212 sick: Multistate outbreak of cyclosporiasis linked to Del Monte Fresh produce vegetable tray

The U.S. Centers for Disease Control and Prevention (CDC) reports that Cyclospora cayetanensis is a single-celled parasite that causes an intestinal infection called cyclosporiasis.

As of July 5, 2018 (9am EDT), CDC has been notified of 212 laboratory-confirmed cases of cyclosporiasis in persons who reportedly consumed pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip. The reports have come from four states.

Seven (7) of these people have been hospitalized, and no deaths have been reported.

Epidemiologic evidence indicates that pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip are the likely source of these infections.

Most ill people reported eating pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip.

Most ill people reported buying pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip in the Midwest. Most people reported buying the trays at Kwik Trip convenience stores.

The investigation is ongoing. CDC will provide updates when more information is available.

General advice for consumers about prevention of cyclosporiasis can be found here.

On June 15, 2018, Del Monte Fresh Produce recalled 6 oz., 12 oz., and 28 oz. vegetable trays containing fresh broccoli, cauliflower, celery sticks, carrots, and dill dip. Recalled products were sold in clear, plastic clamshell containers.

Recalled products were distributed to the following stores: Kwik Trip, Kwik Star, Demond’s, Sentry, Potash, Meehan’s, Country Market, FoodMax Supermarket, and Peapod.

Victims blame FDA for food-recall failures

I don’t blame any regulatory type for going early or going late in a foodborne disease outbreak.

There’s lots of armchair quarterbacks out there, and we’ve tried to present the various viewpoints on many an outbreak.

There’s also a lot people out there with nothing but a personal agenda, based on profit rather than peer review.

Christine Haughney of Politico reports that people had been getting sick from eating I.M. Healthy Original Creamy SoyNut Butter for more than two months when Peter Ebb, a 59-year-old Boston lawyer and health enthusiast, went for a run and then ate his usual gluten-free English muffin smeared with soy nut butter.

Later that morning — March 6, 2017 — Ebb saw a message from Amazon, which had sold him the nut butter, that the manufacturer had recalled it for contamination by E. coli bacteria. Ebb threw away a protein drink he had made with the soy nut butter, but didn’t worry too much. The Food and Drug Administration warning that was linked to the email was worded very cautiously: Though serious illnesses might result, even potentially leading to death, “most healthy adults can recover completely within a week.”

Six days later, Ebb was hospitalized and developed a deadly type of kidney failure. Within days, doctors told his wife to send for their children in case they needed to bid him a last goodbye. He survived, but remains unable to work full time and has trouble climbing the stairs. Now, he’s joining with 18 other victims to file claims against the companies responsible and call attention to the inadequacy of the nation’s recall system.

“If I had heard about the problem even one week earlier and stopped then, I might have been able to avoid the disease completely, and life today would be very different,” Ebb said.

A POLITICO investigation found that the I.M. Healthy SoyNut Butter case — which officials at the FDA and the Centers for Disease Control and Prevention have hailed as an improvement over past failures — was nonetheless emblematic of persistent weaknesses in the nation’s food-safety system, some of which haven’t been corrected for two years after being flagged by the agency’s inspector general.

Two months elapsed between the first person sickened by eating I.M. Healthy SoyNut Butter on Jan. 4 and the recall orders that began on March 3 and expanded three more times until March 10. The FDA, working through a national network of labs that identifies outbreaks, pinpointed the contamination on Feb. 22. The nine-day lag time in persuading the manufacturer to begin recalling the tainted products was a significant improvement over previous lag times — which were as high as 165 days in one infamous case, according to the inspector general. But victims maintain that the FDA should have ordered a recall on its own authority, given that a few days or even hours can make a difference in a deadly outbreak.

