The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration investigated a multistate outbreak of Salmonella Montevideo infections.
Ten people infected with the outbreak strain of Salmonella Montevideo were reported from three states.
No hospitalizations and no deaths were reported.
Epidemiologic evidence indicated that raw sprouts were the likely source of this multistate outbreak.
Ill people in this outbreak reported eating raw sprouts on sandwiches served at Jimmy John’s restaurants in Illinois and Wisconsin.
One ill person in this outbreak reported eating raw sprouts purchased from a grocery store in Minnesota.
This outbreak appears to be over. Any contaminated sprouts that made people sick in this outbreak would now be older than their recommended shelf life. FDA and state, and local regulatory officials conducted traceback investigations to help determine the source of the sprouts and their distribution chain. To date, no contamination source has been identified.
Public health investigators used the PulseNet system to identify illnesses that may be part of this outbreak. PulseNet is the national subtyping network of public health and food regulatory agency laboratories coordinated by CDC. DNA fingerprinting was performed on Salmonella bacteria isolated from ill people by using techniques called pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS). CDC PulseNet manages a national database of these DNA fingerprints to identify possible outbreaks. WGS gives a more detailed DNA fingerprint than PFGE.
As of February 27, 2018, 10 people infected with the outbreak strain of Salmonella Montevideo were reported from 3 states.
Illnesses started on dates ranging from December 20, 2017 to January 28, 2018. Ill people ranged in age from 26 to 56, with a median age of 42. All 10 (100%) were female. No hospitalizations and no deaths were reported.
Epidemiologic evidence indicated that raw sprouts were the likely source of this multistate outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Eight (80%) of ten people interviewed reported eating at multiple Jimmy John’s restaurant locations. Of these eight people, all eight (100%) reported eating raw sprouts on a sandwich from Jimmy John’s in Illinois and Wisconsin. This proportion is significantly higher than results from a survey[PDF – 29 pages] of healthy people, in which 3% reported eating sprouts on a sandwich in the week before they were interviewed. Two ill people in Wisconsin ate at a single Jimmy John’s location in that state. One ill person reported eating raw sprouts purchased from a grocery store in Minnesota.
This outbreak appears to be over. Any contaminated sprouts that made people sick in this outbreak would now be older than their recommended shelf life. FDA and state, and local regulatory officials conducted traceback investigations to help determine the source of the sprouts and their distribution chain. To date, no contamination source has been identified.
Regardless of where they are served or sold, raw and lightly cooked sprouts are a known source of foodborne illness and outbreaks. People who choose to eat sprouts should cook them thoroughly to reduce the risk of illness.
The patients, comprising one man and 10 women aged 63 to 76, developed abdominal pain, nausea, vomiting, diarrhoea and fever about 12 to 26 hours after having lunch at a restaurant at Lau Fau Shan in Yuen Long on January 7.
Five of them sought medical attention, of whom one required hospitalisation but was discharged upon treatment. The stool specimen of that patient tested positive for Vibrio parahaemolyticus. All affected persons are now in stable condition.
“I’ve been doing this all my life and we’ve never had a case of anyone dying from eating an oyster,” Larry Toomer, owner of the Bluffton Oyster Co., said. “We know where our oysters came from because we harvest them, refrigerate them ourselves and then cook them shortly after.”
Toomer says that there is always a risk when consuming any raw food, but the oysters that are harvested off the coast of the Low country typically don’t have bacteria due cleansing nature of the tidal waters they grow in.
“Something will always be somebody’s last meal,” Toomer says. “If you’re immune system is not up to snuff you shouldn’t eat anything raw, whether that is an oyster, or burger or any other type of meat, but something is going to set you off if you’re already sick. But other than that, we shouldn’t worry too much.”
I got invited by one of my former students to give a talk about food safety stuff at an American military base in Germany, about 2012.
This was after 5,500 people became sick and 53 died from E. coli O104 linked to raw sprouts, primarily in Germany.
Met a couple of lifelong friends, continued my work with the U.S. military, because those folks need to eat too, and learned that public bathroom in Germany is an oxymoron and people just piss at the side of the road (Australia has excellent public bathrooms, best I’ve ever seen).
After my presentation, one of my military friends said, guess you’re not a fan of Jimmy John’s.
I said, no, I’m not a fan of bullshit.
