Blue Bell may be down homey, but dragged its feet on Listeria outbreak

Posted on September 16, 2015 by Douglas Powell

According to an editorial in The Wichita Eagle, when a food manufacturer learns from health officials that its product is tainted with a pathogen, and confirms the contamination itself, surely it should halt production until the problem is fixed and recall the affected products right away.

Yet a Houston Chronicle investigative report on the listeria outbreak linked to Blue Bell ice cream earlier this year indicated the company took its time to do both.

That’s troubling news especially in Wichita, as five patients at Via Christi Hospital St. Francis for unrelated conditions became ill from eating Blue Bell ice cream and three died, The Eagle reported in March. The U.S. Food and Drug Administration and Centers for Disease Control and Prevention said the three deaths among 10 infected patients in four states were those in Kansas.

Focusing on a machine nicknamed “Gram” that ran nearly around the clock at the plant in Brenham, Texas, the Chronicle reported: “On Feb. 13, health officials alerted Blue Bell that they had discovered the pathogen in random samples. On Feb. 19 and 21, Blue Bell’s own tests discovered (Listeria) monocytogenes in drains connected to the freezer on the Gram line. But the company did not change its practices, which had thus far failed to eliminate the bacteria, FDA records show. On March 9, Blue Bell learned of a potential link between Kansas hospital illnesses and individually packaged ice cream, produced on Gram. On March 10, it stopped using the machine. Three days later, it issued the first in a line of recalls: everything made on Gram.”

If Blue Bell Creameries is the worst-case scenario, the majority of food manufacturers operate safely, of course, recognizing that food safety isn’t just crucial for public health but essential to stay in business.

39 sick: UK E. coli O157 outbreak linked to leafy greens

Posted on September 8, 2015 by Douglas Powell

In early August 2015 a number of cases of Escherichia coli O157 phage type 8 verotoxin type 2a (MLVA profile 17-9-6-13-8-4-5-5 or a single locus variant thereof) were found to be genetically clustered by whole genome sequencing (WGS) and to share the same SNP address.

As of 3 September, the cluster comprises 38 confirmed cases, with one additional probable case and four possible cases for which WGS results are pending. Onset dates for confirmed and probable cases range from 29 July to 12 August 2015. Cases are widely distributed across England, with one case in Wales but none identified in Scotland to date. In England, the majority of confirmed cases (seven each) have been reported from Anglia and Cheshire and Merseyside, with 14 additional Health Protection Teams across the country also affected and reporting between one and three cases each. Most cases are female aged 18 to 73 years.

Analysis of enhanced questionnaires has shown that 33/38 confirmed members of the cluster had exposure to pre-packed salad and that 19 of these had purchased their pre-packed salad at the same supermarket chain. A focused survey carried out with 24 of the confirmed cases indicated that the most common exposures were to two salad products from one supermarket chain which share one ingredient. Trace-back has been initiated and one packer/distributor has been identified which is supplied by three farms. Samples are being collected from the supermarket chain outlets visited by cases, the distributor/packer and from the supply farms.

Investigations to determine the exact source and cause of contamination are on-going.

Burying the outbreak announcement in a monthly report and not going public about the source is a public health fail.

Going public, Dutch style

Posted on August 28, 2015 by Douglas Powell

Mandatory notification can be a useful tool to support infectious disease prevention and control.

Guidelines are needed to help policymakers decide whether mandatory notification of an infectious disease is appropriate. We developed a decision aid, based on a range of criteria previously used in the Netherlands or in other regions to help decide whether to make a disease notifiable.

Criteria were categorised as being effective, feasible and necessary with regard to the relevance of mandatory notification. Expert panels piloted the decision aid. Here we illustrate its use for three diseases (Vibrio vulnificus infection, chronic Q fever and dengue fever) for which mandatory notification was requested. For dengue fever, the expert panel advised mandatory notification; for V. vulnificus infection and chronic Q fever, the expert panel concluded that mandatory notification was not (yet) justified.

Use of the decision aid led to a structured, transparent decision making process and a thorough assessment of the advantages and disadvantages of mandatory notification of these diseases. It also helped identify knowledge gaps that required further research before a decision could be made. We therefore recommend use of this aid for public health policy making.

