57 sick: Outbreak of Salmonella infections linked to eggs in Canada

The Public Health Agency of Canada (PHAC) is collaborating with provincial public health partners, the Canadian Food Inspection Agency (CFIA) and Health Canada to investigate an outbreak of Salmonella infections involving Newfoundland and Labrador, and Nova Scotia. The outbreak appears to be ongoing, as recent illnesses continue to be reported to PHAC.

Based on the investigation findings to date, exposure to eggs has been identified as a likely source of the outbreak. Many of the individuals who became sick reported consuming, preparing, cooking and baking at home with eggs. Some individuals reported exposure to eggs at an institution (including nursing homes and hospitals) where they resided or worked before becoming ill.

Eggs can sometimes be contaminated with Salmonella bacteria on the shell and inside the egg. The bacteria are most often transmitted to people when they improperly handle, eat or cook contaminated foods.

Illnesses can be prevented if proper safe food handing and cooking practices are followed. PHAC is not advising consumers to avoid eating properly cooked eggs, but this outbreak serves as a reminder that Canadians should always handle raw eggs carefully and cook eggs and egg-based foods to an internal temperature of at least 74 C (165 F) to ensure they are safe to eat.

PHAC is issuing this public health notice to inform Canadians of the investigation findings to date and to share important safe food handling practices to help prevent further Salmonella infections.

As the outbreak investigation is ongoing, it is possible that additional sources could be identified, and food recall warnings related to this outbreak may be issued. This public health notice will be updated as the investigation evolves.

As of February 18, 2021, there have been 57 laboratory-confirmed cases of Salmonella Enteritidis illness investigated in the following provinces: Newfoundland and Labrador (25), and Nova Scotia (32). Individuals became sick between late October 2020 and late January 2021. Nineteen individuals have been hospitalized. No deaths have been reported. Individuals who became ill are between 2 and 98 years of age. The majority of cases (68%) are female.

Between October and December 2020, CFIA issued food recall warnings for a variety of eggs distributed in Cape Breton, Nova Scotia, and Newfoundland and Labrador. The recalled eggs are now past their shelf-life and are no longer available for purchase. Some individuals who became sick in this outbreak reported exposure to recalled eggs; however, there are a number of recent ill individuals that do not.

It is possible that more recent illnesses may be reported in the outbreak because there is a period of time between when a person becomes ill and when the illness is reported to public health officials. For this outbreak, the illness reporting period is between three and six weeks.

Anyone can become sick with a Salmonella infection, but young childrenthe elderlypregnant women or people with weakened immune systems are at higher risk for contracting serious illness.

Most people who become ill from a Salmonella infection will recover fully after a few days. It is possible for some people to be infected with the bacteria and to not get sick or show any symptoms, but to still be able to spread the infection to others.

Raw or undercooked eggs and egg-based foods carrying Salmonella may look, smell and taste normal, so it’s important to always follow safe food-handling tips if you are buying, cleaning, chilling, cooking and storing any type of eggs or egg-based foods. If contaminated, the Salmonella may be found on the shell itself or may be inside the egg. The following food preparation tips may help reduce your risk of getting sick, but they may not fully eliminate the risk of illness.

  • Always handle raw eggs carefully and cook eggs and egg-based foods to an internal temperature of at least 74°C (165°F) to ensure they are safe to eat.
  • Do not eat raw or undercooked eggs. Cook eggs until both the yolk and white are firm.
  • When purchasing eggs, choose only refrigerated eggs with clean, uncracked shells.
  • Always wash your hands before and after you touch raw eggs. Wash with soap and warm water for at least 20 seconds. Use an alcohol-based hand rub if soap and water are not available.
  • Eggs (whether raw or cooked) should not be kept at room temperature for more than two hours. Eggs that have been at room temperature for more than two hours should be thrown out.
  • Use pasteurized egg products instead of raw eggs when preparing foods that aren’t heated (such as icing, eggnog or Caesar salad dressing).
  • Do not taste raw dough, batter or any other product containing raw eggs. Eating even a small amount could make you sick.
  • Microwave cooking of raw eggs is not recommended because of the possibility of uneven heating.
  • Sanitize countertops, cutting boards and utensils before and after preparing eggs or egg-based foods. Use a kitchen sanitizer (following the directions on the container) or a bleach solution (5 mL household bleach to 750 mL of water), and rinse with water.
  • Do not re-use plates, cutting boards or utensils that have come in contact with raw eggs unless they have been thoroughly washed, rinsed and sanitized.
  • Use paper towels to wipe kitchen surfaces, or change dishcloths daily to avoid the risk of cross-contamination and the spread of bacteria. Avoid using sponges as they are harder to keep bacteria-free.
  • Do not prepare food for other people if you think you are sick with a Salmonella infection or suffering from any other contagious illness causing diarrhea.