Before the U.S. government shut down, the folks at the Centers for Disease Control managed to publish the latest outbreak info of Salmonella linked to raw sprouts in Jimmy Johns subs, the preferred lunch meeting snack for Kansas State University food professors, who know nothing about safety.
To recap:
An outbreak linked to raw sprouts in the U.S. that sickened 140 people occurred between November 2010 into 2011, involving sandwich franchise, Jimmy John’s (CDC, 2011; Illinois Department of Public Health, 2010).
The owner of the Montana Jimmy John’s outlet, Dan Stevens, expressed confidence in his sprouts claiming that because the sprouts were locally grown they would not be contaminated, although the source of the contaminated sprouts had not yet been identified (KRTV, 2010).
By the end of December 2010 a sprout supplier, Tiny Greens Farm, was implicated in the outbreak (Food and Drug Administration, 2010).
Jimmy John’s owner, John Liautaud, responded by stating the sandwich chain would replace alfalfa sprouts with clover sprouts since they were allegedly easier to clean (Associated Press, 2011c). However, a week earlier a separate outbreak had been identified in Washington and Oregon (still miss ya, Bill Keene) in which eight people were infected with Salmonella after eating sandwiches containing clover sprouts from a Jimmy John’s restaurant (Oregon Department of Human Services, 2011; Terry, 2011). This retailer was apparently not aware of the risks associated with sprouts, or even outbreaks associated with his franchisees.
The FDA inspection of the Tiny Greens facility found numerous issues which may have led to pathogen contamination, including “the company grew sprouts in soil from the organic material decomposed outside without using any monitored kill step on it,” mold was found in the mung-bean sprouting room, and the antimicrobial treatment for seeds was not demonstrated to be equivalent to the recommended FDA treatment (Roos, 2011).
Months later, Bill Bagby Jr, owner of Tiny Greens, was quoted as saying “after the changes we made, it’s next to impossible for anything to happen,” hindering communication efforts by being defensive and overconfident (Des Garennes, 2011; Sandman & Lanard, 2011). Bagby also expressed confidence in sprouts following the German outbreak, commenting that for many like him, the nutritional benefits outweigh the risk: “Sprouts are kind of a magical thing. That’s why I would advise people to only buy sprouts from someone who has a (food safety) program in place (that includes outside auditors). We did not have (independent auditors) for about one year, and that was the time the problems happened. The FDA determined that unsanitary conditions could have been a potential source of cross-contamination and so we have made a lot of changes since then.”
In the second week of October, 2013, three Jimmy John’s restaurants in the Denver Metro area reportedly served up sandwiches that sickened eight people with E. coli bacteria.
“We believe that their illness came from a produce item that was on those sandwiches that they ate,” said Alicia Cronquit, epidemiologist with the Colorado Department of Public Health and Environment.
Cronquist said all eight cases were reported between October 18th and 22nd, and all of the people impacted ate at Jimmy John’s between October 7th and 15th.
The Department of Public Health has not closed down the three restaurants, and will not identify their locations because Cronquist says they do not believe the restaurants are at fault.
“Our leading hypothesis for what’s happened is that there was a contaminated produce item that was distributed to the stores,” Cronquist said. “We have not identified any food handling issues at the particular establishments that we think would contribute to illness.”
Raw sprouts are the poster child for failures in what academics call risk communication.
About 1999, graduate student Sylvanus Thompson started working with me on risk analysis associated with sprouts. He got his degree and went on to rock-star status in the food safety world with the implementation of the red-yellow-green restaurant inspection disclosure program with Toronto Public Health, but we never published anything.
I remember frantically flying to Kansas City to hang out with this girl in Manhattan (Kansas) I’d met a couple of weeks before, in the midst of the 2005 Ontario raw sprout outbreak that sickened over 700; Jen Tryon, now with Global News, interviewed me at the airport, with me wearing a K-State hockey shirt (that’s the joke; there is no hockey at K-State, and I was still employed by Guelph; and I was going to hang out with this girl).
After the German E. coli O104 outbreak, along with the ridiculous public statements and blatant disregard for public safety taken by sandwich artist Jimmy John’s in the U.S., I figured we really needed to publish something.
The basic conclusions:
raw sprouts are a well-documented source of foodborne illness;
risk communication about raw sprouts has been inconsistent; and,
continued outbreaks question effectiveness of risk management strategies and producer compliance.