Going public: Early disclosure of food risks for the benefit of public health

Mar.17

NEHA, Volume 79.7, Pages 8-14

Benjamin Chapman, Maria Sol Erdozaim, Douglas Powell

http://www.neha.org/node/58904

Often during an outbreak of foodborne illness, there are health officials who have data indicating that there is a risk prior to notifying the public. During the lag period between the first public health signal and some release of public information, there are decision makers who are weighing evidence with the impacts of going public. Multiple agencies and analysts have lamented that there is not a common playbook or decision tree for how public health agencies determine what information to release and when. Regularly, health authorities suggest that how and when public information is released is evaluated on a case-by-case basis without sharing the steps and criteria used to make decisions. Information provision on its own is not enough. Risk communication, to be effective and grounded in behavior theory, should provide control measure options for risk management decisions. There is no indication in the literature that consumers benefit from paternalistic protection decisions to guard against information overload. A review of the risk communication literature related to outbreaks, as well as case studies of actual incidents, are explored and a blueprint for health authorities to follow is provided.

185 sick: Cyclosporiasis in Del Monte veggie trays

As of June 28, 2018 (11am EDT), the U.S Centers for Disease Control (CDC) has been notified of 185 laboratory-confirmed cases of cyclosporiasis in persons who reportedly consumed pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip. The reports have come from four states.

Seven (7) of these people have been hospitalized, and no deaths have been reported.

  • Epidemiologic evidenceindicates that pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip are the likely source of these infections.
    • Most ill people reported eating pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip.
    • Most ill people reported buying pre-packaged Del Monte Fresh Produce vegetable trays containing broccoli, cauliflower, carrots, and dill dip in the Midwest. Most people reported buying the trays at Kwik Trip convenience stores.
    • The investigation is ongoing. CDC will provide updates when more information is available.

The median illness onset date among patients is May 31, 2018 (range: May 14 to June 9).  Ill people range in age from 13 to 79 years old, with a median age of 47. Fifty-seven percent (57%) are female and 7 people have been hospitalized. No deaths have been reported.

Illnesses that began after May 17, 2018 might not have been reported yet due to the time it takes between when a person becomes ill and when the illness is reported.

Will it mean fewer sick people? Trump’s plan to consolidate federal food safety efforts won’t work

Timothy D. Lytton, Associate Dean for Research & Faculty Development and Distinguished University Professor & Professor of Law at Georgia State University College of Law writes in this contributed op-ed that:

The Trump administration on June 21 unveiled an ambitious plan to consolidate federal food safety efforts within the U.S. Department of Agriculture.

Currently, 15 agencies throughout the federal government administer 35 different laws related to food safety under the oversight of nine congressional committees.

The administration calls this system “illogical” and “fragmented.”

“While [the USDA’s Food Safety Inspection Service] has regulatory responsibility for the safety of liquid eggs, [the Food and Drug Administration in the Department of Health and Human Services] has regulatory responsibility for the safety of eggs while they are inside of their shells,” the document explains. “FDA regulates cheese pizza, but if there is pepperoni on top, it falls under the jurisdiction of FSIS; FDA regulates closed-faced meat sandwiches, while FSIS regulates open-faced meat sandwiches.”

Concern about this state of affairs has been fueling similar consolidation proposals for decades.

But my research for a forthcoming book on the U.S. food safety system suggests that the Trump administration plan faces a number of challenges that make a major reorganization of federal food safety regulation both impractical and undesirable.

The curious division of labor between the U.S. Department of Agriculture and the Food and Drug Administration dates back to the passage of two laws enacted in 1906.

The Meat Inspection Act mandated inspection of all beef carcasses. The Pure Food and Drug Act prohibited the sale of adulterated food in interstate commerce.

Initially, both laws were implemented by officials at the USDA. Its Bureau of Animal Industry placed inspectors trained in veterinary science at every meat plant. Meanwhile, its Bureau of Chemistry employed laboratory scientists to test foods for adulteration.

In 1940, Franklin Roosevelt moved the Bureau of Chemistry, by then renamed the Food and Drug Administration, out of the USDA and into the Federal Security Agency, which later became the Department of Health and Human Services. Today, the FDA is responsible for overseeing the production of most foods other than meat and poultry.

Separately, the Bureau of Animal Industry was renamed the Food Safety Inspection Service, which is still responsible for all meat and poultry inspections.

Concerns about regulatory fragmentation grew as Congress assigned new tasks related to food safety to a variety of other agencies.