Symptoms of a Salmonella infection, called salmonellosis, typically start 6 to 72 hours after exposure to Salmonella bacteria from an infected animal or contaminated product.
Symptoms include:

  • fever
  • chills
  • diarrhea
  • abdominal cramps
  • headache
  • nausea
  • vomiting

These symptoms usually last for 4 to 7 days. In healthy people, salmonellosis often clears up without treatment, but sometimes antibiotics may be required. In some cases, severe illness may occur and hospitalization may be required. People who are infected with Salmonella bacteria can be infectious from several days to several weeks. People who experience symptoms, or who have underlying medical conditions, should contact their health care provider if they suspect they have a Salmonella infection.

The Public Health Agency of Canada leads the human health investigation into an outbreak and is in regular contact with its federal, provincial and territorial partners to monitor the situation and to collaborate on steps to address an outbreak.

Health Canada provides food-related health risk assessments to determine whether the presence of a certain substance or microorganism poses a health risk to consumers.

The Canadian Food Inspection Agency conducts food safety investigations into the possible food source of an outbreak.

Raw eggs a potential problem in Spaghetti alla carbonara

Spaghetti alla carbonara is a traditional Italian dish, which the sauce made of raw egg yolks is heated using only the heat of cooked pasta. Concerns about the safety of this preparation have been raised due the possibility of egg yolks be contaminated by Salmonella and the heat treatment may not be sufficient for total Salmonella inactivation. 

This study was undertaken to analyze the survival of Salmonella in spaghetti alla carbonara in which the only thermal processing of egg yolks was the heat transfer from the pasta. A pool of Salmonella was inoculated in egg yolks reaching 8.8 log10 CFU/g. Contaminated egg yolks were added to the cooked spaghetti, away from the heat source. Results indicated that immediately after cooking and draining, the pasta reached 86.0 °C. After 4.5 min of contact with the egg yolks, the mean temperature of spaghetti alla carbonara decreased to lower than 60 °C. The preparation method was able to inactivate approximately 4.7 log10 CFU/g of Salmonella and the spaghetti alla carbonara processed by this method had a creamy and silky sauce formed by yolks. Based on the results, it should be advisable the use of thermo-processed eggs to ensure the safety of this preparation.

Survival of Salmonella in spaghetti alla carbonara

LWT

Stefani Machado Lopes and Eduardo Cesar Tondo

https://doi.org/10.1016/j.lwt.2020.109115

https://www.sciencedirect.com/science/article/pii/S0023643820301031

Yes Minister: Dozens of people stricken by Salmonella-infected British eggs

Dozens of people have been poisoned after consuming British eggs contaminated with salmonella, an investigation has found, despite recent government assurances that the risk had been virtually eliminated.

Andrew Wasley of The Guardian reports at least 45 consumers have fallen ill since January this year in a major disease outbreak health officials have traced back to contaminated eggs and poultry farms.

Despite outbreaks of this strain occurring for more than three years, the government has issued no public warnings about the safety of hens’ eggs. In 2017, the Food Standards Agency (FSA) told the public that it was safe for vulnerable people, including pregnant women and the elderly to eat raw, runny or soft-boiled eggs. At the time the head of the FSA said: “The risk of salmonella is now so low you needn’t worry.”

Internal records obtained by the Bureau of Investigative Journalism and the Guardian show that 25 egg-laying poultry flocks in the UK have tested positive for salmonella in 2019 so far, seven of them contaminated with the most serious strains of the bacteria. Two egg-packing factories – one that supplies leading supermarkets – have also been contaminated, records show.