Sprouts present a unique food safety challenge compared to other fresh produce, as the sprouting process provides optimal conditions for the growth and proliferation of pathogenic bacteria. The sprout industry, regulatory agencies, and the academic community have been collaborating to improve the microbiological safety of raw sprouts, including the implementation of Good Manufacturing Practices (GMP), establishing guidelines for safe sprout production, and chemical disinfection of seed prior to sprouting. However, guidelines and best practices are only as good as their implementation. The consumption of raw sprouts is considered high-risk, especially for young, elderly and immuno-compromised persons (FDA, 2009).
In late December 2011, less than one year after making the switch to clover sprouts, Jimmy John’s was linked to another sprout related outbreak, this time it was E.coli O26 in clover sprouts. In February 2012, sandwich franchise Jimmy John’s announced they were permanently removing raw clover sprouts from their menus. As of April 2012, the outbreak had affected 29 people across 11 states. Founder and chief executive, John Liautaud, attempted to appease upset customers through Facebook stating, “a lot of folks dig my sprouts, but I will only serve the best of the best. Sprouts were inconsistent and inconsistency does not equal the best.” He also informed them the franchise was testing snow pea shoots in a Campaign, Illinois store, although there is no mention regarding the “consistency” or safety of this choice.
In spite of widespread media coverage of sprout-related outbreaks, improved production guidelines, and public health enforcement actions, awareness of risk remains low. Producers, food service and government agencies need to provide consistent, evidence-based messages and, more importantly, actions. Information regarding sprout-related risks and food safety concerns should be available and accurately presented to producers, retailers and consumers in a manner that relies on scientific data and clear communications.’
On Friday, Jan. 19, 2018,CDC along with public health and regulatory officials in several states, and the U.S. Food and Drug Administration (FDA) announced a multistate outbreak of Salmonella Montevideo infections that has sickened at least eight people.
Illnesses started on dates ranging from December 20, 2017 to January 3, 2018. Ill people range in age from 26 to 50, with a median age of 34. All 8 (100%) are female. No hospitalizations and no deaths have been reported.
Epidemiologic evidence indicates that raw sprouts served at Jimmy John’s restaurants are a likely source of this multistate outbreak.
In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill. Seven (88%) of eight people interviewed reported eating at multiple Jimmy John’s restaurant locations. Of these seven people, all seven (100%) reported eating raw sprouts on a sandwich from Jimmy John’s in Illinois and Wisconsin. This proportion is significantly higher than results from a survey[PDF – 29 pages] of healthy people, in which 3% reported eating sprouts on a sandwich in the week before they were interviewed. Two ill people in Wisconsin ate at a single Jimmy John’s location in that state.
Federal, state, and local health and regulatory officials are conducting traceback investigations from the six Jimmy John’s locations where ill people ate raw sprouts. These investigations are ongoing to determine where the sprouts were distributed, and to learn more about the potential route of contamination.
The information available to date indicates that raw sprouts served at Jimmy John’s restaurants in Illinois and Wisconsin may be contaminated with Salmonella Montevideo and are not safe to eat. CDC recommends that consumers not eat raw sprouts served at Jimmy John’s restaurants in Illinois and Wisconsin.
Failures in sprouts-related risk communication
Food Control.2012. 10.1016/j.foodcont.2012.08.022
Erdozain, M.S., Allen, K.J., Morley, K.A. and Powell, D.A.
Nutritional and perceived health benefits have contributed to the increasing popularity of raw sprouted seed products. In the past two decades, sprouted seeds have been a recurring food safety concern, with at least 55 documented foodborne outbreaks affecting more than 15,000 people. A compilation of selected publications was used to yield an analysis of the evolving safety and risk communication related to raw sprouts, including microbiological safety, efforts to improve production practices, and effectiveness of communication prior to, during, and after sprout-related outbreaks. Scientific investigation and media coverage of sprout-related outbreaks has led to improved production guidelines and public health enforcement actions, yet continued outbreaks call into question the effectiveness of risk management strategies and producer compliance. Raw sprouts remain a high-risk product and avoidance or thorough cooking are the only ways that consumers can reduce risk; even thorough cooking messages fail to acknowledge the risk of cross-contamination. Risk communication messages have been inconsistent over time with Canadian and U.S. governments finally aligning their messages in the past five years, telling consumers to avoid sprouts. Yet consumer and industry awareness of risk remains low. To minimize health risks linked to the consumption of sprout products, local and national public health agencies, restaurants, retailers and producers need validated, consistent and repeated risk messaging through a variety of sources.
