wgMLST (median allele differences <10). This molecular finding, combined with the epidemiologic information, led the Food and Drug Administration to initiate an inspection of Company A’s Ohio facility on January 16, 2016. Two food samples collected during the inspection yielded Listeria, and wgMLST analysis indicated that they were highly related (median allele differences <10) to clinical and retail product isolates.

On January 21, 2016, Company A voluntarily halted production at its Ohio facility and conducted a market withdrawal of all packaged salad products from that facility because of possible Listeria contamination.* The market withdrawal included 22 varieties of packaged salads sold under various brand names. Company A issued a voluntary recall of these products on January 27, 2016, which further identified the list of affected products and brand names.

After the market withdrawal and recall, CDC fielded >450 inquiries about listeriosis from concerned consumers and clinicians, and the CDC outbreak website received >787,000 page views, more views than after any other foodborne illness outbreak to date.

lettuceAs of March 28, 2016, there were 19 persons meeting the case definition from nine states (Connecticut, Indiana, Massachusetts, Michigan, Missouri, New Jersey, New York, Ohio, and Pennsylvania) with isolation dates through January 31, 2016. All were hospitalized; one died. One illness in a pregnant woman resulted in a preterm live birth. One otherwise healthy child developed meningitis.

The Public Health Agency of Canada investigated 14 cases of listeriosis associated with this outbreak, with onset dates from May 7, 2015 to February 23, 2016 (3). Six Canadian clinical isolates were compared with U.S. clinical isolates and were highly related by wgMLST. Three cases reported consuming packaged salad processed at the Ohio facility. In January 2016, the Canadian Food Inspection Agency (CFIA) collected 55 packaged salads from stores in Canada representing 12 different products processed at the Ohio facility. CFIA isolated the outbreak strain and issued a food recall warning on January 22, 2016, for all products processed at the Ohio facility and distributed in Canada.

The wgMLST analysis identified this listeriosis cluster and provided evidence of the link between contaminated food products and human illness. This allowed timely recall of potentially contaminated food, which might have prevented additional cases of serious illness.

This is the first reported outbreak of listeriosis associated with leafy greens and the eighth reported outbreak of listeriosis associated with fresh produce in the United States; all occurred since 2008 (4).** It is unclear whether the appearance of these outbreaks might be attributed to improved outbreak detection, changes in consumer behavior, or changes in production and distribution. Fresh produce processors are advised to review food safety plans and consider incorporating measures to avoid the growth and persistence of Listeria.†† The Listeria Initiative questionnaire has been revised to include additional questions about fresh produce to better identify produce vehicles of Listeria.

Outbreak of listeriosis associated with consumption of packaged salad – United States and Canada, 2015-2016

Weekly / August 26, 2016 / 65(33);879–881

JL Self, A Conrad, S Stroika, A Jackson, L Burnworth, J Beal, A Wellman, KA Jackson, S Bidol, T Gerhardt, M Hamel, K Franklin, C Kopko, P Kirsch, ME Wise, C Basler

http://www.cdc.gov/mmwr/volumes/65/wr/mm6533a6.htm?s_cid=mm6533a6_e

Dole and Listeria: The Shaggy Defense

Dole’s Springfield plant, source of an awful outbreak of listeriosis linked to over 30 illnesses and four deaths, had resident Listeria monocytogenes problem. With illnesses stretching back to July 2015, linked through whole genome sequencing, the pathogen was hanging out somewhere.

The Packer reports that Dole is disputing a couple of lawsuits that have been filed on behalf of victims.

A suit filed in July for the estate of Ellen DiStefano alleges Dole failed to design and implement a food safety program capable of preventing listeria contamination of its salad mixes.

Listeria was found eight times in the Springfield plant from March 2014 to December 2015, according to a Food and Drug Administration report cited in court documents. The suit, filed in U.S. District Court for the Southern District of Ohio, also claims Dole did not use newer detection technologies such as genome sequencing.

DiStefano became ill Jan. 17 and died Feb. 27. She was 79.

“The product was not defective at the time it left Dole’s custody and control,” attorney R. Leland Evans said July 15 in the court record. “Any later defect was caused by a substantial alteration and change in the condition of the product by other parties over whom Dole had no control.”

Show me the data.

 

Really, it wasn’t us: Leafy green cone of silence, Dole version

As early as 2014, the U.S. Food and Drug Administration had evidence that Listeria was circulating in Dole’s Springfield, Ohio plant, which bags lettuce and other supposedly healthy meals.

spongebob.oil.colbert.may3.10It took 18 months before Dole shut down and issued a recall.

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

Last week, attorneys for Dole denied responsibility in a wrongful death lawsuit linked to a listeria outbreak that has since been tied to its Springfield plant.