Eggs produced by the infected poultry flocks were placed under restrictions, meaning they cannot be sold to the public and must be sent for processing to kill the bacteria or be disposed of – while birds from infected flocks were culled.

However, some contaminated eggs did reach the public, with PHE confirming that 45 people had become ill after eating eggs infected with salmonella since January. The exact route to the public is unclear.

The government records also reveal that in 2018, 28 flocks tested positive for salmonella, four of them with dangerous strains.

According to PHE a further 55 human cases prior to 2019 were also being linked to the outbreak.

The revelations come just two years after the Food Standards Agency (FSA) declared that almost all eggs produced in the UK were free of salmonella. A major health scare in the 1980s had led to warnings that vulnerable groups should not consume raw or lightly cooked eggs – or food containing them – because of the salmonella risk. The then junior health minister Edwina Currie sparked a public outcry after saying “most” British egg production was infected with salmonella.

But in 2017 the FSA lifted the advice, stating the presence of salmonella in eggs had been “dramatically reduced” and that “British Lion” eggs – which cover about 90% of UK egg production – were safe to eat.

Speaking at the time, the then FSA chair Heather Hancock said: “We are now saying if there is a British Lion egg, you’re safe to do that. The risk of salmonella is now so low you needn’t worry. And that’s true whether you’re a fit healthy adult, or whether you’re pregnant or elderly or young. It’s only people on strictly medically supervised diets who need to avoid those eggs.”

PHE stated that it had been investigating this strain of salmonella for three years, despite the FSA clearing eggs for consumption.

The British Retail Consortium said: “Food safety remains a top priority for UK retailers and all UK sourced eggs are produced to the Lion code of practice. Retailers will comprehensively investigate any safety issues in our food supply and will take swift action as necessary.”

Uh-huh.

Australia still has an egg problem: First court appearance for bakery owners that sickened 58 with Salmonella

In Feb. 2019, people started showing up sick with Salmonella at hospitals in Adelaide, South Australia.

Ultimately 58 people were sickened and health types linked the outbreak to a raw egg butter being served with Vietnamese rolls from three bakeries all owned by Angkor Bakery.

Last week, five people connected with the three Angkor Bakery stores, including two of the owners, faced the Elizabeth Magistrates Court in South Australia. They were charged with failing to comply with food standards and providing unsafe food products.

As my colleague Andrew Thomson of Think ST Solutions writes, outbreaks occur due to a systems breakdown: it’s a financial burden on everyone, including the broader food industry; it causes much pain and suffering for those involved and in legal terms a food business at the centre of an outbreak can be liable for injuries caused and prosecuted by health authorities for failing to provide safe food.

One of the bakery owners told awaiting media outside Court last week of the true cost of this incident to the business: lost public confidence and business sales and now the entire business concern is for sale; owners are unable to engage legal representation due to the financial cost; it has fractured the family.

Steve White from global insurance brokerage and risk management firm, Arthur J Gallagher (Australia), says the best way to protect your customers – and to avoid costly lawsuits, penalties and damage to reputation and business interruption – is to know your obligations, maintain food safety standards and have the right insurance.

The case has been adjourned until November.

How a frozen meringue led Australian investigators to the source of a potent Salmonella outbreak

Jess Davis of ABC News reports a frozen meringue was key to identifying and outbreak of Salmonella enteritidis (SE), a bacteria that until last year was not found in Australia, that sickened almost 200 people.

People first started getting sick in May 2018 and by July a cluster of cases had appeared in New South Wales. That was when health authorities started investigating.

“Health, through their investigations, were able to look at a number of isolates of Salmonella enteritidis that came from humans, who unfortunately had been ill, and use a technology called whole genome sequencing,” said NSW Food Authority CEO Lisa Szabo.

“So it’s a genetic-based technology that helps us join the dots, shall I say. And this was the first time they could see a group of people with the same whole genome sequence.”

Anyone with a confirmed case of SE was interviewed by investigators and asked for a detailed account of what they’d eaten — to try to find what the different cases had in common.