For example, Congress instructed the Federal Trade Commission to regulate food advertising, the Environmental Protection Agency to set pesticide tolerances and the National Marine Fisheries Service to inspect seafood.

Proponents of putting food safety under the roof of a single agency have argued that the current system causes confusion because different agencies produce inconsistent standards.

They further allege that overlapping jurisdictions create inefficiencies and that inadequate coordination leaves gaps in coverage. They also worry that the involvement of so many different actors diffuses political accountability.

The first high-profile proposal to consolidate federal food safety regulation was made in 1949, during the Truman administration, when a presidential commission recommended transferring food safety oversight to the USDA, just as the Trump administration has.

In 1972, consumer activist Ralph Nader advocated creating a new consumer safety agency to oversee food safety. And a few years later, a Senate committee recommended moving the USDA’s food safety responsibilities to the FDA.

Those are just three examples of more than 20 such proposals from both sides of the political aisle, including one by President Barack Obama in 2015.

None of these consolidation efforts succeeded for the same reasons the current one is unlikely to work now.

First of all, the many congressional committees that currently oversee agencies that regulate food safety are unlikely to support any reorganization that would reduce their power. Congressional oversight affords lawmakers who serve on committees opportunities to help interest groups and constituents in exchange for political support.

Similarly, industry associations are unlikely to support a reorganization that would disrupt their relationships with existing agencies. Consolidation threatens to reduce their access and influence over agency decisions.

In addition to the political obstacles to consolidation, there are practical problems. Merely merging the 5,000 food safety officials in the FDA and the 9,200 officials in the FSIS under the oversight of a single administrator would not eliminate the differences in jurisdiction, powers and expertise responsible for the current bureaucratic fragmentation. Meaningful consolidation would require a complete overhaul of federal food safety laws and regulations, a task of extraordinary legal and political complexity.

Moreover, consolidating food safety efforts in a single agency might create new forms of fragmentation. For example, transferring the FDA Center for Veterinary Medicine’s program for regulating drug residues in beef and poultry to the USDA would separate it from the FDA’s veterinary drug approval program.

And finally, reorganization is costly and would take years for the different agency teams newly working together to develop bonds of trust and cooperation. And these costs would have to be paid upfront, without a clear idea of whether the expected gains will ever pay off.

Consolidation need not be all or nothing.

For example, some have proposed more modest consolidation of inspection services, policy planning and communications that would be less costly and not so difficult.

Nonetheless, Congress has shown little interest in considering any bureaucratic reorganization of federal food safety regulation, even a partial consolidation.

In other words, the Trump administration may have to settle for the less ambitious goal of better interagency coordination, which offers an alternative way to address concerns about duplication and coverage gaps. This more modest approach would not, however, address the persistent problem of fragmentation.

In food safety, as in other regulatory reform arenas, it may turn out that half a loaf is better than none.

On Salmonella, go with science or rapper who craves Honey Smacks?

Joshua Espinoza of Complex writes that Boosie Badazz is in disbelief over the 2018 Honey Smacks recall.

Just days after it was announced that the beloved cereal was linked to 73 salmonella outbreaks in 31 states, the Baton Rouge rapper went to social media demanding further proof of the reported contamination.

“I just got home and my kids told me some shit about Honey Smacks are no longer available. I don’t if this true, but I’m pissed. I need proof,” he said in an Instagram video. “I think somebody might be tryin’ to fuck with me […] They say it’s full of salmonella, they were sayin’ something—well I’m full of salmonella!”

Boosie’s love for Honey Smacks has been well documented over the years. There are a number of videos of the rapper doing nothing more than grubbing on the puffed wheat breakfast cereal.

“I need proof, man. Fuck that. They just can’t take them off the market,” he goes on in the video. “I need proof. Somebody DM proof. The scientists, somebody, DM me some proof.”

How badazz is it to eat a kid’s cereal?

5 dead, 197 sick from E. coli O157 linked to romaine lettuce

The U.S. Centers for Disease Control reports there are now five people dead and 197 sick from E. coli O157:H7 linked to romaine lettuce.