To notify or not to notify: decision aid for policy makers on whether to make an infectious disease mandatorily notifiable

Eurosurveillance, Volume 20, Issue 34, 27 August 2015

P Bijkerk, EB Fanoy, K Kardamanidis, SM van der Plas, MJ te Wierik, ME Kretzschmar, GB Haringhuizen, HJ van Vliet, MA van der Sande

http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21216

E. coli O157 outbreak sickens at least 24 people in Canada

Posted on August 25, 2015 by Douglas Powell

The Public Health Agency of Canada is warning the public about an outbreak of a potentially deadly form of E. coli after at least 24 people became infected and five of them ended up being hospitalized.

The 24 cases of Escherichia coli O157 occurred between July 12 and Aug. 8, with the “peak of illnesses” reported between July 25 and Aug. 1, according a statement from PHAC. The source of the illnesses has not yet been identified and the investigation is ongoing.

Community bands together after E. coli death

Posted on August 15, 2015 by Douglas Powell

As an Indiana community came together Thursday night to remember 9-year-old Destiny Smith, the State Department of Health says its staff has confirmed three people have been infected with E. coli.

The confirmation Friday comes as the department investigates reports of diarrheal illness in three northern Indiana counties.

Health Department officials say the agency is working with public health officials in Fulton, Wabash, and Marshall counties to determine the cause of illness in the three other individuals. The six cases currently known include one death.

Destiny’s family is still confused as to why and how they could lose their daughter so suddenly, but the community held a vigil to celebrate her life.

Full of sunshine, that’s how Destiny Smith’s family and friends would describe her personality.

57 sick including 24 dead in 2008 Maple Leaf Listeria outbreak: the scientific paper

Posted on August 12, 2015 by Douglas Powell

Beginning in the summer of 2008, the deaths of two Toronto nursing home residents in were attributed to listeriosis infections. This eventually prompted an August 17, 2008 advisory 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 Listeria monocytogenes.

When genetic testing determined a match between contaminated meat products and listeriosis patients on Aug. 23, 2008, all products manufactured at Maple Leaf Foods plant 97B were recalled and the facility closed

Several weeks later, the company determined that organic material trapped deep inside the plant’s meat slicing equipment harbored Listeria, despite routine sanitization that met specifications of equipment manufacturers. In total, 57 cases of illness were detected, including 24 deaths, connected to the consumption of the plant’s contaminated deli meats.

Notable from the paper:

Plant inspections identified several areas of concern. A building construction project was initiated in April 2008. There was structural damage and poor maintenance in certain rooms containing RTE product and evidence of condensate dripping onto unpackaged finished product in a common refrigerated storage room. IMP documentation indicated that Listeria spp. were detected at least 16 times between May 1 and August 16, 2008 in routine environmental swabs of food contact surfaces on lines A and B, 2 other production lines (lines C and D), and associated equipment. In response to each positive finding, the IMP staff sanitized production line surfaces and other areas where bacteria could grow. However, there was no analysis of trends over time to identify the underlying cause of the contamination. The cleaning and disinfection procedures at the IMP were inadequate. In addition, employee flow between rooms created opportunities for cross-contamination of finished product.

Experts who investigated the source of product contamination at the IMP concluded that contaminated mechanical meat slicers were the most likely cause (Weatherill, 2009). As observed in previous outbreaks, meat slicers can provide a site for the growth of L. monocytogenes and cross-contamination of finished products (Tompkin, 2002). Sanitation procedures used prior to the outbreak were ineffective at removing organic material harbored within the slicer.

As I have long maintained, the best food producers, processors, retailers and restaurants will go above and beyond minimal government and auditor standards and sell food safety solutions directly to the public. The best organizations will use their own people to demand ingredients from the best suppliers; use a mixture of encouragement and enforcement to foster a food safety culture; and use technology to be transparent — whether it’s live webcams in the facility or real-time test results on the website — to help restore the shattered trust with the buying public.

And the best cold-cut companies should stop dancing around and explicity tell pregnant women, old people and other immunocompromised folks, through labels or point-of-sale information, don’t eat this food unless it’s heated (watch the cross-contamination).