To compare WGS-based approaches with conventional typing for Salmonella surveillance, we performed concurrent WGS and multilocus variable-number tandem-repeat analysis (MLVA) of Salmonella Typhimurium isolates from the Australian Capital Territory (ACT) for a period of 5 months. We exchanged data via a central shared virtual machine and performed comparative genomic analyses. Epidemiological evidence was integrated with WGS-derived data to identify related isolates and sources of infection, and we compared WGS data for surveillance with findings from MLVA typing.
We found that WGS data combined with epidemiological data linked an additional 9% of isolates to at least one other isolate in the study in contrast to MLVA and epidemiological data, and 19% more isolates than epidemiological data alone. Analysis of risk factors showed that in one WGS-defined cluster, human cases had higher odds of purchasing a single egg brand. While WGS was more sensitive and specific than conventional typing methods, we identified barriers to uptake of genomic surveillance around complexity of reporting of WGS results, timeliness, acceptability, and stability.
In conclusion, WGS offers higher resolution of Salmonella Typhimurium laboratory surveillance than existing methods and can provide further evidence on sources of infection in case and outbreak investigations for public health action. However, there are several challenges that need to be addressed for effective implementation of genomic surveillance in Australia.
Incorporating whole-genome sequencing into public health surveillance: Lessons from prospective sequencing of salmonella typhimurium in Australia
16 January 2018
Foodborne Pathogens and Disease
Laura Ford, Glen Carter, Qinning Wang, Torsten eemann, Vitali Sintchenko, Kathryn Glass, Deborah Williamson, Peter Howard, Mary Valcanis, Cristina Castillo, Michelle Sait, Benjamin Howden, and Martyn Kirk
An explosive increase of CPC isolated from rectal swabs of patients during weekly routine screening led to the declaration of an outbreak. A hospital-wide prevalence screening was initiated as well as screening of all patients on admission and before transfer to another ward, and canteen staff, patient rooms, medical and kitchen inventory and food. Swabs were streaked out on selective plates. All CPC isolates were analysed by mass spectrometry and selected isolates by whole-genome sequencing.
In total, 76 mostly unrelated cases in different wards were identified. The CPC was isolated from retained samples of prepared vegetable salads and puddings and from a mixing machine used to prepare them only after an overnight culture. The immediate ban on serving potential source food resulted in a sharp decline and finally disappearance of novel cases. Repeated testing of pre-sliced vegetables showed a high degree of contamination with C. freundii without a carbapenemase, indicating a possible source.
This report demonstrates that an explosive increase in carbapenemase-expressing Enterobacteriaceae contamination may be caused by a foodborne source, and suggests that pre-sliced vegetables have to be taken into account as a putative pathogen repository. It also underlines the importance of appropriate cooling, transport, re-heating and distribution of meals and indicates that probing of non-organic surfaces is limited by low sensitivity, which may be increased by additional overnight cultivation in appropriate media.
A nosocomial foodborne outbreak of a VIM carbapenemase-expressing Citrobacter freundii
This study estimates illness (diarrhea) risks from fecal pathogens that can be transmitted via fecal-contaminated fresh produce. To do this, a quantitative microbial risk assessment (QMRA) framework was developed in National Capital Region, India based on bacterial indicator and pathogen data from fresh produce wash samples collected at local markets.
Produce wash samples were analyzed for fecal indicator bacteria (Escherichia coli, total Bacteroidales) and pathogens (Salmonella, Shiga-toxin producing E. coli (STEC), enterohemorrhagic E. coli (EHEC)). Based on the E. coli data and on literature values for Cryptosporidium and norovirus, the annual mean diarrhea risk posed by ingestion of fresh produce ranged from 18% in cucumbers to 59% in cilantro for E. coli O157:H7, and was <0.0001% for Cryptosporidium; for norovirus the risk was 11% for cucumbers and up to 46% for cilantro. The risks were drastically reduced, from 59% to 4% for E. coli O157:H7, and from 46% to 2% for norovirus for cilantro in post-harvest washing and disinfection scenario.