  • 197 people infected with the outbreak strain of E. coli O157:H7 have been reported from 35 states.
  • 89 people (48%) have been hospitalized, including 26 people who have developed hemolytic uremic syndrome.
  • 5 deaths have been reported from Arkansas (1), California (1), Minnesota (2), and New York (1).
  • Illnesses started on dates ranging from March 13, 2018 to May 12, 2018.
  • Ill people range in age from 1 to 88 years, with a median age of 29.
  • Sixty-eight percent of ill people are female.

The Public Health Agency of Canada has identified people in several Canadian provinces infected with the same DNA fingerprint of E. coli O157:H7.

It takes two to three weeks between when a person becomes ill with E. coli and when the illness is reported to CDC. Most of the people who recently became ill ate romaine lettuce when lettuce from the Yuma, Arizona, growing region was likely still available in stores, restaurants, or in peoples’ homes. Some people who became sick did not report eating romaine lettuce, but had close contact with someone else who got sick from eating romaine lettuce.

According to the U.S. Food and Drug Administration, the last shipments of romaine lettuce from the Yuma growing region were harvested on April 16, 2018, and the harvest season is over. It is unlikely that any romaine lettuce from the Yuma growing region is still available in people’s homes, stores, or restaurants due to its 21-day shelf life.

The traceback investigation indicates that the illnesses associated with this outbreak cannot be explained by a single grower, harvester, processor, or distributor. While traceback continues, the FDA will focus on trying to identify factors that contributed to contamination of romaine across multiple supply chains.  The agency is examining all possibilities, including that contamination may have occurred at any point along the growing, harvesting, packaging, and distribution chain before reaching consumers. 

The FDA has identified Harrison Farms of Yuma, Arizona, as the grower and sole source of the whole-head romaine lettuce that sickened several people in an Alaskan correctional facility, but has not determined where in the supply chain the contamination occurred.

On May 31, 2018 the FDA released a blog with updated information on the traceback investigation (for additional information, visit FDA Update on Traceback Related to the E. coli O157:H7 Outbreak Linked to Romaine Lettuce).

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

This is a thing: FDA issues warning about snorting chocolate

For a while last year, snorting chocolate was a thing. It was peddled to folks in the club scene as an alternative to doing illegal drugs. Now, federal regulators have issued a warning to a company that distributes chocolate to be used for snorting (right, someone who looks creepily like Chapman, who would know as much about snorting anything as Woody Allen did in Annie Hall).

Known as Coco Loko, this is a powder mixed with other ingredients usually found in energy drinks. While not referring specifically to Coco Loko, the U.S. Food and Drug Administration has warned that inhaling chocolate powder can cause vocal cord spasms that make it hard to speak or breathe and may induce or aggravate asthma. It can also cause tightening of the muscles that line the airways in the lungs. Two of the ingredients — taurine and guanine — have not been evaluated for use through inhalation.

The powdered chocolate, sold by Orlando-based Legal Lean, debuted in mid-2017. The company’s website promises that Coco Loko will provide a blast of the feel-good chemical serotonin — similar to the euphoria produced by the club drug ecstasy. The company’s website cautions users to consume it responsibly, and that is isn’t intended for children or pregnant women.

What will I do with those tossed salads and scrambled eggs? Ditch them

Amy and I agree on this: If we need to fall asleep, put on an episode of Frasier.

Five minutes later we’re in la-la land.

Inspectors with the U.S. Food and Drug Administration say they found dozens of rodents and poor worker hygiene at a North Carolina chicken farm operated by an Indiana egg producer that last week recalled more than 200 million eggs.

Vic Ryckaert and Holly Hays of the Indy Star report that according to a FDA report, inspectors spent March 26 to April 11 at the Rose Acre Farms egg operation in Pantego, North Carolina, and found “unacceptable rodent activity” and dirty equipment. They also noted employees touching dirty floors, equipment and their bodies without washing their hands.

The unsafe conditions allow “for the harborage, proliferation and spread of filth and pathogens,” inspectors said.

In an emailed statement, Seymour-based Rose Acre Farms said the inspection report “is based on raw observations and in some cases lack proper context.”

“It’s unfair to be judged on the farm’s operation without proper perspective or a chance to formally respond to an incomplete representation of a massive facility that houses more than three million hens,” the company said. 