The Dole legal thingies argued its product was not defective when it left the company’s Listeria-positive facility.

“Any later defect was caused by a substantial alteration and change in the condition of the product by other parties over whom Dole had no control,” the company’s response states.

The most recent case was filed when Ellen H. DiStefano, 79, of Franklin County, became ill on Jan. 17 after eating a salad she bought in Belmont County that was packaged in Springfield, according to the complaint. She was taken to a hospital, diagnosed with an infection caused by the listeria monocytogenes bacteria and died on Feb. 27, the complaint states.

The case is one of two civil lawsuits pending against the Springfield manufacturer. The company has also denied responsibility for an incident in which a Warren County woman said her mother was left in a coma after eating salad tainted with listeria. That case is also pending in U.S. District Court.

Given that level of legal swarminess, I wouldn’t touch the stuf.

Leafy greens, listeria, environmental sampling and tragedy

Dole’s Springfield plant, source of an awful outbreak of listeriosis linked to over 30 illnesses and four deaths, had resident Listeria monocytogenes problem.

With illnesses stretching back to July 2015, confirmed through the amazing whole genome sequencing, the pathogen was hanging out somewhere.

Matt Sanctis of the Springfield News-Sun and I chatted yesterday about the FDA 483 reports posted by folks last week and we talked about environmental testing, best practices and what happens when a positive result is found.ryser_conveyer1

There are lots of risk management decisions and trade offs in environmental sampling – where to test, what to look for, what to do when you find something – all of which United Fresh has fantastic guidance about.

The big questions that folks have are is Lm in the leafy green processing environment common? (yes – see here. And here. and here. And another Dole one. That’s just going back 2 years); should firms be testing food contact surfaces? (it’s complicated – depends why you are testing and what else you are looking for); and, did Dole react correctly when they found listeria in the environment nine times in 2 years (I dunno, there’s not a lot of info).

The idea of environmental sampling is to seek out residential Lm and get rid of it. To accomplish that, positive test results lead to further testing (closer to the product) and an investigation into the cause.

Internal tests at Dole showed positive signs of listeria as early as 2014, according to U.S. Food and Drug Administration inspection reports obtained by the Springfield News-Sun.

Dole performed swab tests at its Springfield facility that tested positive for listeria as many as nine times, beginning in July 2014, the inspection reports show. However the company continued to produce and ship products across the U.S. and Canada.

Dole confirmed Monday that it has been contacted by the U.S. Department of Justice as part of an investigation into its Springfield facility. A listeria outbreak there has been linked to four deaths and several illness across the U.S. and Canada.

The FDA released the inspection reports Monday in response to Freedom of Information Act requests the News-Sun filed in January and March.

“Those FDA reports deal with issues at our plant that we have corrected,” said Bil Goldfield, a Dole spokesman. “We have been working in collaboration with the FDA and other authorities to implement ongoing improved testing, sanitation and procedure enhancements, which have resulted in the recent reopening of our Springfield plant.”

It’s concerning the company continued to ship products after finding several positive samples of listeria over a span of more than a year, said Bill Marler, a food safety attorney based in Seattle. Marler represents the family of Kiki Christofield in their lawsuit against Dole.

“The thing that is concerning to me is you’re finding listeria repeatedly over a long period of time,” Marler said. “It’s less of an issue of should they have told the FDA. It’s more of an issue of should they have shut down their facility and gotten a handle on why they continue to have an ongoing listeria problem?”

“The finished product sample, as well as the in-process sub-samples collected from the water knife, the trans-slicer, and the metal tray beneath the cross-conveyor, all on Trim Line 1, were found by FDA laboratory analysis to be positive for Listeria monocytogenes,” the FDA report says.

Employees at Dole didn’t swab food contact areas for listeria, according to the inspection reports, instead swabbing various locations throughout the facility as close to food contact areas as possible.

More information is needed to determine whether Dole failed its duty to consumers or what steps it took after finding positive samples of listeria in its facility, said Benjamin Chapman, an associate professor and food safety specialist at North Carolina State University.

One key question the FDA reports don’t fully answer is whether the listeria samples were brought into the factory on a product like lettuce or whether it established a foothold within the facility, which Chapman said would be a more serious problem.

It’s also important to know what — if anything — Dole did to resolve the issue, he said.

“It’s not surprising there would be listeria there,” Chapman said. “What we don’t know is if those nine times they found it, whether it was transient or if it was resident. They might know that and they might not. It really depends on what they did further once they found those samples.”

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

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

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

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

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

But rather than pay attention, they ignored the safety.

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

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

And those in charge begin to ignore the safety systems.