A few weeks after being interviewed, one of those people remembered they had a frozen meringue cake in their freezer, leftover from a birthday party, around the time they got sick.

Officers went to that person’s home, collected the cake and had it tested.

“We were able to isolate the Salmonella enteritidis and it had that same whole genome sequence. At the same time we could see who manufactured that cake,” Ms Szabo said.

“We could go back to the manufacturer, have a look at their environment, look at how they handle food and where they get their ingredients from, and that’s where we saw the connection to the egg farm.”

It wasn’t until September that the frozen meringue led investigators to a farm on the outskirts of Sydney, but by then the bacteria had slowly started spreading across the industry.

“Once we detected salmonella enteritidis on this particular farm, we then commenced another round of investigations … more from the biosecurity and then the farm side of trying to understand … [whether the] farm had other connections to other properties around the state” Ms Szabo said.

But how the bacteria made its way into Australian eggs in the first place is likely to remain a mystery.

One property in Victoria and 13 in NSW have been affected so far and more than half-a-million birds have been culled at a cost of $10 million.

The spread of SE has been blamed largely on the interconnected nature of the egg industry, with all the infected farms connected in some way.

Egg farmers often trade produce with each other, and equipment and workers also regularly move from farm to farm.

Veterinarian Rod Jenner said SE was difficult to contain because it could survive and multiply without a host and could live in the environment for up to two years.

“It can survive in dust and dirt, in vehicles, and can travel in the wind. Rodents, wild birds, that sort of thing, can carry it on their skin or in their bodies as well,” he said.

“So it has actually been demonstrated to travel vast distances and be contaminated, be deposited on other farms that have previously been free.”

A farmer’s worst nightmareBede Burke’s egg farm at Tamworth in NSW was the 11th property to be infected, with a notification it had tested positive to SE during a routine check just over three months ago.

“Your whole world crashes down around you, you know,” Mr Burke said.

“We just didn’t sleep for a week and that first seven or eight days was really traumatic. We had to learn how to both decontaminate and disinfect the premises.”

When the notification came through on the eve of the federal election, Mr Burke had to withhold his eggs from sale and was faced with the prospect of culling entire flocks.

“But then you’ve got heap of eggs on your premises, you can’t not stop packing eggs, we were still going to pack 90,000 eggs a day,” he said.

“It’s just stress beyond all belief and then start planning for the worst.”

But he was lucky the contamination was picked up early and while a swab of dirt and dust had tested positive, it hadn’t yet spread to his egg or birds.

There have been no confirmed cases of SE since June and the industry hopes that will be the end of it.

But the outbreak has raised serious questions about how biosecurity is managed. Despite the disease becoming a national problem, its enforcement and regulation is state-based.

Philip Szepe, who runs an egg farm at Kinglake in Victoria, tests for all strains of salmonella every three months.

But he’s concerned that not all farmers are as diligent and said biosecurity was too reliant on self-regulation.

“Government’s really good at responding to crisis. It’d be great if the Government had a bit more engagement with the industry around monitoring, surveillance and compliance,” he said.

Australia still has an egg probem: 51 sick from Salmonella at bakery

Brad Crouch of The Advertiser writes that raw eggs are to blame for a salmonella outbreak that so far has left 51 people sick including 19 admitted to hospital.

A SA Health investigation into the outbreak linked to three Angkor Bakery stores has found the likely source of contamination related to handling of raw egg products.

SA Health’s Acting Director of Public Health Services, Dr Fay Jenkins, said a number of food and environmental samples collected from all stores last week returned positive results for Salmonella.

 “Given the sample results and the strain of the Salmonella outbreak, it is most likely that the cause of contamination was related to handling raw egg products,” Dr Jenkins said.

“The owners of the Angkor Bakery stores continue to work closely with the local councils and SA Health to improve their practices, and all three bakeries closed voluntarily during the investigation.”

“Many food poisoning outbreaks have been associated with foods containing raw or partially cooked eggs such as aioli, mayonnaise, hollandaise or tartare sauce and mousse,” Dr Jenkins said.

“The external shell of eggs may contain harmful bacteria such as salmonella, and while eggs may not necessarily look or smell ‘off’ they may be contaminated.