Abstract

A multi-province outbreak of listeriosis occurred in Canada from June to November 2008. Fifty-seven persons were infected with 1 of 3 similar outbreak strains defined by pulsed-field gel electrophoresis, and 24 (42%) individuals died. Forty-one (72%) of 57 individuals were residents of long-term care facilities or hospital inpatients during their exposure period. Descriptive epidemiology, product traceback, and detection of the outbreak strains of Listeria monocytogenes in food samples and the plant environment confirmed delicatessen meat manufactured by one establishment and purchased primarily by institutions was the source of the outbreak. The food safety investigation identified a plant environment conducive to the introduction and proliferation of L. monocytogenes and persistently contaminated with Listeria spp. This outbreak demonstrated the need for improved listeriosis surveillance, strict control of L. monocytogenes in establishments producing ready-to-eat foods, and advice to vulnerable populations and institutions serving these populations regarding which high-risk foods to avoid.

Multi-Province Listeriosis Outbreak Linked to Contaminated Deli Meat Consumed Primarily in Institutional Settings, Canada, 2008

Foodborne Pathogens and Disease, Volume: 12 Issue 8: August 10, 2015

Currie Andrea, Farber Jeffrey M., Nadon Céline, Sharma Davendra, Whitfield Yvonne, Gaulin Colette, Galanis Eleni, Bekal Sadjia, Flint James, Tschetter Lorelee, Pagotto Franco, Lee Brenda, Jamieson Fred, Badiani Tina, MacDonald Diane, the National Outbreak Investigation Team, Ellis Andrea, May-Hadford Jennifer, McCormick Rachel, Savelli Carmen, Middleton Dean, Allen Vanessa, Tremblay Francois-William, MacDougall Laura, Hoang Linda, Shyng Sion, Everett Doug, Chui Linda, Louie Marie, Bangura Helen, Levett Paul N., Wilkinson Krista, Wylie John, Reid Janet, Major Brian, Engel Dave, Douey Donna, Huszczynski George, Di Lecci Joe, Strazds Judy, Rousseau Josée, Ma Kenneth, Isaac Leah, and Sierpinska Urszula

http://online.liebertpub.com/doi/abs/10.1089/fpd.2015.1939#utm_source=ETOC&utm_medium=email&utm_campaign=fpd

Going public: Yes, Blue Bell sucks at risk analysis

Posted on June 29, 2015 by Douglas Powell

Food safety experts, puzzling over the earliest days of Blue Bell Creameries’ response to a finding of listeria in some of its products, were confused.

In mid-February, company workers began quietly reclaiming products from retailers and institutional customers such as hospitals. That was about a month before the iconic Texas-based ice-cream maker announced its first product recall in 108 years.

The stealth approach, called a withdrawal, came before any illness had been linked to the tainted ice cream. A withdrawal, which generally is used for minor problems, requires no broad notice to the public.

While the state health department called the withdrawal acceptable, some food safety experts are questioning why the public was not made aware of Blue Bell’s issues sooner.

“With something like this, I don’t understand how they got away with doing a withdrawal,” said Cliff Coles, president of California Microbiological Consulting Inc. “Withdrawal is not nearly as strong of language as a recall. If you knew that you had listeria, why wasn’t it a recall?

“I think they could have stepped up to the plate a whole lot quicker and done a whole lot more to protect the consuming public,” he added. “They pussyfooted around what they should have done in the first place.”

He and other food safety experts said they were unaware of any past cases in which a withdrawal, rather than a public recall, was used in a case in which a pathogen such as listeria was found in a ready-to-eat food.

Blue Bell, which first announced the listeria issue in a March 13 recall notice, has declined to go into detail about the withdrawal, citing pending litigation.

Blue Bell has been criticized for moving slowly to alert the public to the magnitude of its problem. The March 13 recall notice came as a terse, six-paragraph statement that pointed the finger at a specific production line that put out a “limited” amount of product. The release noted that “all products produced by this machine were withdrawn. Our Blue Bell team members recovered all involved products in stores and storage.”

Asked if that means 100 percent of the amount distributed was reclaimed, and that none of the product ended up in the hands of consumers, the company declined to comment, citing pending litigation.