Or hope the problem will just go away.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Going public (not so much): Dole inspections show recalls, but no contamination in Ohio facility

If Dole can’t answer basic questions about the safety of its packaged leafy greens, why should consumers buy the stuff, let alone feel confident?

160122-dole-salad-mn-1530_8b681a6748a4253c3ec1c087b4cd8b0d.nbcnews-fp-1200-800Dole salad products had been recalled in recent years due to concerns about salmonella and listeria before the recent outbreak that shuttered the Springfield facility in January, federal inspection documents show.

The Springfield News-Sun reviewed U.S. Food and Drug Administration records dating back to 2011 obtained through a Freedom of Information Act request.

Those documents show the Springfield plant recalled products a handful of times after traces of listeria and salmonella were found in pre-packaged salad mixes produced there. However samples collected during subsequent inspections didn’t find evidence of contamination at the plant.

A recent lawsuit filed by a Warren County woman also cited at least eight prior outbreaks or recalls company-wide stretching back to 2006.

Dole voluntarily closed the Springfield site in January. It’s not clear whether the site has reopened, in part because company leaders have declined to comment multiple times, but the parking lots is often full of cars.

Products packaged at the facility in the current outbreak were linked to at least 19 hospitalizations in the U.S. in nine states, including one death in Michigan.

In Canada, the outbreak was linked to 14 illnesses in five provinces. Three people in Canada died, however it hasn’t been determined if listeria contributed to those deaths.

listeria4A food safety expert said it’s not uncommon for a food processing facility to remain shuttered for weeks or even months after a significant outbreak.

“This is pretty normal and falls within the expected range of remediation efforts on the part of the organization,” said Naila Khalil, an associate professor in the Center of Global Health at Wright State University.

The Springfield News-Sun reviewed dozens of pages of FDA inspection reports obtained through a public records request.

Those documents show FDA inspectors visited a handful of times since 2011 after samples collected by various agencies contained pathogens like listeria, E. coli and salmonella.

The records also show subsequent samples collected at the Springfield facility didn’t test positive for those pathogens.

The FDA inspected the Springfield site in March 2014 after Canadian public health authorities detected a sample of listeria in a pre-packaged salad blend processed here. Dole voluntarily recalled the product.

In that case, the FDA issued a report to the company for failure to maintain floors and walls in good repair and failure to provide adequate screening or other protection against pests. Additional observations included food residue found on multiple surfaces, water leaks and ice melt dripping onto the floor of the finished product warehouse from a container of iced broccoli.

Specific concerns listed in the report include a cutting board found with deep grooves that couldn’t easily be cleaned, ruts in the floor containing standing water and peeling paint and rust.

Company officials were cooperative and pledged to address those concerns, the report says.

The documents also provide a glimpse into Dole’s sampling and prevention procedures.

The firm collects environmental, water, raw material and finished product sampling, the FDA documents show. The 2014 inspection showed the company’s goal is 50 samples per week, chosen from a list of pre-designated locations on a rotating basis.

In cases in which a pathogen is detected, the area is cleaned and sanitized, followed by additional swabs in a pattern around where the original sample was taken and repeated until no additional traces are found.

Why wouldn’t Dole just make such data public and quell whispers of conspiracy?

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ohio woman with mother in coma sues Dole following Listeria-in-lettuce outbreak

An Ohio woman has filed a lawsuit against the Dole Fresh Vegetables company after claiming tainted salad put her mother in a coma.

listeria4Health officials have reported that 18 Americans and 11 Canadians have been stricken with listeriosis linked to a Dole processing plant in Springfield.

Four have died.

Constance Georgostathis has filed suit against Dole after claiming a salad mix tainted with Listeria placed her mother, Kiki Christofield, in a coma.

According to a news release from Georgostathis’ attorney, Georgostathis bought the salad from a Kroger on late January. On Jan. 23, Christofield began to feel sick and by Jan. 26 she reportedly was experiencing extreme head and neck pain, confusion and and altered mental state. She entered a comatose state on Jan. 31 at Bethesda North Hospital near Cincinnati.

The Dayton Daily News adds that Dole Fresh Vegetables officials declined to comment late Monday afternoon, citing the pending litigation. The company also declined to provide further updates about their investigation into the outbreak or if and when the Springfield facility might re-open.

Bill Marler, a Seattle attorney who’s representing the family, said he isn’t aware of any similar suits filed in relation to the outbreak.

“Listeria in bagged salad is pretty unusual,” Marler said. “One of the things we’re seeing a lot more of is it has partly to do with there are a lot more people who are immune-compromised and people who are elderly, and that’s unfortunately what listeria targets.”

Lab tests performed by the Ohio Department of Health linked the outbreak to packaged salads produced in Springfield.