“It’s important to check that eggs are clean and not cracked or dirty — and those that are should be thrown out.

Lakhina Eung, the shop owner of the bakery in Burton, told ABC News she was sorry to anyone impacted by the outbreak and hoped the community would still support the business.

“I couldn’t sleep for over three days now so it’s been stressful,” she said.

“I am really sorry to everyone that is affected and also I hope that the community will still be supportive to us and our customers [will] still support us.

“I hope that the public and the community still trusts us and we [will] try our best to do everything as the council and SA Health require.”

As soon as you learn some basic microbiology and don’t make customers barf.

A table of Australian egg-related outbreaks is available at https://barfblog.com/wp-content/uploads/2017/05/raw-egg-related-outbreaks-australia-5-1-17.xlsx.

And to Dave, Sophie and Carol, who told me in the past week to stop pissing in the wind, this is for you.

It was probably the raw egg butter: 11 sick with Salmonella, Australia still has an egg problem

A salmonella outbreak linked to three bakeries in the northern suburbs has left nine people in hospital.

SA Health has confirmed 11 cases of salmonella have been reported after people ate Vietnamese rolls from three Angkor Bakery stores.

Deputy chief medical officer Dr Nicola Spurrier said that of those eleven people, nine were hospitalised due to the severity of the poisoning.

 “Early investigations indicate the cases could be linked to raw egg butter, pate or BBQ pork ingredients.

“The businesses complied with a council request on Tuesday to cease using these ingredients and, from today, the businesses have agreed to cease selling all Vietnamese rolls until the source has been identified.

“Cleaning and sanitising procedures have also been assessed and improved,and will continue to be monitored.”

An updated table of raw-egg related outbreaks in Australia is available at raw-egg-related-outbreaks-australia-2-3-2019

Raw and local risky: Milk & Honey sued over salmonella outbreak caused from raw egg use

Guess lots of areas got raw-egg-based problems.

Jason Steen of Scoop Nashville reports that newly filed court documents reveal Milk & Honey served salmonella-tainted ‘short rib gnocchi’ to patrons during August of 2018, causing over 20 patrons to fall ill with salmonella poisoning, and the Metro Health Department to deem it an outbreak.

Between August 3rd and August 15th of 2018, more than 20 patrons of Milk & Honey, a restaurant on 11th Ave S in the Gulch, were diagnosed with salmonella poisoning, according to the Metro Health Department, who formally deemed the incident an ‘outbreak’. Environmental, epidemiological, and lab testing linked the outbreak to the raw egg product furnished to Milk & Honey by a vendor, Gravel Ridge Farms. Specifically, they found the gnocchi was were only being cooked to 130 degrees, well below the required 145 degree required cook-kill temperature.

Documents from the lawsuit and Metro Health reveal:

Milk & Honey purchased unpasteurized raw eggs and/or raw egg product from Gravel Ridge Farms to be used in food prep, as part of their desire to source “local foods”

Milk & Honey used the unpasteurized eggs in a featured menu item: ‘Short Rib Gnocchi’. The gnocchi portion of this dish involves fashioning flour and raw egg yolk into dough, cutting it into pieces, and placed on a pan for freezing.

A plaintiff in the lawsuit dined at Milk & Honey in August of 2018, after which he fell sick with symptoms that found him hospitalized at Centennial Medial Center, which was diagnosed as salmonella poisoning.

At least 20 additional patrons were diagnosed with salmonella poisoning after eating the same dish.

An investigation by the Metro Health Department found a ‘lack of management oversight’ into the preparation of the short rib gnocchi. During their initial interview with the restaurant management, boiling of the raw gnocchi was indicated, however, in a reconstruction of events, it was learned that boiling did not take place in the actual kitchen production of the dish. It was being pan-seared upon each order, instead of boiled.

The Metro Health Department also found a lack of training to be a factor. The employee responsible for the final cooking and preparation of the dish was not unfamiliar with Gnocchi and was not trained on measuring or verifying final cooking temperatures of the raw gnocchi.