Context this.

The company said it will make public its response to the inspection, which is due on April 26.

“Until then, we would urge everyone to wait until all the facts are presented before rushing to judgment,” the company said.

The FDA said at least 23 illnesses have been reported. The eggs were distributed to consumers in Colorado, Florida, New Jersey, New York, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia.

FDA spokesman Peter Cassell declined to comment specifically about the Rose Acre Farms inspections but said the facility must correct the issues before the next inspection or face repercussions. Consequences could include product seizures or, in a more serious step, shutting down the facility. 

Cassell encouraged shoppers not to assume that they are not exposed to the recall because they are not geographically near the states where cases have been reported.

“Consumers should look for the brands and the lot numbers we provided,” he said. “We want to make sure that people are getting the right information.”

The recall involved eggs sold under the brand names Country Daybreak, Crystal Farms, Coburn Farms, Sunshine Farms, Glenview and Great Value. Also included were eggs sold at Walmart and Food Lion stores.

The cartons were stamped with plant number P-1065 and the Julian date range of 011 through 102.

The company’s Hyde County Egg facility in North Carolina produces 2.3 million eggs a day.

Inspectors found “insanitary conditions and poor employee practices” throughout the farm, according to the FDA report.

The inspectors’ observations in the report included:

Dozens of live and dead rodents, including baby mice, in chicken houses and manure pits.

Employees skipping steps in the cleaning process by wiping off detergent before allowing it to soak in the eggs.

Condensation dripping onto crack detectors, egg graders and other production equipment.

Water pooling on floors and forklift pathways.

Grimy, dirty floors, pallets and equipment. 

Farm workers touching dirty equipment and trash cans as well as their face, hair and “intergluteal cleft” before touching eggs or handling equipment that touches eggs without washing hands or changing gloves.

The deli is not safer: Slicer cleaning and Listeria

The Centers for Disease Control and Prevention (CDC) estimates that 3,000 people die in the United States each year from foodborne illness, and Listeria monocytogenes causes the third highest number of deaths. Risk assessment data indicate that L. monocytogenes contamination of particularly delicatessen meats sliced at retail is a significant contributor to human listeriosis. Mechanical deli slicers are a major source of L. monocytogenes cross-contamination and growth.

In an attempt to prevent pathogen cross-contamination and growth, the U.S. Food and Drug Administration (FDA) created guidance to promote good slicer cleaning and inspection practices. The CDC’s Environmental Health Specialists Network conducted a study to learn more about retail deli practices concerning these prevention strategies. The present article includes data from this study on the frequency with which retail delis met the FDA recommendation that slicers should be inspected each time they are properly cleaned (defined as disassembling, cleaning, and sanitizing the slicer every 4 h).

Data from food worker interviews in 197 randomly selected delis indicate that only 26.9% of workers (n = 53) cleaned and inspected their slicers at this frequency. Chain delis and delis that serve more than 300 customers on their busiest day were more likely to have properly cleaned and inspected slicers. Data also were collected on the frequency with which delis met the FDA Food Code provision that slicers should be undamaged. Data from observations of 685 slicers in 298 delis indicate that only 37.9% of delis (n = 113) had slicers that were undamaged. Chain delis and delis that provide worker training were more likely to have slicers with no damage.

To improve slicer practices, food safety programs and the retail food industry may wish to focus on worker training and to focus interventions on independent and smaller delis, given that these delis were less likely to properly inspect their slicers and to have undamaged slicers.

Retail deli slicer inspection practices: An EHS-Net study, May 2018

LAUREN E. LIPCSEI,1* LAURA G. BROWN,1 E. RICKAMER HOOVER,1 BRENDA V. FAW,2 NICOLE HEDEEN,3 BAILEY MATIS,4DAVID NICHOLAS,5 and DANNY RIPLEY6

Journal of Food Protection, vol. 81 no. 5

https://doi.org/10.4315/0362-028X.JFP-17-407

http://jfoodprotection.org/doi/abs/10.4315/0362-028X.JFP-17-407?code=fopr-site

Flour power: Raw is risky

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.