The present QMRA study revealed the potential hazards of eating raw produce and how post-harvest practices can reduce the risk of illness. The results may lead to better food safety surveillance systems and use of hygienic practices pre- and post-harvest.
Quantitative microbial risk assessment to estimate the risk of diarrheal diseases from fresh produce consumption in India
The risk model considered variability and uncertainty in Salmonella contamination in seeds, Salmonella growth and spread during sprout production, sprout consumption, and Salmonella dose response.
Based on an estimated prevalence of 2.35% for 6.8 kg seed batches and without interventions, the model predicted 76,600 (95% confidence interval (CI) 15,400–248,000) cases/year. Risk reduction (by 5- to 7-fold) predicted from a 1-log10 seed treatment alone was comparable to SIW testing alone, and each additional 1-log10 seed treatment was predicted to provide a greater risk reduction than SIW testing. A 3-log10 or a 5-log10 seed treatment reduced the predicted cases/year to 139 (95% CI 33–448) or 1.4 (95% CI <1–4.5), respectively. Combined with SIW testing, a 3-log10 or 5-log10 seed treatment reduced the cases/year to 45 (95% CI 10–146) or <1 (95% CI <1–1.5), respectively. If the SIW coverage was less complete (i.e., less representative), a smaller risk reduction was predicted, e.g., a combined 3-log10 seed treatment and SIW testing with 20% coverage resulted in an estimated 92 (95% CI 22–298) cases/year.
Analysis of alternative scenarios using different assumptions for key model inputs showed that the predicted relative risk reductions are robust. This risk assessment provides a comprehensive approach for evaluating the public health impact of various interventions in a sprout production system.
Risk assessment of salmonellosis from consumption of alfalfa sprouts and evaluation of the public health impact of sprout seed treatment and spent irrigation water testing
January 2018, Risk Analysis
Yuhuan Chen, Regis Pouillot, Sofia Farakos, Steven Duret, Judith Spungen, Tong-Jen Fu, Fazila Shakir, Patricia Homola, Sherri Dennis, Jane Van Doren
Among those affected are 25 hospitalized for severe dehydration, including a pregnant woman. There are also sufferers of all ages, such as a one-year-old baby and up to an adult older than 91. According to the health authority, the number of patients should not increase substantially due to the number of days that have passed since the closure of the premises, on Jan. 3. 2018. Now it is expected that laboratories in Santiago will determine the serotype of the strain, which may allow them to fully define whether the raw egg was responsible for this outbreak.
Jeanette LeBlanc contracted a deadly flesh-eating bacteria called Vibrio that day, resulting in her death a few weeks later.
LeBlanc’s symptoms started out similar to an allergic reaction. In fact, that’s what she suspected it was before doctors told her otherwise. She had red patches of a rash on her legs and experienced respiratory issues before the symptoms worsened, KLFY reported.
The Centers for Disease Control and Prevention said the bacteria that causes Vibriosis creates 80,000 cases of illness in the United States each year and 100 deaths. The Vibrio bacteria live in coastal waters, those where oysters also live. The oysters contract the bacteria by filtering water to feed and the bacteria ends up in the tissues of the oyster, then when someone like LeBlanc eats it raw, they also contract the bacteria.
In Hong Kong, the Centre for Health Protection (CHP) of the Department of Health today (December 29) reported its investigations into three food poisoning outbreaks suspected to be related to the consumption of raw oysters in three different restaurants.
They involve:
One man and two women, aged from 25 to 39, who have developed abdominal pain, diarrhea and vomiting about 11 to 50 hours after having lunch (including raw oysters) in a restaurant in Yau Ma Tei on December 17. All sought medical attention;
2.Two women, aged from 36 to 37, who have developed similar symptoms about 30 to 33 hours after having dinner (including raw oysters) in a restaurant in Kowloon Bay on December 19. Both sought medical attention; and
One man and three women, aged from 22 to 24, who have developed similar symptoms about 16 to 59 hours after having dinner (including raw oysters) in a restaurant in Tsim Sha Tsui on December 25.
The U.S. Centers for Disease Control (CDC), public health and regulatory officials in several states, and the U.S. Food and Drug Administration investigated a multistate outbreak of Salmonella Montevideo infections.