Taylor Monen, who is the owner of Milk & Honey, wrote a follow-up letter to Metro Health, which reads, in part:

After your visit on Friday, we felt that our past cook that evening probably did not cook the gnocchi long enough to reach a temperature that would have completely killed this bacteria present in the gnocchi…

I am not certain that I will be keeping it on the menu unless I am able to acquire pasteurized egg product that we can use to make these gnocchi noodles.

During the same email, Monen acknowledges the dangers of using small farms for egg sourcing, and acknowledged safer alternatives were readily available from food suppliers.

The newly filed lawsuit claims seeks claims of negligence in the amount of $575,000.00 &  punitive damages  up to $1,000,000.00.

Vanity: Raw egg face masks and risks

Ireland has an egg and a BS problem.

Miranda Larbi of The Irish Sun reports that experts have slammed beauty bloggers who claim that they have the answer to treating wrinkles –  smearing raw egg whites onto their faces.

The DIY hack, they say, is not only is it totally bogus, but it could also spread harmful bacteria.

Putting raw egg on your face has absolutely no benefit for your skin, experts say

Cosmetic surgeon Christopher Inglefield is concerned that raw egg masks will result in Brits getting harrowing bouts of food poisoning due to contamination from the unrefrigerated foodstuff.

Mr Inglefield, founder of the London Bridge Plastic Surgery clinic, warned: “Not only is this ineffective practice, it could potentially spread harmful bacteria, such as Campylobacter and even salmonella if you’re really unlucky.

“You should always wash your hands after handling raw egg.

“If it’s on your face all day then you are potentially contaminating everything and everyone you touch. Just think of the risks.”

Bloggers like Beauty Vixxen, AKA Lizbeth Eguia, have promoted using raw egg as a face mask, but experts warn it’s not safe

Not just Australia: Poland has an egg problem

According to the European Centre for Disease Prevention and Control,  1,412 cases have been found associated with this outbreak: 532 confirmed and 166 probable cases since 1 February 2017 and 343 historical-confirmed and 367 historical-probable cases between 2012 and 31 January 2017. In addition, no dates have been reported for four outbreak-confirmed cases, so they are unclassifiable as current or historical cases (Table 1).

Table 1. Distribution of cases by case classification and country, EU/EEA, February 2012 to November 2018 (n=1 420; 4 cases missing date of onset or sampling or receipt at reference laboratory), as of 12 November 2018

 Reporting country  Confirmed cases       Probable cases          Historical-confirmed cases Probable-confirmed cases   Total number of cases

Belgium          0          46        14        127      187

Croatia           0          0          4          0          4

Czech Republic         0          6          0          3          9

Denmark       16        0          6          2          24

Finland           0          0          0          1          1

France 21        0          8          0          29

Greece            0          0          0          2          2

Hungary        0          29        0          5          34

Ireland           12        0          4          4          20

Ireland           1          0          0          0          1

Italy    0          12        1          19        32

Luxembourg 4          0          5          0          9

Netherlands  8          25        90        164      287

Norway         22        18        11        32        83

Poland            25        0          0          0          25

Slovenia         0          7          3          0          10

Sweden          11        20        12        2          45

United Kingdom      412      3          185      6          606

Total   532      166      343      367      1408

                          698                    710 

Most outbreak cases were reported during the summer months. Due to reporting delays, additional cases are expected to be reported with onset in recent months.

A total of 112 confirmed or historical-confirmed cases were reported with travel history in an EU country during the incubation period and therefore were likely infected there. Countries where infections likely took place were Poland (25 cases identified from 2016 to 2018), Bulgaria (22 cases from 2015 to 2018), Cyprus (14 cases in 2016 and 2018), Portugal (11 cases from 2015 to 2017) and Hungary (10 cases from 2016 to 2018). Additional travel-associated cases were also reported (<10 cases per country) with travel history to Austria, Belgium, Greece, Italy, the Netherlands, Romania, Slovenia and Spain.

The 2016 and 2017 European outbreak investigations identified eggs originating from Poland as the vehicle of infection in this outbreak (ECDC/EFSA rapid outbreak assessments published in March and December 2017). Outbreak-confirmed cases belong to four different WGS clusters.