That’s a key point. Food safety experts said a withdrawal would only be appropriate if the company could guarantee that it could account for 100 percent of the product that left the plant.

“Even if one [listeria-tainted] box was sold, at that point, the mechanism is no longer withdrawal,” said Mansour Samadpour, president of Seattle-based IEH Laboratories, a food consulting firm. “It has to be a recall. You have to announce it so anyone who purchased it would know not to consume it.”

“The key there is 100 percent,” he said.

In emailed answers to questions from The Dallas Morning News, Blue Bell challenged the notion that it did not move quickly enough to protect public health.

“From the moment we found out about a presumptive positive [listeria] test on February 13, we began working with regulators and immediately retrieved (we call this a withdrawal) the products that were on the market, which had been produced on a specific machine,” the company said. “That machine was already down for maintenance, so no more products were produced on that machine, and it has since been retired.

“As soon as we were notified on February 13, we notified FDA, and began instructing our employees to recover the products in question, which had been distributed to institutional and retail sales accounts,” the company said. “We went to those account locations and withdrew the products.”

Going public: Seven people struck by campy in UK but public health body refuses to name restaurant it closed down

Posted on June 9, 2015 by Douglas Powell

Wales Online reports that a public health body says it will not name a Cardiff restaurant at the centre of a food poisoning outbreak.

Public Health Wales says it is “satisfied” that the situation – which led to seven people being confirmed with the campylobacter infection – has been dealt with and there is “no risk to public health.”

The victims ate at the restaurant during the weekend of May 16, and two people are also suspected to have the infection.

At the end of last week, Public Health Wales, the Regulatory Service for Cardiff, the Vale of Glamorgan and Bridgend councils, Cardiff and Vale University Health Board and the Food Standards Agency said they were working together to investigate an outbreak of campylobacter with links to the restaurant.

The restaurant is not being named despite the fact that new laws require all premises dealing with food to openly display their food hygiene ratings.

Facebook user Claire Drewen said: “That is wrong! The public have a right to know. Public Health Wales should release the name. Maybe people would like to avoid the restaurant when it reopens.”

But Greg Cannon said: “Why can’t we have an intelligent debate rather than scaremongering? There is probably a very good legal as well as commercial argument for not naming; but in the age of social media all it takes is one Facebook or Twitter post and the name is known. PHW might avoid the legal case and the public still get the information they think they need.”

Posted on May 27, 2015 by Douglas Powell

Dale Bass of Kamloops This Week (that’s in British Columbia, Canada) writes that when norovirus hit customers at one Greek restaurant in the city, there were headlines with the name of the Victoria Street eatery — and it was shut down for days.

When norovirus struck another Greek restaurant just 16 months later, there was nothing in media releases identifying the eatery and it was not ordered closed.

Doug Dick was one of several people who became sick with the virus after eating at Minos restaurant on Tranquille Road in North Kamloops earlier this month. He asked KTW why Minos was not closed, since Dorian’s Greek House in downtown Kamloops was closed in December 2013.

Dick wondered if the reaction to Dorian’s situation came as a result of it being Royal Inland Hospital medical staff becoming ill there, something Joyce Michaud, the Interior Health Authority’s environmental-health officer — and the person who oversees inspections of places like restaurants — said is incorrect.

She said when her team is advised of a suspicious health outbreak, it doesn’t consider the occupations of those who are sick unless there is a direct link.

The focus, Michaud said, is identifying the bug, figuring out where it came from and, if possible, where it is, and helping the facility take steps to eradicate it.

Part of that is ensuring people who need to have medical tests get them done and often, which means delivering the test kits to sick people, Michaud said, rather than asking them to leave their homes.

Dick also wondered why IHA didn’t issue a press release warning people about about Minos.

Michaud noted the IHA didn’t issue a press release about Dorian’s, either. Because RIH operating-room staff becoming ill, a release was sent out advising the public surgeries were being cancelled.

Because the medical staff had not eaten at the restaurant — Dorian’s catered an event for them — the first task was to identify where the virus had come from, Michaud said. Soon there were many more people contacting the IHA with norovirus symptoms and, when it became apparent there was a public-health risk linked to Dorian’s, the restaurant was identified.

With Minos, there was one report on May 4 of someone becoming ill after eating there on May 2. An inspector was sent to the restaurant and, in the absence of any leftover food from that date, reviewed food-safety practices with the staff and told them the facility had to be thoroughly cleaned because the virus could linger on surfaces.

“The next day, we got another call and we called the restaurant again,” Michaud said, noting the IHA did not see it as an ongoing risk to the public since the restaurant had undergone a thorough cleaning.

“With Dorian’s, there was an order issued [to close until it was given permission from IHA to reopen] ,but there was no need for an order at Minos,” Michaud said.

Orders like that issued to Dorian are also posted on the authority’s website at interiorhealth.ca.

While it did confirm the name of the restaurant to people calling the authority to report illness, Michaud said a decision to release a name “is typically done on the basis of ongoing risk to the community and/or where it would aid ongoing investigation by having those at risk contact IH.

“The situation at Minos was not one where it appeared the restaurant was contributing to ongoing illness,” she said.

So much for the image: FDA says Blue Bell found Listeria in its factory as early as 2013

Posted on May 8, 2015 by Douglas Powell

It’s a classic case of avoiding the safety.

The safety in this case was Listeria testing. Not much of a safety, but it’s a necessary evil that procedures are working. And when positives come back, action should be taken.

Lauren Raab of the Los Angeles Times writes that Blue Bell Creameries knew it had a listeria problem as early as 2013, and it has failed to make its ice creams and sorbets in a way that would minimize the possibility of contamination, according to Food and Drug Administration reports made public Thursday.

The report on the Blue Bell plant in Broken Arrow, Okla., found the most egregious problems.

On five occasions in 2013 and 10 in 2014, Listeria was found in the plant’s processing room and kitchen on surfaces that did not come in contact with food, the FDA said. And the report found that on at least one occasion, after the plant performed its usual cleaning and sanitizing procedures, Listeria was found again in the same place, and the coliform bacteria count was higher than before the cleaning.

The plant also failed to test for bacteria on food contact surfaces, the report said.

The FDA found lapses in hand-washing and glove-changing as well. For example, the report said, one worker was observed picking up buckets of orange puree from “wet wood pallets which had black mold-like residue and red stains” and then, without changing gloves, touching the rims and insides of the buckets.

Water used to clean equipment, utensils and food-packaging materials was not sufficiently hot, the report found, and ingredients, including unpasteurized milk products, were stored at temperatures that were not sufficiently cold.

Furthermore, the report said, condensation that gathered on equipment dripped into tanks containing ingredients and even into quart containers of finished product.

The plant also used some equipment that was difficult or impossible to clean properly, such as porous wood pallets and a stainless-steel mixer with rough welding, the report said.

The FDA reported shorter lists of similar problems at Blue Bell plants in Brenham, Texas, and Sylacauga, Ala.

Blue Bell did not respond Thursday afternoon to phone calls and emails requesting comment.

According to the Centers for Disease Control and Prevention, 10 people — five in Kansas, three in Texas and one each in Arizona and Oklahoma — are confirmed to have had listeriosis linked to Blue Bell products. All 10 patients were hospitalized, and three in Kansas died, officials said. The illnesses date as far back as January 2010.

Blue Bell recalled all of its products worldwide last month because of Listeria concerns.

The company has said it is expanding its testing and safety procedures. The measures include “expanding our system of swabbing and testing our plant environment by 800% to include more surfaces” and “sending samples daily to a leading microbiology laboratory for testing,” it says on its website.

The situation at Blue Bell “is pretty bad,” said Doug Powell, a former Kansas State University professor of food safety who now publishes the food safety website barfblog.com. Given the FDA’s findings, he said, “it’s not surprising there was an outbreak.”

Blue Bell should have told customers when listeria was first found at the Broken Arrow plant in 2013, and it should have moved to fix the problem right away, Powell said.

By contrast, Powell said, Jeni’s Splendid Ice Creams, which is also dealing with a Listeria problem, has done a much better job: “They have not been linked to any sick people, but as soon as they found Listeria, they just shut down everything.”

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